Essential Tremor
NHS Tayside RefGuide
Warning
Who to refer
- Patients who have not responded to adequate trials of below medications
- Diagnostic uncertainty.
- See National Essential Tremor Factsheet for more information
Who not to refer
Treatment naive patients.
Treatment
- Essential tremor is a progressive condition and symptom progression on treatment is expected.
- Initial management: removal of any exacerbating factors (caffeine, alcohol, drugs, thyroid etc)
- 1st line drug treatment (in those with functionally limiting symptoms)
- Propranolol: slow release 80mg daily, increased as required/tolerated to 320mg. If symptoms only in social situations, may consider 10-20mg as required.
- Primidone: 50mg at night. Increased slowly to maximum 250mg bd/tds. Withdraw slowly.
- TOPIRAMATE NO LONGER RECOMMENDED.