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Treatment may not be necessary unless tremors interfere with the patient's ability to perform daily activities or if they are considered embarrassing to the patient.
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Medications result in symptom improvement in most patients, although one out of four patients may not benefit from treatment. Two medications are considered the first line of therapy: propranolol and primidone. Propranolol blocks the action of stimulant substances called neurotransmitters, particularly compounds related to adrenaline. Primidone is an anti-seizure medication, which also modulates the function of some neurotransmitters. Both medications are considered equally efficacious.
However, both have significant side effects. The side effects of propanolol include:
- Fatigue
- Shortness of breath (people with asthma should not use this drug)
- Slowing of the heart rhythm
- Nose stuffiness
The problems associated with primidone include:
- Drowsiness
- Difficulty concentrating
- Nausea
- Poor gait (walking style), balance, and coordination
Other medications that may reduce tremors include anti-seizure drugs such as gabapentin, mild tranquilizers such as alprazolam or clonazepam, and calcium-channel blockers (flunarizine and nimodipine).
Recently, intramuscular injections of botulinum toxin in the hand have been used to reduce tremor by weakening local muscles. If tremor is severe and interfering with functioning, surgery may also be an option to alleviate the tremor. Such surgery usually involves implanting a device called deep brain stimulator in a specific area of the brain called the basal ganglia.
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