Topic: Essential Tremor
Subject: Medicine
A 75 year old white male complains of a tremor which has been progressive over the past 2 years. The tremor interferes with writing, pouring liquids, and eating soup. He has no other medical problems. He abstains from alcohol and tobacco products. Physical examination is remarkable for an action tremor of the upper extremities and a head tremor. No rigidity or gait disorder is noted. Of the following agents, which one is most appropriate as initial drug therapy for this problem?

Essential tremor is the most likely cause of a disabling action tremor in this age group. A resting tremor, rigidity, and other associated problems are seen with Parkinsons disease. Propranolol and primidone are the agents of choice. Alprazolam may have beneficical effects, but it is not a first-line agent because of the risk of sedation and habituation. Clonazepam has not been found to be effective in this disorder. Low doses of theophylline have been found to be somewhat beneficial, but it is considered a second-line agent for essential tremor. Selective Beta-blockers such as metoprolol are not as effective as propranolol.