Essential tremor (previously called benign essential tremor) is an autosomal dominant condition which usually affects both upper limbs

Features

• postural tremor: worse if arms outstretched
• improved by alcohol and rest
• most common cause of titubation (head tremor)

Management

• propranolol is first-line
• primidone (barbiturate anticonvulsant) - useful alternative or adjunct if propranolol contraindicated or inadequate