Essential tremor (ET) is the most common pathologic cause of action (voluntary movement) tremor. Starts with hands and later progress to involve the head and vocal cords. It is brought by limb movements and postural positions against gravity.
The first line of treatment of ET includes either propranolol (preferred and most efficient) or primidone (if the patient has asthma or heart block...). Combination of propranolol and primidone can be tried if no contraindication and single treatment is not efficient before trying the second line of treatment which is usually less effective with more side effects.
Propranolol usually started at low dose 10-20 mg qid to max total 360 mg in a day being increased in a weekly fashion. If symptoms are not severe and the patient only want to take it on certain occasion you can give 10-20 mg at the time of the event.
Primidone can be started 25 mg QHS to a max of 250 mg QHS being titrated by 25 mg weekly or less if tolerated.
The second line of treatment of ET includes topiramate, benzodiazepines or gabapentin. Topiramate works in high doses but must be started with low dose at 25 mg once/bid first week then increase 25-50 mg/day weekly until goal of 200-400 mg daily dose is reached. Benzos include alprazolam 0.125 to 3 mg daily or clonazepam 0.5-6 mg daily. Gabapentin 100-300 mg TID and may increase 300 mg/day weekly until max allowed dose per patient condition and comorbidities.
Although ET may improve with alcohol consumption, however, alcohol has serious health effects and drug interactions, hence, doctors don't advise drinking it.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.