<s>[INST] I have had essentioal tremors for about 20 years and the last 2-3 years have gotten worse. I am at the max on medication (primodine, propanaol) and the tremors still continue. What would you suggest be my next step? This has really taken a toll on my daily living. Thank you, Sue [/INST] Essential tremors have limited management strategy in the form of medical treatment. You are on both propranolol and pyrimidine. If you are still disabled then probably you should consult a movement disorder specialist and think about going for the surgery with the options of thalamotomy and Deep Brain stimulation. Both the procedures have high success rates and a movement disorder specialist might explain more about them. Please do not lose hope. You can get better. </s>