Overview

Essential tremor (ET) is a common neurological movement disorder that causes rhythmic shaking during posture or voluntary movement. It most often affects the hands and arms while writing, eating, drinking, using tools, or holding objects. It can also affect the head, voice, jaw, or, less often, the legs and trunk. ET is estimated to affect approximately 7 million people in the United States, although the true number is uncertain because mild or socially concealed tremor may never reach medical attention.¹

Essential tremor is not simply “nervousness,” and it is not the same as Parkinson’s disease. Stress, fatigue, illness, caffeine, and some medications can amplify tremor, but they do not by themselves establish its cause. ET can remain mild for years or become disabling enough to interfere with meals, handwriting, work, hobbies, grooming, public speaking, and social confidence.

The most important essential tremor updates as of July 10, 2026 are:

• A major 2026 evidence review highlighted how limited the medication trials remain. The International Parkinson and Movement Disorder Society reviewed 31 randomized trials of 16 medical interventions. More than one trial reported tremor improvement with propranolol, primidone, topiramate, and botulinum toxin A, but most studies were small, short, or at risk of bias. Under the review’s modern grading framework, the evidence was insufficient to make high-confidence long-term efficacy conclusions for any medication. This does not mean established treatments never work; it means expectations should be individualized and measured by function, tolerability, and sustained benefit.⁶
• Two distinct prescription wrist-worn neuromodulation systems are now FDA cleared. Cala kIQ™ Plus, cleared in March 2026, delivers patterned stimulation to the median and radial nerves for temporary relief of tremor in the treated hand after stimulation. The Felix NeuroAI™ Wristband, cleared in July 2025, continuously monitors tremor and adjusts stimulation while worn to aid upper-limb functional limitations.¹⁴¹⁵
• A 90-day randomized trial supports the Felix wristband, with important limitations. Among 125 adults, the modified activities-of-daily-living score improved by 6.9 points with active stimulation and 2.7 points with sham stimulation. Skin irritation occurred in 33.7% of active-device participants versus 4.8% with sham. Longer-term effectiveness, adherence, access, and cost still need consideration.¹⁶
• Staged treatment of both arms with MR-guided focused ultrasound is available for carefully selected patients. Current FDA labeling permits treatment of the opposite side at least 9 months after the first thalamotomy in adults age 22 or older with medication-refractory ET. Focused ultrasound creates a permanent, nonadjustable brain lesion, and persistent speech, swallowing, sensory, or coordination effects occurred in some participants in the staged-bilateral trial.¹⁹²⁰
• Botulinum toxin has stronger randomized evidence for selected head tremor, and upper-limb research is advancing. In a 117-participant head-tremor trial, 31% of patients receiving electromyography-guided injections achieved the prespecified clinical improvement at week 18, compared with 9% receiving placebo; the advantage was no longer demonstrated at week 24, and neck pain, weakness, and swallowing difficulty were important adverse effects. In 2025, AbbVie also reported positive Phase 2 topline results for individualized onabotulinumtoxinA injections in upper-limb ET, but this remains an unapproved use and full peer-reviewed results were not available at the evidence cutoff.¹²²⁵
• Ulixacaltamide is under FDA review, but no 2026 approval decision is expected. The sponsor reported positive Phase 3 results and an accepted U.S. new drug application. The FDA target action date is January 29, 2027. Ulixacaltamide remains investigational, and the Phase 3 program had not yet been fully published in a peer-reviewed journal at this article’s evidence cutoff.²¹²²²³

Evidence cutoff: This article reflects publicly available evidence through July 10, 2026. Regulatory status, device availability, insurance coverage, and research findings can change. Sponsor-reported and conference-presented findings are identified as such and should not be interpreted as FDA approval or established long-term benefit.

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What Essential Tremor Is

A tremor is an involuntary, rhythmic, oscillating movement. In ET, the defining tremor is an action tremor of the upper limbs. Action tremor includes:

• Postural tremor: shaking while holding the arms or hands against gravity, such as holding a cup or phone.
• Kinetic tremor: shaking during voluntary movement, such as writing, pouring, eating, applying makeup, or using tools.
• Intention tremor: increasing tremor as the hand approaches a target, which can occur in ET but also warrants examination for cerebellar disease when prominent.

