REVIEW – April 2020

Essential tremor

Authors: Alfred Georg Klamas

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Essential tremor (ET) is a syndrome with an uncertain etiology characterised by a postural or kinetic tremor of the hands with or without a tremor of the head, neck, and voice. Several nonmotor symptoms such as degradation of cognitive functions, depression, poor quality of sleep, and a subjectively perceived loss of hearing have been associated with ET. ET causes decline in the quality of life of the patients, which is associated with shame and motor disability. The incidence of ET is bimodal: the syndrome most commonly manifests in early adulthood or after the age of 60. Both genetic and environmental factors have been associated with the development of ET; pathologically, ET has been associated with alterations in the neuronal circuits of the brain, a decrease in the amount of GABA receptors in the dentate nucleus, and neurodegenerative processes in the cerebellum. Certain criteria must be met before the diagnosis of ET can be established. Propranolol, primidone and topiramate are considered first choice drugs in the treatment of ET. Atenolol, sotalol, zonisamide, gabapentin, alprazolam, clozapine, and olanzapine are second choice medications. In the case of refractory ET, botulinum toxin type A, thalamotomy and thalamic deep brain stimulation may be used. Surgical treatments are only justified in severe cases of essential tremor.