Traitement du tremblement essentiel : des médicaments à la stimulation cérébrale profonde

Essential tremor (ET) affects nearly 0.9% of the general population but its treatment remains difficult due to partial efficacy and relative tolerance of currently available therapies. One of the reasons for the partial effectiveness of ET treatments is related to poorly understood pathophysiology. The pharmacological option remains the first-line treatment before a surgical solution. Among available drugs, ß-blockers and primidone are preferred before trying second-line treatments such as anti-epileptics and benzodiazepines. When these treatments do not lead to satisfactory control of tremor despite accurate titration and limitation of side effects, deep brain stimulation of the ventral intermediate nucleus of the thalamus can be proposed. However, this last solution requires careful preoperative evaluation to determine the benefit/risk ratio of such a procedure.