ET usually affects both upper limbs by the time the formal syndrome is established, but the severity is often asymmetric and symptoms may begin in one hand. Tremor can spread over time. Head or voice tremor may occur, although isolated head or voice tremor without bilateral arm tremor is not classified as ET under the current consensus definition and should prompt careful evaluation for dystonia or another tremor syndrome.²

Rest tremor can occasionally appear in long-standing ET, but it is not the defining feature. New rest tremor, slowness, stiffness, reduced arm swing, or gait change should trigger reassessment for Parkinson’s disease or another parkinsonian disorder rather than being assumed to be “just more ET.”

How Essential Tremor Can Affect Daily Life

• Spilling from a cup, bowl, or spoon
• Difficulty cutting food, cooking, shaving, applying makeup, fastening buttons, or inserting contact lenses
• Illegible handwriting or difficulty signing documents
• Problems typing, using a mouse, operating tools, playing an instrument, or performing precise professional tasks
• A shaky head or voice that can be mistaken for anxiety
• Avoidance of restaurants, meetings, photographs, or social events
• Safety concerns from hot liquids, sharp objects, ladders, or work equipment

ET is generally not an emergency or directly life-threatening condition, but calling it “benign” can minimize real disability. Severity, progression, treatment response, and psychosocial impact vary substantially among patients.¹⁴

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What Causes Essential Tremor?

There is no single established cause or diagnostic brain lesion for all ET. Current research supports a disorder of oscillating motor networks involving the cerebellum, thalamus, and motor cortex. Abnormal synchronization within this cerebello-thalamo-cortical network appears to generate or amplify tremor. GABAergic signaling, ion-channel function, and other neurotransmitter systems may contribute, but no single mechanism explains every patient.⁴

ET often runs in families, especially when it begins earlier in life, but inheritance is usually more complex than a simple dominant gene. A 2024 genome-wide association meta-analysis involving 16,480 ET cases and more than 1.9 million controls identified multiple risk loci, supporting a polygenic and biologically heterogeneous condition. Many patients have no known family history, and routine clinical genetic testing does not currently confirm or exclude ET.⁵

Stress and anxiety can worsen visible shaking by increasing normal physiologic tremor and muscle activation. They can also create a self-reinforcing cycle in which concern about being observed further magnifies tremor. This does not make ET a psychological disorder.

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How Essential Tremor Is Diagnosed in 2026

ET remains a clinical diagnosis. There is no blood test, MRI finding, genetic panel, skin biopsy, or other biomarker that independently confirms it. The central task is to characterize the tremor precisely and determine whether another neurological, medication-related, metabolic, or functional condition better explains it.

The Current Consensus Definition

The 2018 International Parkinson and Movement Disorder Society classification defines ET as an isolated syndrome of:

• Bilateral upper-limb action tremor
• At least 3 years’ duration
• With or without tremor in the head, voice, or lower limbs
• No definite dystonia, ataxia, parkinsonism, or other neurological signs that establish another syndrome²

The 3-year duration criterion is a classification safeguard against labeling a newly evolving tremor too early. It does not mean that a patient must wait three years for evaluation, symptom treatment, or follow-up. A shorter-duration isolated action tremor may be classified provisionally while its pattern becomes clearer.

What “Essential Tremor Plus” Means—and Does Not Mean

ET-plus is a descriptive label for a patient who has the features of ET plus subtle additional signs of uncertain significance, such as impaired tandem gait, questionable dystonic posturing, mild cognitive findings, or rest tremor that does not yet establish another syndrome.²

The category is controversial. It has not been shown to represent one distinct biological disease, and it does not reliably predict prognosis or treatment response. Some “plus” signs may emerge with age or longer tremor duration; others may eventually prove to reflect dystonia, Parkinson’s disease, cerebellar disease, neuropathy, medication effects, or another diagnosis. The practical response is not alarm, but careful documentation and longitudinal follow-up.³

What a Tremor Evaluation Usually Includes

• History: age at onset, progression, affected body regions, task-specific triggers, family history, disability, alcohol response, and whether the tremor appeared abruptly or gradually.
• Medication and substance review: caffeine, nicotine, stimulants, decongestants, bronchodilators, thyroid hormone, lithium, valproate, amiodarone, some antidepressants, antipsychotics, corticosteroids, alcohol withdrawal, and other agents can cause or amplify tremor.
• Examination in several conditions: at rest, with the arms outstretched, in “wing-beating” posture, during finger-to-nose testing, handwriting, spiral drawing, pouring, drinking, and other tasks that reproduce the patient’s difficulty.
• Search for other neurological signs: bradykinesia, rigidity, dystonic posturing, abnormal eye movements, weakness, numbness, cerebellar incoordination, gait change, and neuropathy.
• Targeted laboratory testing: thyroid studies, metabolic testing, drug levels, or other tests when the history suggests a reversible cause.
• Brain imaging: MRI is not routinely required for a stable, typical ET presentation, but is appropriate for sudden onset, rapid progression, focal deficits, marked asymmetry with other signs, prominent ataxia, or another atypical pattern.

