Essential Tremor


Benign essential tremor

Clinical features:

Postural and action tremor, present during the following activities:

  • Pouring water, using a spoon to drink water, drinking water, finger-to-nose maneuver, and drawing a spiral

Head titubation may occur

Findings on Investigations:

MRI brain: usually normal

  • Images presynaptic dopamine transporters
  • Helps differentiate between PD (abnormal, reduced in putamen) and essential tremor (normal)

Investigations to consider:

  • Thyroid Function Tests TFT
  • If < 40 y.o. serum ceruloplasmin: <20 mg per decilitre +/-slit lamp examination
  • DAT SPECT (123I-FP-CIT SPECT) “DaTSCAN”: if atypical or to distinguish between esstential tremor and Parkinson disease


1st line:

  • Propranolol BID or prn, especially long acting
  • Primidone start at low dose

2nd line:

  • Topiramate TPM P.O.
  • Alprazolam P.O., lorazepam.
  • Gabapentin GBP, Nimodipine P.O., Theophylline

Consider, selected cases:

  • Deep brain stimulation:
  • Contralateral thalamus


  • Thalamotomy

Related articles:

Parkinson’s disease,