Essential tremor affects people in different ways, and there is no cure. The right essential tremor treatments can manage or reduce symptoms and improve your quality of life.
Essential tremor experts at the Penn Medicine Movement Disorders Center offer the most innovative treatments available for the best possible outcomes. We personalize your treatment with your lifestyle, preferences, and goals in mind.
Treatments for Essential Tremor
There is no one-size-fits-all treatment for essential tremor. Some people with mild symptoms may not need any treatment. But if you have an essential tremor diagnosis and symptoms interfere with your work or daily activities, your doctor may recommend treatment with medications, adaptive devices, focused ultrasound, or deep brain stimulation.
Medications for Tremor Control
Essential tremor treatment often begins with oral medications. Some people with essential tremor respond well to medication, but many do not. Some individuals need to gradually increase the dose of their medications, as the tremor gets worse over time.
Medications that can effectively reduce essential tremor include:
- Beta-blockers: These medications are usually used to treat high blood pressure and performance anxiety. In particular, propranolol has shown some effectiveness in relieving tremor.
- Anti-seizure medications: Certain anti-seizure medications have been shown to reduce tremor and may be an alternative to people with essential tremor who do not respond to beta-blockers. Primidone is an anti-seizure medication that can decrease essential tremor. Other anti-seizure medications that may help manage symptoms include topiramate, gabapentin, and zonisamide.
- Benzodiazepines: People with essential tremor symptoms can benefit from treatment with benzodiazepines, such as clonazepam and alprazolam. These medications are a subset of anti-seizure medications that also treat muscle tension and anxiety.
- Botulinum toxin injections: These injections temporarily weaken the targeted muscle group. Doctors use it to treat essential tremor affecting the head and voice. Careful use of botulinum toxin can also be useful to reduce hand essential tremor in certain cases.
Essential Tremor Treatment with Ultrasound
MR-guided high-intensity focused ultrasound is a procedure that targets a brain region called the thalamus with concentrated sound waves. The thalamus serves as a relay station for brain messages about sensation and movement.
During this procedure, neurosurgeons use magnetic resonance imaging (MRI) scans to locate the target area of the brain. During treatment, sound waves produce heat that destroys brain tissue in the thalamus to stop the tremors. Heat imaging through the MRI scanner monitors the temperature of brain tissue to keep you safe.
Because there is no incision, this treatment has a very low infection risk. In addition, you do not need to stay overnight in the hospital. Most people experience reduced tremors immediately after focused ultrasound.
MR-guided high-intensity focused ultrasound treats essential tremor only on one side of the body at a time. In December of 2022, the United States Food and Drug Administration (FDA) approved staged focused ultrasound treatments to ultimately treat both sides of the body for essential tremor. People with essential tremor affecting both sides of the body can receive a second treatment at least nine months after the first treatment.
Implantable Devices
Your doctor may recommend deep brain stimulation (DBS) if medications and adaptive devices are not effective in reducing your symptoms.
DBS surgery involves placing a thin electrical lead into the thalamus. A thin wire connects the lead to a stimulator device implanted in the chest (similar to a pacemaker). This stimulator sends electrical signals to the lead in the thalamus to disrupt the abnormal nerve signal causing the essential tremor.
DBS effectively treats essential tremor on both sides of the body. Your doctor can adjust the stimulation if your symptoms get worse. This adjustability makes deep brain stimulation the most versatile and long-lasting treatment option for patients with essential tremor.
At Penn Medicine, our neurosurgeons were pioneers in DBS for essential tremor. We offer all available DBS device options and have the expertise to recommend the right one for you.
Lifestyle Modifications for Essential Tremor
While you can't eliminate essential tremor through lifestyle choices, there are things you can do to lessen the impact of tremors on your daily life. Some people use weighted utensils or pens designed to reduce tremors, or devices that stimulate the nerves in the limbs to minimize tremors.
Other lifestyle modifications to reduce essential tremor include:
- Avoiding caffeine, which can increase tremors
- Using cups with straws and lids to prevent spills
- Choosing a low-maintenance hairstyle so that grooming is less difficult
- Keeping arms close to the body to decrease tremors when using the hands
- Using voice recording to make lists and take notes
- Decreasing stress levels with meditation, mindfulness, breathing exercises, and other strategies
Why Choose Penn Medicine for Essential Tremor Treatment?
When essential tremor makes it hard to perform daily activities, you need effective treatments that can restore your function. The Movement Disorders Center at Penn Medicine is home to an expert team of essential tremor specialists who offer personalized care based on your priorities and preferences.
People who choose us for essential tremor treatment find:
- Personalized treatment options: We offer every available treatment option for essential tremor, including the latest options as they become available. Our specialists have the experience to recommend the right options at the right time. We work with you to understand your goals and preferences and help you make a treatment choice that's right for you.
- Surgical expertise: Our experienced neurosurgeons have extensive experience performing procedures for essential tremor and other movement disorders. Our team performs more DBS surgeries than anyone in the region. You can count on our team for precise, effective surgery.
- Focus on safety: Our neurosurgeons use advanced guidance systems, minimally invasive approaches, and thermal monitoring during surgical procedures to ensure accuracy that keeps you safe. These leading-edge techniques promote faster healing and a more comfortable recovery. Our comprehensive pre-operative screening process ensures that you're ready for surgery.
- DBS device variety: Penn Medicine offers all available DBS options, each with different strengths and features, to individuals with essential tremor. Our experienced neurologists and neurosurgeons can help you choose the right device for your unique needs and symptoms.