When a DaTscan May Help

A DaTscan can support the distinction between a degenerative parkinsonian syndrome and a non-parkinsonian tremor when the clinical examination remains uncertain. It is not a routine test for typical ET, does not diagnose ET, and cannot distinguish Parkinson’s disease from multiple system atrophy or progressive supranuclear palsy. Some medications can interfere with image interpretation, so the ordering team must review the medication list rather than having a patient stop drugs independently.¹¹

Essential Tremor, Parkinson’s Tremor, and Dystonic Tremor

No single feature—symmetry, alcohol response, tremor frequency, or one drawing sample—reliably separates all cases. Some patients can have both ET and Parkinson’s disease. New slowness, stiffness, rest tremor, reduced arm swing, or falls warrants reassessment. See our updated guide to Parkinson’s disease.

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Conditions That Can Mimic or Worsen Essential Tremor

• Enhanced physiologic tremor: amplified normal tremor from anxiety, sleep deprivation, fever, pain, hyperthyroidism, low blood sugar, medication effects, stimulants, or withdrawal.
• Medication- or toxin-induced tremor: including lithium, valproate, bronchodilators, stimulants, excess thyroid hormone, some antidepressants, amiodarone, and others.
• Parkinson’s disease or another parkinsonian disorder.
• Dystonic tremor: often irregular, asymmetric, position specific, and accompanied by abnormal posture or muscle pulling.
• Cerebellar tremor: usually slower, with prominent intention tremor, incoordination, abnormal eye movements, or gait ataxia.
• Neuropathic tremor associated with peripheral nerve disease.
• Functional tremor: a genuine neurological disorder with variability, distractibility, or entrainment on examination; it is not intentional or “fake.”
• Orthostatic tremor: rapid leg tremor and unsteadiness while standing that improves with sitting or walking.
• Wilson disease or other uncommon metabolic/genetic disorders in selected younger patients or atypical presentations.

Abrupt onset, stepwise worsening, major day-to-day variability from the beginning, prominent imbalance, weakness, numbness, abnormal eye movements, or a new medication exposure should broaden the evaluation rather than being automatically attributed to ET.

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Treatment Goals and the Quality of the Evidence

Treatment is based on functional impact, not simply how visible the tremor appears. Mild tremor that does not bother the patient may require education and observation rather than medication. Treatment becomes reasonable when tremor causes disability, safety concerns, occupational problems, pain from compensatory muscle use, or meaningful social distress.

The 2026 MDS review is important because it separates widespread clinical use from the strength of the underlying trials. Propranolol and primidone have decades of use and were previously classified as clinically useful; topiramate and botulinum toxin have also demonstrated benefit in multiple trials. Yet the modern review found that the studies were generally too small and short to support confident, durable population-level conclusions.⁶⁷

Practical interpretation: a medication trial should have a defined goal—such as drinking from a cup, writing a signature, using utensils, or completing a work task—and should be continued only when the real-world benefit outweighs side effects and burden.

Propranolol

Propranolol is a nonselective beta blocker and the only commonly used oral medication with an FDA-labeled essential-tremor indication. It may be used regularly or, in selected patients, before a predictable high-demand activity. It tends to help upper-limb tremor more reliably than head or voice tremor.⁸

Potential problems include fatigue, dizziness, low blood pressure, slow heart rate, exercise intolerance, sleep effects, and sexual side effects. It is contraindicated in bronchial asthma, cardiogenic shock, sinus bradycardia, and greater-than-first-degree heart block under current labeling. It can also mask warning symptoms of low blood sugar and requires individualized review in patients with diabetes, heart disease, circulation problems, or other blood-pressure medications.⁸

Primidone

Primidone is an antiseizure medication used off label for ET and is another established first-line option. Some patients respond well to small doses, but sensitivity to the first doses is common. Starting very low and increasing slowly can reduce early intolerance.

