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Essential Tremor Treatment Guidelines

Essential tremor (ET) is a nervous system disorder that causes involuntary shaking, which can make everyday tasks more difficult. These tremors typically begin in the hands, but they can also affect the head, voice, arms, and legs. Hand tremors make it difficult for people with essential tremor to perform simple tasks such as eating, tying shoelaces, and writing.

Fortunately, there are ways to treat essential tremor and make it more manageable. As technology and research continues to expand, essential tremor treatment guidelines change the way people live with this condition. In this post, we’ll talk about the essential tremor guidelines updated by the International Essential Tremor Foundation (IETF), and go in-depth on the devices and procedures that can help mitigate this disease. If you want to get a better understanding of how essential tremor clinical practice guidelines are changing to help patients, we’ve got you covered.


Essential Tremor Overview

There are several things that can cause tremors in an individual, but essential tremor is a more naturally occurring condition. Essential tremor causes involuntary shaking in your hands, but may also affect your head, arms, and legs. This condition is most common in older patients, but it can be present in younger people as well.

Here’s what you need to know about the symptoms, causes, and risk factors of essential tremor and how they play a role in the ET treatment guidelines.

Essential Tremor Overview

There are several things that can cause tremors in an individual, but essential tremor is a more naturally occurring condition. Essential tremor causes involuntary shaking in your hands, but may also affect your head, arms, and legs. This condition is most common in older patients, but it can be present in younger people as well.

Here’s what you need to know about the symptoms, causes, and risk factors of essential tremor and how they play a role in the ET treatment guidelines.


  • Shaking that begins in the hands
  • Shaking that’s more noticeable on one side of your body
  • Worsens with movement
  • May cause involuntary head movements
  • Can be aggravated by external factors such as stress, caffeine, and temperature changes


  • Essential tremor is most often caused by a genetic mutation. Individuals who have a single parent with a genetic mutation for essential tremor have a 50% chance of developing ET.
  • In individuals without a genetic mutation, age seems to be the biggest contributing factor. Essential tremor is typically more common in adults over the age of 40.

Risk Factors

  • A genetic mutation for essential tremor is the biggest risk factor
  • Drinking excessive amounts of alcohol
  • Eating too much meat [1]

Assessment of Essential Tremor

In order to diagnose essential tremor, a health care professional may perform a series of neurological, laboratory, and performance tests. These tests are designed to rule out other possible diagnoses and get a better idea of the severity of the condition.

Neurological tests include testing an individual’s ability to feel sensations, testing reflexes, checking posture, and examining balance and gait. These tests help rule out other neurological disorders.

Laboratory tests involve testing samples to figure out if a patient could be suffering from another ailment. Blood and urine tests can check for thyroid disease, metabolic problems, or abnormal reactions to certain medications.

Performance tests are the simplest of all. Under the American Academy of Neurology essential tremor guidelines, your health care professional will have you perform basic tasks such as writing, drinking from a glass, and holding your arms outstretched.

Other Diagnoses

There are other conditions that can cause tremors and can easily be mistaken for essential tremor. Visiting a health care professional for a diagnosis is an important part of essential tremor treatment guidelines because it allows you to rule out other possible causes of tremors.

Other causes of tremors may include the following:

Parkinson’s disease

Parkinson’s disease is one of the most common causes of tremors and is often mistaken for essential tremor. Parkinson’s presents with some of the same symptoms as essential tremor, including tremors in the hands. However, there are some key differences between Parkinson’s and ET. Patients experiencing essential tremor typically have a shaky voice, head nodding, and tremors that worsen when moving. While these symptoms aren’t typically present in Parkinson’s patients, it’s important to get an expert diagnosis.

Other causes of tremors

In addition to conditions that may mimic the symptoms of essential tremor, there are also other factors that can cause tremors. Shaky hands, arms, or legs may be caused by anxiety, alcohol abuse, an overactive thyroid, mercury poisoning, or using certain medicines. Because essential tremor clinical practice guidelines are different from treating tremors caused by anxiety or alcohol, you should visit a doctor if you’re experiencing tremors. Your doctor can help you figure out what’s causing your tremors and whether the essential tremor treatment guidelines are right for you.

Management of Essential Tremor

Like many medical conditions, there is no cure for essential tremor. Essential tremor treatment guidelines are focused on reducing the severity of tremors and aiding patients with everyday tasks. Treatment options range from routine Botox injections that can reduce tremors to wrist weight bracelets that make it easier to keep your hands steady. Here’s what you need to know about managing essential tremor.

