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Table 2 Treatment options in primary orthostatic tremor

From: Lessons I have learned from my patients: everyday life with primary orthostatic tremor

Drugs/Neurostimulation Doses Reported clinical effect
Clonazepam 0.5 mg- 6 mg /day Moderate to marked benefit in 50 to 30% of the patients
Gabapentin 300–2400 mg/day Moderate to marked benefit
Beta-blockers (propranolol 20–240 mg/day Little effect of POT. May improve arm postural tremor
Primidone 125–250 mg/day No effect, poor tolerance
L-Dopa Pramipexolea 300–800 mg/day Rare cases (short term benefit)b
Antiepileptic drugs (valproic acid, phenobarbital, carbamazepine, levetiracetam, topiramate, pregabalin)   Minimal to no effect
Few cases. No prolonged treatments
cDeep Brain stimulation
Spinal cord stimulation
Thalamusc Rare cases. Variable results. Some increase in time in the upright position.
Botulinum toxin (tibial anterior)   No beneficial effect
  1. PD Parkinson’s disease
  2. aAnecdotal effect of pramipexole bL-Dopa or pramipexole may help in slow orthostatic tremor in Parkinson’s disease, little or no benefit on POT preceding or associated with PD. cDeep brain stimulation of the thalamus (Ventral intermediate nucleus Vim) same target as in Essential Tremor