Brief Answer:
Essential tremor

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a neurologist in the XXXXXXX OH area. I would like to give you some opinions on your case. I note that you have had tremors since childhood quite possibly with the nodding of the head. Apparently, most of your adult life you recall having tremors of the hands. This is now interfering with your day to day activities. I can't tell for sure but it would appear that the only medications you've been on is Xanax which worked to calm the tremors but you became dependent upon them. You would like to know what may be available for these tremors. I am going to hazard a few guesses here about your tremors. Please tell me how many of these describe your tremors:

1. Are calmed by at least somewhat for at least an hour or so using any form of alcohol

2. Become more intense in the presence of activity using the hands (especially fine or close in work such as using a screw driver, sewing, knitting, writing cursively), fatigue, anxiety, fear, anger, increased caffeine intake, and some medications

3. Able to be better control when your forearms/elbows are locked closer to the body.

4. Head bobbing tends to be at the same frequency as the hands

5. Someone in the family (likely a male) has these tremors such as father, brothers, uncles, grandfather, cousins


If at least 2 of the above are true then, I believe you have a condition known as Benign Essential tremor. If the condition is present in your family it would be referred to as Familial Essential Tremor.

Several classes of medications are known to function well for these types of tremors which should always be tried ahead of benzodiazepines such as Xanax. My first choice for you would be a medication which goes by the brand name in the U.S.A. of Inderal. Generic is propranolol. It is known as a BETA BLOCKER and my prediction for you is that it would be an excellent choice since you've apparently never been tried on any types of specific medications for these tremors. I say this because you would be relatively speaking "virgin" to such agents which gives you a high likelihood of responding at low doses.

I'm a bit surprised that nobody has recommended these medications to you yet seeing as how you've had these tremors for so long. Were people just hesitant to treat you unless they substantially interfered with your activities?

At any rate, there are other classes of medications which can be tried but I would recommend propranolol. Metoprolol and atenolol are other beta blockers that have been used but my favorite in terms of efficacy and ease of dosing schedules is propranolol. Be sure that you increase the dose of the medication very slowly because you may find your tremors controlled at a very low dose given the fact that you've never been treated before. In other words, I think it is preferable for you to find the LOWEST DOSE of the medication that will control your symptoms to a functional level. That way, we leave room for the future if it gets to a point where your tremors get "habituated" to the medication and it needs to be raised.

I hope this information is of value to you and wish you lots of luck in trying to secure some for a trial. Please go by the advice of whomever will be treating you, however, I would highly recommend a VERY VERY SLOW titration upward until you reach a point of efficacy without overshooting the minimum dose as this could give you unwanted side effects or simply place you at a level you don't need making it more difficult to raise the dose in the future as necessary.

If this information was helpful would you do me the favor of providing some written feedback and an accompanying STAR RATING?

At the same time and if there are no further questions you have for me could you CLOSE THE QUERY on your end as this will be the signal to the network officials that I have satisfactorily addressed your question which allows the case to be filed for future reference or educational purposes as needed.

This query required 41 minutes of physician specific time to review, research, and document in final draft form for patient envoy.

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