Non-Surgical/Non-Pharmacological Options

For many patients, finding a non-surgical and non-pharmacological treatment option is the preferred option. The most common non-surgical and non-pharmacological essential tremor treatment method is Cala Trio therapy. Through peripheral nerve stimulation, this groundbreaking wrist-worn device can be calibrated to treat your unique tremor, empowering you to perform daily tasks with confidence. The Cala Trio bracelet is only available via prescription by a physician.

There are several benefits of using the Cala Trio therapy to treat essential tremor. To use the device, simply choose an activity, such as writing a letter, and use the Cala Trio for a 20-40 minute session prior to doing that activity. The device will then use peripheral nerve stimulation to target the central tremor network in your brain, improving your motor output. Fully charging the device takes about 3-4 hours, and a single charge typically lasts for about 5 sessions. While the Cala Trio therapy is a non-pharmacological treatment method, it can be combined with pharmacological treatment as prescribed.

As a side note, the Cala Trio is not recommended for patients who have a pacemaker, defibrillator, or deep brain stimulator. It is not recommended for patients with a condition that causes seizures, pregnant women, and people who have skin irritation or open wounds on the wrist.

Pharmacological Treatment Options

If your primary goal with essential tremor treatment is to avoid surgery, there are several pharmacological treatment options. For the best results, you can combine medication with a device like the Cala Trio.

There are three primary classes of medicines used to treat essential tremor: beta-blockers, anticonvulsants, and benzodiazepines.

  • Propranolol is a beta-blocker and is the only FDA-approved medication for essential tremor. Like other beta-blockers, possible side effects include lightheadedness, fatigue, impotence, bradycardia, nausea, weight gain, rash, and diarrhea. However, this medication has been shown to reduce tremors in many patients.
  • Anticonvulsants used to treat essential tremor include Primidone, Gabapentin and Topiramate. These medications may come with side effects that include dizziness, fatigue, sedation, nausea, shortness of breath, headaches, and other flu-like symptoms.
  • Alprazolam can be specifically helpful in treating essential tremor in individuals who suffer from anxiety. The big concern with benzodiazepines is the risk of addiction, as well as the potential negative side effects.

Make sure you consult a healthcare professional about your medical history and whether pharmacological treatment is right for you before taking these medications.

Surgical Treatment Options

As a last resort, surgical treatment may be an option for essential tremor. Deep brain stimulation (DBS), focused ultrasound (FUS) and gamma knife radiosurgery (GKS) are the most common surgical treatments under current essential tremor treatment guidelines.

All of these surgical treatment options focus on the VIM nucleus of the thalamus, which is a specific area of the brain. DBS and FUS can provide immediate relief, while GKS typically takes weeks to months to see results. There are pros and cons to each surgical treatment method, so the best thing you can do as a patient is talk with a healthcare professional to determine the best treatment option for your ET.

Botulinum Toxin

Botulinum toxin, or Botox, can also be used to treat essential tremor. Treatment using Botox for essential tremor involves injecting botulinum toxin into a specific part of the body, targeting muscles that are near the area where tremors occur. In order for Botox injections to reduce tremors, they must be administered in the right spot. Botox injections can be a good alternative to oral pharmacological treatment if an individual is not responding to their medication. Side effects of Botox injections include muscle weakness, rash, pain, stiffness, cramping, hematoma, and paresthesia.

Assistive Devices

There are also several devices that can help reduce the severity and frequency of tremors in patients with ET. Exoskeletons can produce countermovements to help minimize shaking, while orthotics move with your body to reduce tremor severity. There are even handheld devices that help reduce tremor power by using technology to counteract tremors.

Limb weights are one of the most popular assistive devices for ET because they’re simple. By applying weight, these bracelets can add a bit of stability to your hand, making it easier to steadily self-feed, reach for a glass, and complete other typical tasks. There are several benefits of wrist weight bracelets for tremors, especially when used in conjunction with other treatment methods.

Steps to Take to Manage Essential Tremor

While essential tremor can make simple tasks more difficult, essential tremor treatment guidelines help patients get the treatment they need to reduce tremor power and regain control over motor function. Devices like the Cala Trio wrist-worn device are a big part of reducing essential tremor without turning to surgical or pharmacological treatment methods. Through advanced technology, these devices help reduce the severity of your essential tremor so you can focus on your day-to-day life.