Early adverse effects can include marked sleepiness, dizziness, vertigo, imbalance, nausea, blurred vision, or ataxia. Alcohol and other sedating drugs can worsen these effects. Primidone should not be started, adjusted, or stopped abruptly without clinician guidance, particularly because it is metabolized partly to phenobarbital and withdrawal can be medically significant.⁹

Topiramate and Other Oral Options

Topiramate is used off label and can reduce tremor in some patients, particularly when propranolol or primidone is ineffective or unsuitable. Its usefulness is limited by paresthesias, cognitive slowing or word-finding difficulty, appetite and weight loss, mood effects, metabolic acidosis, kidney stones, acute eye complications, and fetal risk. It should be tapered rather than stopped suddenly.¹⁰

Gabapentin, selected other beta blockers, and benzodiazepines are sometimes considered, but evidence is less consistent. Benzodiazepines can cause sedation, impaired driving, falls, tolerance, dependence, and withdrawal and are not a routine long-term solution for tremor. Medication choice should account for age, asthma, heart rate, blood pressure, kidney stones, cognition, fall risk, pregnancy plans, other prescriptions, and the specific tasks the patient wants to improve.

Medication note: Primidone, topiramate, gabapentin, and several other medications discussed for ET are used off label in the United States. Off-label use can be medically appropriate, but it requires individualized risk-benefit review.

Alcohol Is Not a Treatment

Some people notice temporary improvement after alcohol, but that response is neither specific enough to diagnose ET nor a safe treatment strategy. Alcohol can cause rebound tremor, impaired balance and judgment, medication interactions, tolerance, dependence, sleep disruption, and withdrawal tremor. A history of alcohol response can be useful diagnostically, but clinicians should not prescribe alcohol as therapy.⁴

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Botulinum Toxin for Hand, Head, and Voice Tremor

Botulinum toxin weakens selected overactive muscles for a limited period. Its value depends heavily on correct diagnosis, careful muscle selection, dose, injection guidance, and the patient’s functional priorities. Botulinum toxin is not FDA approved specifically for essential tremor, so this use is off label.

• Hand tremor: individualized injections can reduce tremor, but finger, wrist, or grip weakness may offset benefit. Modern kinematic, electromyographic, or ultrasound-guided strategies aim to improve targeting.
• Head tremor: the 2023 randomized trial provides meaningful evidence for selected patients. At week 18, 31% receiving botulinum toxin met the prespecified improvement threshold versus 9% receiving placebo. Benefit was not demonstrated at week 24, consistent with the treatment wearing off. Adverse events occurred in nearly half of treated participants and included head or neck pain, posterior neck weakness, and dysphagia.¹²
• Voice tremor: injections into laryngeal muscles may help selected patients, but temporary breathiness, weak voice, and swallowing difficulty are important risks. Evaluation by an experienced movement-disorder neurologist and laryngology or voice team is often appropriate.

A 2025 Phase 2 trial called ELATE evaluated individualized onabotulinumtoxinA injections for upper-limb ET. AbbVie reported that the primary endpoint and all six secondary endpoints were met. Localized, transient muscular weakness occurred in 24.5% of treated participants and 2.3% of placebo participants. These are sponsor-reported findings, the full results had not yet been published in a peer-reviewed journal at this article’s evidence cutoff, and onabotulinumtoxinA remains unapproved specifically for ET.²⁵

Head tremor should be examined carefully for cervical dystonia because injection patterns and treatment goals differ between essential and dystonic tremor.

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Wearable Neuromodulation

Prescription wrist-worn devices stimulate peripheral nerves to influence the central tremor network. They do not cure ET, and evidence is strongest for upper-limb function rather than head or voice tremor.

