Treating Essential Tremors

AAN guidelines suggest blood pressure drugs treat essential tremor

(RxWiki News) Hoping to offer better guidance in treating essential tremors, the American Academy of Neurology has scrapped recommending treatment with certain seizure and schizophrenia drugs.

Instead they are recommending blood pressure medication propranolol and seizure drug primidone as the best way to improve shaking under a set of revised guidelines.

"Talk to your neurologist about treatment for essential tremors."

Dr. Theresa A. Zesiewicz, a physician with the University of South Florida and lead author of the guidelines, said additional research is needed because not all people with essential tremor, a common tremor disorder that typically affects the hands, head and voice, benefit from these drugs.

Dr. Zesiewicz stressed that is important that patients who do not receive benefit from the recommended drugs work with their neurologist to consider other treatment options.

Authors also noted that seizure drugs gabapentin and topiramate, in addition to high blood pressure medications atenolol and sotalol, and anxiety drug alprazolam may be helpful for treating symptoms.

Weaker evidence was found suggesting that high blood pressure drugs nadolol and nimodipine, and seizure drug clonazepam and botulinum toxin A, also could aid essential tremor patients.

When it came to brain surgery, the American Academy of Neurology suggested two surgeries could aid patients who do not respond well to drugs.

Those surgeries include deep brain stimulation, which requires implanting a brain pacemaker that sends electrical impulses to certain parts of the brain, and thalamotomy, an invasive procedure that involves destroying a tiny section of the brain that controls involuntary movements.

Unlike the academy's last guideline update in 2005, they are no longer recommending seizure drugs levetiracetam and flunarizine or the drug 3,4-diaminopyridine, typically used to treat rare muscle diseases. They also did not find sufficient evidence to support the use of clozapine, a schizophrenia medication.

The guideline was published in the Oct.19 issue of Neurology, the medical journal of the American Academy of Neurology.

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Review Date: 
October 24, 2011