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Mov Disord. 2019 May 2. doi: 10.1002/mds.27700. [Epub ahead of print]

MDS evidence-based review of treatments for essential tremor.

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Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
CNS-Campus Neurológico Sénior, Torres Vedras, Portugal.
Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, Kansas, USA.
Department of Neurology, University Hospital 12 de Octubre; Center of Biomedical Network Research on Neurodegenerative diseases (CIBERNED), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.
National Neuroscience Institute, Duke NUS Medical School, Singapore.
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
Clinical Trials Unit, Office of the Clinical Director, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian Albrechts University Kiel, Kiel, Germany.



Essential tremor is one of the most prevalent movement disorders. Many treatments for essential tremor have been reported in clinical practice, but it is uncertain which options have the most robust evidence. The International Parkinson and Movement Disorder Society commissioned a task force on tremor to review clinical studies of treatments for essential tremor.


To conduct an evidence-based review of current pharmacological and surgical treatments for essential tremor, using standardized criteria defined a priori by the International Parkinson and Movement Disorder Society.


We followed the recommendations of the International Parkinson and Movement Disorder Society Evidence Based Medicine Committee.


Sixty-four studies of pharmacological and surgical interventions were included in the review. Propranolol and primidone were classified as clinically useful, similar to Topiramate, but only for doses higher than 200 mg/day. Alprazolam and botulinum toxin type A were classified as possibly useful. Unilateral Ventralis intermedius thalamic DBS, radiofrequency thalamotomy, and MRI-guided focused ultrasound thalamotomy were considered possibly useful. All the above recommendations were made for limb tremor in essential tremor. There was insufficient evidence for voice and head tremor as well as for the remaining interventions.


Propranolol, primidone, and topiramate (>200 mg/day) are the pharmacological interventions in which the data reviewed robustly supported efficacy. Their safety profile and patient preference may guide the prioritization of these interventions in clinical practice. MRI-guided focused ultrasound thalamotomy was, for the first time, assessed and was considered to be possibly useful. There is a need to improve study design in essential tremor and overcome the limitation of small sample sizes, cross-over studies, short-term follow-up studies, and use of nonvalidated clinical scales. © 2019 International Parkinson and Movement Disorder Society.


clinical trials; essential tremor; evidence-based medicine; systematic review; treatment


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