Cala kIQ™ Plus

The FDA cleared Cala kIQ Plus on March 17, 2026. It delivers transcutaneous afferent patterned stimulation to the median and radial nerves. Its ET indication is to aid temporary relief of tremor in the treated hand following stimulation. It is used at home after calibration and is a prescription device.¹⁴

Earlier randomized evidence for this stimulation approach showed improvement on some patient- and clinician-rated measures after a treatment session, although the prespecified spiral-drawing primary endpoint did not clearly separate active from sham stimulation. Response varies, and benefit is temporary rather than disease modifying.¹³

Felix NeuroAI™ Wristband

The Felix system stimulates the radial, median, and ulnar nerves, continuously measures tremor, and automatically adjusts stimulation while worn. The FDA-cleared indication is to aid tremor-related functional limitations in the upper limbs of adults with ET.¹⁵

In the 2025 randomized TRANQUIL trial, 125 adults used active or sham devices for 90 days. The active group improved by 6.9 points on the modified TETRAS activities-of-daily-living score versus 2.7 points with sham. Skin irritation was the most common device-related adverse event, occurring in 33.7% of active users and 4.8% of sham users.¹⁶

How to interpret wearable-device evidence: FDA clearance confirms that the device met the applicable regulatory pathway; it does not guarantee meaningful benefit for every patient. Comfort, skin tolerance, hand dominance, tremor pattern, required wear time, ability to use the associated technology, cost, consumable supplies, and insurance coverage all matter.

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Procedures for Medication-Refractory Tremor

Deep brain stimulation and MR-guided focused ultrasound are considered when tremor remains disabling despite reasonable medication trials, medications are contraindicated or poorly tolerated, and the diagnosis and treatment goals are clear. Both are best established for upper-extremity tremor. Head, voice, gait, or whole-body symptoms may respond less predictably.

Deep Brain Stimulation

DBS has the longest track record among advanced ET procedures. FDA labeling includes unilateral or bilateral VIM stimulation for adults with disabling upper-extremity tremor that is not adequately controlled by medication and causes significant functional disability.¹⁷

The principal advantage is programmability: stimulation can be adjusted over time to balance tremor control against speech, balance, or coordination effects. The system can be turned off, and components can be replaced or revised, but implantation still involves intracranial surgery and permanent hardware. Risks include bleeding, infection, stroke, seizure, lead or battery problems, pain, speech change, gait imbalance, and stimulation-related paresthesias or ataxia.

MR-Guided Focused Ultrasound Thalamotomy

MR-guided focused ultrasound uses MRI guidance and real-time thermal monitoring to create a small lesion in the thalamic tremor circuit without an incision or implanted device. A sham-controlled trial established benefit for medication-refractory unilateral hand tremor, while also documenting sensory and gait adverse effects.¹⁸

FDA labeling now permits staged treatment of the opposite side at least nine months later in eligible adults age 22 or older. In the 51-person open-label staged-bilateral trial, the treated-side composite tremor and motor score improved by approximately 66% at three months. At 12 months, persistent events included numbness or tingling in 8 participants, dysarthria in 7, ataxia in 6, taste disturbance in 3, and dysphagia in 3. The trial enrolled selected patients who had already undergone successful first-side treatment, so the results do not apply to every patient with bilateral tremor.¹⁹²⁰

Focused ultrasound is not “reversible” and cannot be reprogrammed if symptoms or side effects change. Candidacy depends on diagnosis, symptom distribution, skull characteristics, MRI safety, bleeding risk, gait and speech status, cognition, medical comorbidities, and patient priorities.

Procedure counseling should compare more than tremor reduction. The decision should include which side and activities matter most, whether bilateral treatment is likely to be needed, baseline speech and balance, willingness to have implanted hardware, need for future adjustability, surgical and lesion risks, travel for programming, and how much benefit would justify the burden.

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Ulixacaltamide: A Promising Investigational Medication

Ulixacaltamide is an oral, selective T-type calcium-channel inhibitor designed to reduce abnormal burst firing in the cerebello-thalamo-cortical tremor circuit. It is intended as a mechanism-targeted ET medication rather than a repurposed beta blocker or antiseizure drug.

In October 2025, the sponsor reported that both pivotal Phase 3 Essential3 studies met their primary endpoints. In the parallel-group study, the mean modified activities-of-daily-living score improved by 4.3 points from baseline at week 8 and was statistically superior to placebo; the randomized-withdrawal study also favored continued treatment. These were sponsor-reported topline findings.²¹

Conference materials presented in 2026 reported constipation, dizziness, euphoric mood, “brain fog,” headache, paresthesia, and insomnia among common treatment-emergent adverse events. Drug-related adverse events led to discontinuation in approximately 27% to 28% of ulixacaltamide-treated participants in the two controlled studies, most often because of dizziness or brain fog. These safety findings are important when interpreting the positive efficacy results and remain subject to regulatory review and full peer-reviewed publication.²²

