Benign Essential (Familial)

Tremor
The cause of benign essential tremor is
uncertain, but it is sometimes inherited in an
autosomal dominant manner. Tremor may
begin at any age and is enhanced by
emotional stress. The tremor usually
involves one or both hands, the head, or the
hands and head, while the legs tend to be
spared. Examination reveals no other
abnormalities. Ingestion of a small quantity
of alcohol commonly provides remarkable
but short-lived relief by an unknown
mechanism.
Although the tremor may become more
conspicuous with time, it generally leads to
little disability, and treatment is often
unnecessary. Occasionally, it interferes with
manual skills and leads to impairment of
handwriting. Speech may also be affected if
the laryngeal muscles are involved. In such
circumstances, propranolol may be helpful
but will need to be continued indefinitely in
daily doses of 60240 mg. However,
intermittent therapy is sometimes useful in
patients whose tremor becomes exacerbated
in specific predictable situations. Primidone
may be helpful when propranolol is
ineffective, but patients with essential
tremor are often very sensitive to it. They
are therefore started on 50 mg daily, and
the daily dose is increased by 50 mg every 2
weeks depending on the response; a
maintenance dose of 125 mg three times
daily is commonly effective. Occasional
patients fail to respond to these measures
but are helped by alprazolam (up to 3 mg
daily in divided doses).