Treatment for tremor entirely depends on two factors: one is its cause and the second is the amount of disability that it creates. For e.g.. A mild tremor in a CEO of a company or a surgeon can be significantly disabling, whereas same may not be a problem to manual labor.
General principles
- Treat only if bothersome
- The longer the tremor has been there the more difficult the treatment will be
- Limbtremor responds much better than head/neck to oral treatment
Non-pharmacologic
- Biofeedback
- Weighted objects (e.g., utensils)
- Only dampens it temporarily, not viable long term treatment option
Pharmacologic
- Parkinson’s disease tremors and essential tremors respond well to medical management which includes L-Dopa or dopamine-like drugs such as bromocriptine, pergolide.
- Essential tremor may be treated with beta blockers (such as propranolol and nadolol) or primidone.
- Others: benzodiazepenes, gapapentin anecdotal use
- Botox
Voice, head
Surgical Treatment:
Thalamotomy – Deep brain stimulation is an effective treatment and is most useful to treat bilateral tremors as bilateral thalamotomy is contraindicated. DBS is also used for difficult to treat treatment disorders like Spinocerebellar ataxia, Multiple sclerosis and post stroke tremors.