The sponsor announced on April 14, 2026 that the FDA accepted the new drug application and assigned a target action date of January 29, 2027. Acceptance for review is not approval. Ulixacaltamide was not FDA approved or commercially available as of July 10, 2026.²³²⁴

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Occupational, Lifestyle, and Behavioral Strategies

Practical adaptations are not a substitute for medical care, but they can reduce disability with little systemic risk:

• Occupational therapy: task analysis, bracing or stabilization strategies, handwriting and keyboard adaptations, workplace modifications, and trials of utensils or cups before purchasing expensive equipment.
• Use both hands or support the forearms: stabilizing the elbows, holding a cup with two hands, or bringing the task closer to the body may reduce the mechanical effect of tremor.
• Safer eating and drinking: lidded cups, straws when swallowing is safe, deeper bowls, nonslip mats, plate guards, and insulated containers for hot liquids.
• Writing and technology: larger-barrel pens, voice dictation, touch-screen accessibility settings, electronic signatures, and keyboard shortcuts.
• Trigger management: adequate sleep, regular meals, hydration, treatment of fever or illness, and moderation of caffeine and other stimulants.
• Exercise and balance: regular physical activity supports general health, strength, and confidence. Balance-focused therapy is especially important when gait difficulty, neuropathy, medication sedation, or a planned procedure increases fall risk.
• Mental health support: counseling or cognitive behavioral strategies can reduce avoidance, shame, and anticipatory anxiety. Treating anxiety may reduce an amplifier of tremor even when it does not eliminate the neurological tremor itself.

Heavier or weighted devices help some people and make others fatigue or shake more. A short real-world trial with an occupational therapist is more useful than assuming one device will work for everyone.

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When to Seek Urgent Care or Reassessment

Stable ET usually belongs in outpatient neurological care. Seek urgent evaluation when tremor begins suddenly or accompanies:

• New weakness, numbness, facial droop, speech difficulty, confusion, severe dizziness, double vision, or inability to walk
• A sudden severe headache, head injury, seizure, fainting, or altered consciousness
• Fever, severe agitation, marked rigidity, or possible medication toxicity or withdrawal
• Very low blood sugar symptoms, severe palpitations, chest pain, or another acute medical illness

Arrange a nonemergency reassessment for a major change in pattern; new rest tremor, slowness, stiffness, falls, abnormal posturing, weakness, numbness, or imbalance; rapid progression; new medication exposure; or tremor that no longer fits the established diagnosis.

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The Best Essential Tremor Care Is Staged and Individualized

1. Confirm the tremor syndrome. Distinguish ET from enhanced physiologic, medication-induced, parkinsonian, dystonic, cerebellar, neuropathic, functional, and other tremors.
2. Measure what matters. Identify the specific activities, safety issues, or social situations that justify treatment and document a baseline.
3. Address reversible amplifiers. Review medications and substances, sleep, caffeine, thyroid disease, glucose, anxiety, and other contributors.
4. Use a structured treatment trial. Match medication or a wearable device to medical history and goals, then assess meaningful function and adverse effects rather than continuing indefinitely without evidence of benefit.
5. Target the involved body region. Oral medication is most established for arm tremor; botulinum toxin may be preferable for selected head, voice, or task-specific limb tremor.
6. Discuss procedures before disability becomes overwhelming. Patients with medication-refractory functional impairment should receive a balanced comparison of DBS and focused ultrasound, ideally from a multidisciplinary movement-disorders team.
7. Revisit the diagnosis over time. A changing examination may reveal Parkinson’s disease, dystonia, ataxia, neuropathy, or another condition that changes treatment.

Bottom line: Essential tremor is common, heterogeneous, and sometimes substantially disabling. There is no cure or universal best treatment, but patients now have a broader range of options: established medications, targeted botulinum toxin, two types of prescription wrist-worn neuromodulation, adjustable DBS, and staged focused ultrasound for carefully selected patients. Ulixacaltamide is a notable investigational development, but its FDA decision is targeted for 2027—not 2026—and regulatory review is still underway.

At Los Altos Neurology, we provide a detailed tremor examination, medication and medical-cause review, differentiation of essential tremor from Parkinson’s disease and dystonia, functional treatment trials, and individualized counseling about botulinum toxin, wearable devices, focused ultrasound, and deep brain stimulation. The goal is not merely to make a tremor score smaller, but to improve the activities and confidence that matter to each patient.

