January 24, 2026

@michaelokun

Do you know the essential tremor medication treatment updates for 2026? Spoiler alert: Medications for essential tremor are not awesome. Do treatment conversations need a reset? Essential tremor is one of the most common movement disorders and it results in action tremor that more commonly shows up when the hands are being used. Dash and colleagues describe in a new paper in Movement Disorders, an updated evidence-based review from the International Parkinson and Movement Disorder Society examining medical treatments for essential tremor. The group applied modern standards. Key Points: - Propranolol, primidone, topiramate and botulinum toxin showed tremor improvement in more than one trial, however the overall evidence quality was low. - Many commonly used medications were supported by small studies w/ short follow-up and there were frequent methodological limitations. - Using updated GRADE criteria, no available medical therapy met the threshold for confident efficacy due mostly to bias and imprecision. My take: This is an important and sobering update. Essential tremor is common, disabling and frequently under-treated, yet our evidence base has not kept pace w/ the clinical need. Treatments do not help some folks, and we urgently need better designed, longer and more meaningful trials. Here are 5 points that resonated w/ me: 1- Essential tremor remains a high burden condition affecting daily function and quality of life. 2- Widely used medications may help some folks, however the strength of evidence is weaker than many assume. 3- Short trials and small sample sizes continue to limit confidence in treatment recommendations. 4- Shared decision making matters and should incorporate benefits, side effects and individual goals. 5- The future of essential tremor medicines will depend on higher quality trials and innovation beyond incremental drug testing. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.70184 #parkinson #tremor #fixelinstitute #michaelokun