General measures Not all individuals with<unk>  require treatment, but many treatment options are available depending on symptom severity. Caffeine and stress should be avoided, and adequate good-quality sleep is recommended. Oral medications First-line When symptoms are sufficiently troublesome to warrant treatment, the first medication choices are beta blockers such as propranolol or alternately, nadolol and timolol. Atenolol and pindolol are not effective for<unk> . The anticonvulsant primidone may also be effective.<unk>  is generally responsive to alcohol, but the risks of regular drinking are greater than the potential benefit. Nonetheless,<unk>  patients sometimes self-medicate with alcohol. Propranolol and primidone only have<unk> -reducing effects on about half of<unk>  patients, and the effects are moderate. Second-line Second-line medications are the anticonvulsants topiramate, gabapentin (as monotherapy) or levetiracetam, or benzodiazepines such as alprazolam. Third-line Third-line medications are clonazepam and mirtazapine. Fourth-line Theophylline has been used by some practitioners to treat<unk> , though it may also induce<unk> . However, its use is debated due to conflicting data on its efficacy. Some evidence shows that low doses may lead to improvement.<unk> hanol has shown superior efficacy to those of benzodiazepines in small trials. It improves<unk>  in small doses and its effects are usually noticeable within 20 minutes for 3–5 hours, but occasionally appears in a rebound<unk>  augmentation later. Some systematic reviews of medications for the treatment of<unk>  have been conducted. A 2017 review of topiramate found limited data and low quality evidence to support its efficacy and the occurrence of treatment-limiting adverse effects, a 2017 review of zonisamide found insufficient information to assess efficacy and safety, and a 2016 review of pregabalin determined the effects to be uncertain due to the low quality of evidence. Botulinum injection When medications do not control the<unk>  or the person does not tolerate medication, C. botulinum toxin, deep brain stimulation, or occupational therapy can be helpful. The electrodes for deep brain stimulation are usually placed in the<unk>  center" of the brain, the ventral intermediate nucleus of the thalamus. Ultrasound Additionally, MRI-guided high-intensity focused ultrasound is a nonsurgical treatment option for people with<unk>  who are medication refractory. MRI-guided high-intensity focused ultrasound does not achieve healing, but can improve the quality of life. While its long-term effects are not yet established, the improvement in<unk>  score from baseline was durable at 1 year and 2 years following the treatment. To date, reported adverse events and side effects have been mild to moderate. Possible adverse events include gait difficulties, balance disturbances, paresthesias, headache, skin burns with ulcerations, skin retraction, scars, and blood clots. This procedure is contraindicated in pregnant women, persons who have non-MRI compatible implanted metallic devices, allergy to MR contrast agents, cerebrovascular disease, abnormal bleeding, hemorrhage and/or blood clotting disorders, advanced kidney disease or on dialysis, heart conditions, severe hypertension, and<unk> hanol or substance abuse, among others. The US Food and Drug Administration (FDA) approved Insightec’s Exablate Neuro system to treat<unk>  in 2016. Another treatment for<unk>  is a surgical option; deep brain stimulation is used.
Essential tremor
Dystonia
Holmes tremor
Intention tremor
Myoclonic dystonia
Multiple sclerosis
Focal dystonia
Parkinson's disease