The American Academy of Neurology has updated its 2005 guideline on the treatment of essential tremor.

Conclusions and recommendations are unchanged from the previous guideline for the following interventions:

• Propranolol, primidone (Level A, established as effective)

• Alprazolam, atenolol, gabapentin (monotherapy), sotalol, topiramate (Level B, probably effective)

• Nadolol, nimodipine, clonazepam, botulinum toxin A, deep brain stimulation, thalamotomy (Level C, possibly effective)

• Gamma knife thalamotomy (Level U, insufficient evidence)

Changes to conclusions and recommendations from the previous guideline include the following:

• Levetiracetam and 3,4-diaminopyridine probably do not reduce limb tremor and should not be considered (Level B)

• Flunarizine possibly has no effect in treating limb tremor and may not be considered (Level C)

• There is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozapine (Level U).