How Is Essential Tremor Treated?

Medical treatments

Medical treatments include the use of different medications, such as:

·     Beta Blockers (propranolol)

·     Anticonvulsants (such as primidone, gabapentin, or topiramate)

·     Benzodiazepines (such as clonazepam or diazepam).

Some patients may benefit from local injections of botulinum toxin (BTX), which may help suppress the tremor.

Frequently, medication therapy cannot adequately control tremor or the person experiences intolerable side effects from the medications. In these circumstances, a person may consider a procedural therapy to treat their tremor.

Non-Invasive MR Guided Focused Ultrasound

Some patients may be suitable for MR Guided Focused Ultrasound (MRgFUS). During a single procedure, MR imaging precisely targets high intensity focused ultrasound waves through the intact skull to the ventral intermediate nucleus of the thalamus, an area of the brain that is thought to be responsible for causing tremors. MRgFUS treatment results in an immediate, significant, and durable reduction of tremor. This procedure is currently only being done to relieve tremor from one side of the body, typically in the dominant hand. 

Surgical treatments

The traditional surgical treatment for essential tremor is thalamic deep brain stimulation. This works especially well for limb tremors, although it is also sometimes helpful for head and vocal tremors. During this procedure, electrodes are implanted in the ventral intermediate nucleus of the thalamus, an area of the brain that is thought to be responsible for causing tremors. The electrodes are then connected via an extension to an implantable pulse generator that is placed under the skin near the patient's collarbone. Electrical signals delivered to the thalamus work to suppress the tremor. This therapy has the advantage of being adjustable and reversible, and can be used to treat tremor on both sides of the body. Patients can usually come off or reduce their medications after this procedure.