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References

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2. Bhatia KP, Bain P, Bajaj N, et al. Consensus Statement on the Classification of Tremors from the Task Force on Tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33(1):75-87. doi:10.1002/mds.27121.
3. Louis ED, Bares M, Benito-León J, et al. Essential Tremor-Plus: A Controversial New Concept. Lancet Neurol. 2020;19(3):266-270. doi:10.1016/S1474-4422(19)30398-9.
4. Okelberry T, Lyons KE, Pahwa R. Updates in Essential Tremor. Parkinsonism Relat Disord. 2024;122:106086. doi:10.1016/j.parkreldis.2024.106086.
5. Skúladóttir AT, et al. GWAS Meta-Analysis Reveals Key Risk Loci in Essential Tremor Pathogenesis. Commun Biol. 2024;7:504. doi:10.1038/s42003-024-06207-4.
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7. Ferreira JJ, Mestre TA, Lyons KE, et al. MDS Evidence-Based Review of Treatments for Essential Tremor. Mov Disord. 2019;34(7):950-958. doi:10.1002/mds.27700.
8. U.S. National Library of Medicine. Propranolol Hydrochloride Tablets: Prescribing Information. DailyMed. Accessed July 10, 2026.
9. U.S. National Library of Medicine. Primidone Tablets: Prescribing Information and Medication Guide. DailyMed. Accessed July 10, 2026.
10. U.S. Food and Drug Administration. TOPAMAX (topiramate) Prescribing Information. 2026.
11. U.S. Food and Drug Administration. DATSCAN (ioflupane I 123 injection) Prescribing Information. 2026.
12. Marques A, Pereira B, Simonetta-Moreau M, et al. Trial of Botulinum Toxin for Isolated or Essential Head Tremor. N Engl J Med. 2023;389:1753-1765. doi:10.1056/NEJMoa2304192.
13. Pahwa R, Dhall R, Ostrem J, et al. An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor. Neuromodulation. 2019;22(5):537-545. doi:10.1111/ner.12930.
14. U.S. Food and Drug Administration. Cala kIQ Plus 510(k) Summary and Indications for Use (K253587). March 17, 2026.
15. U.S. Food and Drug Administration. Felix NeuroAI Wristband 510(k) Summary and Indications for Use (K250096). July 1, 2025.
16. Ondo WG, Lv W, Zhu X, et al. Transcutaneous Peripheral Nerve Stimulation for Essential Tremor: A Randomized Clinical Trial. JAMA Neurol. 2025;82(12):1235-1242. doi:10.1001/jamaneurol.2025.3905.
17. U.S. Food and Drug Administration. Abbott Infinity Deep Brain Stimulation System: Summary of Safety and Effectiveness Data (P140009/S039).
18. Elias WJ, Lipsman N, Ondo WG, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016;375:730-739. doi:10.1056/NEJMoa1600159.
19. U.S. Food and Drug Administration. Exablate Neuro Information for Prescribers. Current U.S. labeling accessed July 10, 2026.
20. Kaplitt MG, Krishna V, Eisenberg HM, et al. Safety and Efficacy of Staged, Bilateral Focused Ultrasound Thalamotomy in Essential Tremor: An Open-Label Clinical Trial. JAMA Neurol. 2024;81(9):939-946. doi:10.1001/jamaneurol.2024.2295.
21. Praxis Precision Medicines. Positive Topline Results from Two Pivotal Phase 3 Essential3 Studies of Ulixacaltamide. October 16, 2025. Sponsor news release.
22. Shtilbans A, et al. Combined Efficacy and Safety of Ulixacaltamide in Essential Tremor Across the Pivotal Phase 3 Essential3 Program. American Academy of Neurology Annual Meeting. 2026. Sponsor presentation.
23. Praxis Precision Medicines. FDA Acceptance of the New Drug Application for Ulixacaltamide HCl in Adults with Essential Tremor. April 14, 2026. Sponsor news release.
24. ClinicalTrials.gov. Essential3: Phase 3 Study Evaluating Ulixacaltamide in Essential Tremor (NCT06087276). Accessed July 10, 2026.
25. AbbVie. Positive Topline Results from the Phase 2 ELATE Trial Evaluating OnabotulinumtoxinA for Upper-Limb Essential Tremor. October 6, 2025. Sponsor news release; see also ClinicalTrials.gov NCT05216250.

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