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This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 64, Number 12, June 28, 2005 Polish Data Supplement All Versions of this Article: 01.WNL.0000163769.28552.CDv1 64/12/2008    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in Neurology Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zesiewicz, T. A. Articles by Weiner, W. J. Search for Related Content PubMed PubMed Citation Articles by Zesiewicz, T. A. Articles by Weiner, W. J. Related Collections Tremor All Clinical trials

Practice Parameter: Therapies for essential tremor

Report of the Quality Standards Subcommittee of the American Academy of Neurology

From the Department of Neurology and Parkinson’s Disease and Movement Disorders Center (Drs. Zesiewicz and Hauser, and K.L. Sullivan), University of South Florida, Tampa; Department of Neurology (Dr. Elble), Southern Illinois University School of Medicine, Springfield; GH Sergievsky Center and Department of Neurology (Dr. Louis), College of Physicians and Surgeons, Columbia University, New York, NY; University of Texas Southwestern Medical Center (Dr. Dewey), Dallas; Department of Neurology (Dr. Ondo), Baylor College of Medicine, Houston, TX; Department of Neurology (Dr. Gronseth), University of Kansas Medical Center, Kansas City; and Department of Neurology (Dr. Weiner), University of Maryland School of Medicine, Baltimore.

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.

Background: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use.

Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence.

Results and Conclusions: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.

Approved by the Quality Standards Subcommittee on July 24, 2004; by the Practice Committee on January 29, 2005; and by the AAN Board of Directors on February 26, 2005.

Received October 7, 2004. Accepted in final form March 7, 2005.

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