Essential Tremor Management

Introduction to Essential Tremor Treatment

Essential tremor treatment can provide benefit in up to 80% of patients, according to the International Parkinson and Movement Disorder Society 1

The American Academy of Neurology recommends propranolol as first-line therapy for essential tremor, with approximately 50% efficacy in patients 2
The American Academy of Neurology recommends topiramate as a second-line treatment option for essential tremor, with moderate efficacy and significant side effects, starting at 25mg and gradually increasing to 50mg twice daily 1
Topiramate is effective in patients with comorbid migraine headaches, serving dual purposes, with a mean percentage improvement of 29% in overall tremor rating scores versus 16% with placebo 1
Topiramate may be useful in patients with comorbid migraine headaches, as it is also effective for migraine prophylaxis, according to the American Academy of Neurology 3

Slow titration of topiramate is recommended to minimize side effects, with effects observable at doses as low as 62mg/day and a typical target dose of 292mg/day 1

Topiramate may be considered particularly in patients who have comorbid migraine headaches, as it serves dual purposes, and in patients who have failed first-line treatments such as propranolol or primidone 1
Women of childbearing potential must be informed that topiramate reduces the efficacy of hormonal contraceptives and is teratogenic, according to the American College of Obstetricians and Gynecologists, and must use effective contraception 1, 3

Common side effects of topiramate include paresthesia, weight loss, appetite decrease, cognitive slowing, memory difficulties, nausea, and somnolence, with a high discontinuation rate of 31.9% due to adverse effects 1
Topiramate can cause cognitive slowing and depression, as reported in the Journal of Neurology, Neurosurgery and Psychiatry 1

The treatment approach for essential tremor involves first-line therapy with propranolol, followed by consideration of primidone, and then second-line options such as topiramate, gabapentin, or benzodiazepines for refractory cases 2