Tips and tricks in tremor treatment

Journal of Neural Transmission, vol. 131, pp. 1229–1246

Abstract

Tremor, whether arising from neurological diseases, other conditions, or medication side effects, significantly impacts patients' lives. Treatment complexities necessitate clear algorithms and strategies. Levodopa remains pivotal for Parkinson's tremor, though response variability exists. Some dopamine agonists offer notable tremor reduction targeting D2 receptors. Propranolol effectively manages essential tremor and essential tremor plus (ET/ET +), sometimes with primidone for added benefits, albeit dose-dependent side effects. As reserve medications anticholinergics and clozapine are used for treatment of parkinsonian tremor, 1-Octanol and certain anticonvulsant drugs for tremor of other orign, especially ET. Therapies such as invasive deep brain stimulation and lesional focused ultrasound serve for resistant cases. A medication review is crucial for all forms of tremor, but it is particularly important if medication may have triggered the tremor. Sensor-based detection and non-drug interventions like wristbands and physical therapy broaden diagnostic and therapeutic horizons, promising future tremor care enhancements. Understanding treatment nuances is a key for tailored tremor management respecting patient needs and tolerability. Successful strategies integrate pharmacological, non-invasive, and technological modalities, aiming for optimal symptom control and improved quality of life.

Authors 9

1. Franziska Hopfner corresponding

   Ludwig-Maximilians-Universität München

   Affiliation as printed

   Department of Neurology, Neurologische Klinik und Poliklinik mit Friedrich Baur Institut, Ludwig-Maximilians University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany. franziska.hopfner@med.uni-muenchen.de

2. Carsten Buhmann

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

3. Joseph Claßen

   University Hospital Leipzig · Leipzig University

   Affiliation as printed

   Department of Neurology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany

4. Florian Holtbernd Aachen Department of Neurology JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11)

   Jülich Aachen Research Alliance · RWTH Aachen University

   Affiliation as printed

   Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany

   JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Juelich Research Center GmbH and RWTH Aachen University, Aachen, Germany

5. Stephan Klebe

   Knappschaftskrankenhaus Recklinghausen · Essen University Hospital

   Affiliation as printed

   Department of Neurology, Essen University Hospital, 45147, Essen, Germany

   Department of Neurology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany

6. Jiri Koschel

   Parkinson-Klinik Ortenau

   Affiliation as printed

   Parkinson-Klinik Ortenau, GmbH & Co KG, Kreuzbergstraße 12-16, 77709, Wolfach, Germany

7. Zacharias Kohl

   University of Regensburg

   Affiliation as printed

   Department of Neurology, University of Regensburg, Regensburg, Germany

8. Sebastian Paus
   Affiliation as printed

   Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany

9. David José Pedrosa

   Philipps University of Marburg

   Affiliation as printed

   Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany

   Department of Neurology, Philipps University Marburg, Marburg, Germany