Titrate propranolol and primidone slowly and to tolerance, and complete a medication review and thyroid and pheochromocytoma screen before labeling a symmetric high-frequency tremor as essential. When a patient describes tremor that resolves immediately on walking but returns on standing still, consider orthostatic tremor, as it is frequently misdiagnosed and clonazepam is the preferred first-line treatment.

Essential tremor worsens with action or specific postures, tends to be more symmetric, and has a higher frequency and lower amplitude; Clinicians can also consider gabapentin, various benzodiazepines, and acetazolamide-like agents; Tremor that is present at rest but becomes significantly worse with active movement or positioning; We utilize either a thalamotomy or thalamic deep brain stimulation, both of which demonstrate an impressive efficacy rate of up to ninety percent; Your immediate priority should be a thorough review of their medications—paying close attention to things like lithium, tricyclics, neuroleptics, beta-agonists, or anticonvulsants like valproic acid and carbamazepine