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Essential tremor

Key sources
The following summarized guidelines for the evaluation and management of essential tremor are prepared by our editorial team based on guidelines from the International Parkinson and Movement Disorder Society (IPMDS 2019), the American Academy of Family Physicians (AAFP 2018), and the American Academy of Neurology (AAN 2011; 2005).
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Guidelines

1.Diagnostic investigations

History and physical examination: elicit history and perform a physical examination for the diagnosis of tremor.
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2.Medical management

Pharmacotherapy: as per IPMDS 2019 guidelines, recognize that propranolol and topiramate (> 200 mg/day) are efficacious with acceptable risk and without specialized monitoring in patients with upper limb ET.
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  • Agents with no evidence for benefit

3.Therapeutic procedures

Botulinum toxin injections: as per IPMDS 2019 guidelines, recognize that botulinum toxin A is likely efficacious with acceptable risk and with specialized monitoring in patients with upper limb ET.
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4.Surgical interventions

Thalamotomy
As per IPMDS 2019 guidelines:
Recognize that unilateral radiofrequency thalamotomy is likely efficacious with acceptable risk and with specialized monitoring in patients with upper limb ET.
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Recognize that unilateral MRI-guided focused ultrasound thalamotomy is likely efficacious with acceptable risk and with specialized monitoring in patients with upper limb ET.
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