Overview
Hereditary essential tremor is a neurological disorder characterized by a tremor that is typically bilateral, symmetrical, and most prominent in the upper extremities 1. It is often exacerbated by voluntary movement and can affect the head, voice, and lower limbs 1.Diagnosis
Diagnosis is primarily clinical, based on the presence of a bilateral, symmetrical action tremor of the upper extremities 1.
Exclusion of other causes of tremor, such as Parkinson's disease, physiological tremor, or drug-induced tremor, is essential 1.
Family history of tremor is a key diagnostic feature, with autosomal dominant inheritance being common 1.Management
Pharmacological treatment is indicated for tremors that interfere with daily activities 1.
First-line medications include beta-blockers (e.g., propranolol) and anticonvulsants (e.g., primidone) 1.
Other medications may be considered, including benzodiazepines and gabapentin, though evidence for their efficacy in essential tremor is less robust 1.
Surgical options, such as deep brain stimulation (DBS) or focused ultrasound thalamotomy, may be considered for severe, medically refractory tremor 1.Key Recommendations
Initiate treatment with a beta-blocker or primidone for patients with essential tremor significantly impacting daily function 1. (Evidence: Moderate)
Consider surgical intervention (DBS or focused ultrasound) for severe essential tremor refractory to medical management 1. (Evidence: Moderate)
Perform a thorough neurological examination to exclude secondary causes of tremor before diagnosing essential tremor 1. (Evidence: Expert opinion)References
1 Kitoh R, Nishio SY, Sato H, Ikezono T, Morita S, Wada T et al.. Clinical practice guidelines for the diagnosis and management of acute sensorineural hearing loss. Auris, nasus, larynx 2024. link