Topiramate

Clinical question
How effective are β-blockers and other first-line agents for essential tremor?

Bottom line
Older, small randomized controlled trials (RCTs) show that propranolol reduces tremor severity (about 2 points more than placebo on 10- to 15-point scales) and leads to patients feeling “definitely better” in 64% to 100% versus 14% to 20% (placebo) at 2 to 6 weeks. Benefit is seen from 90 mg/day, with 120 to 240 mg/day most studied. Primidone and topiramate may improve function based on limited RCTs.