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Essential Tremor – Asthma Contraindication — SCE Neurology MCQ

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EasyMovement DisordersEssential Tremor – Asthma ContraindicationSCE Neurology

A 55-year-old man with known essential tremor asks about treatment. His tremor significantly impairs his ability to eat and write. He does not drink alcohol. He has asthma. Which first-line medication should be avoided and what is the alternative?

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Correct answer: C — Avoid propranolol (contraindicated in asthma); offer primidone as first-line alternative

Propranolol (a non-selective beta-blocker) is the first-line treatment for essential tremor but is contraindicated in asthma due to the risk of bronchospasm. Primidone (a barbiturate anticonvulsant) is an equally effective first-line alternative. Other options include topiramate, gabapentin, and botulinum toxin for head/voice tremor. DBS of the VIM thalamus is reserved for severe medication-refractory ET. B: Primidone is the alternative, not to be avoided. C: Topiramate is a reasonable option. D: DBS is not first-line. E: Propranolol is the one to avoid in asthma.

Reference: NICE Essential Tremor Guidance; AAN/MDS ET Practice Guideline (2011)