Managing essential tremor in primary care

Medication choices

Propranolol

Start with 10mg PRN which can be taken regularly with a dose range of 10mg to 80mg BD.

Primidone

We advise following the initiation, escalation and monitoring guidelines in the British National Formulary.

Topiramate

Please see the anti-seizure medication escalation guidelines page for more details.

• Anti-seizure medication escalation guidelines

Zonisamide

Please see the anti-seizure medication escalation guidelines for more details.

• Anti-seizure medication escalation guidelines

Next steps if medication has been unsuccessful

If the patient has tried three medications without satisfactory control they could be referred for MRI guided ultrasound pallidotomy. Patients should firstly be reassessed by the Movement Disorders Service at University Hospitals Birmingham (UHB). Please re-refer via the advice and referral process.

• Advice and refer

Dystonic tremor

Some patients with essential tremor have a dystonic tremor and they may benefit from:

• a double thickness support bandage (available over the counter)
• a lycra splint (available from West Midlands Rehabilitation Centre)
• targeted botulinum toxin injections (provided by the Neurology at UHB – please refer via the advice and referral process)

• Advice and refer