In patients with Wilson's disease, tremor is a recognised neurological manifestation requiring targeted symptomatic management. When initial pharmacological treatment does not achieve adequate relief or reduction of tremor, a structured second-line approach is indicated.
This protocol addresses the symptomatic management of tremor in Wilson's disease — specifically the situation where the treating goal of relief and reduction of tremor has not been met with first-line therapy.
Initial management of action/postural tremor typically begins with propranolol or primidone as first-line agents. When these treatments prove insufficient to achieve relief or reduction of tremor, escalation to a second-line approach is warranted.
The second-line approach involves a class of agents that may offer some relief when first-line options have not been effective. The specific agents, selection criteria, and dosing structure are detailed in the full protocol.
In cases of action/postural tremor, the most effective pharmacological treatment option is propranolol (20–240 mg/day, divided into two or three doses), followed by primidone (25 mg/day up to 750 mg daily in three divided doses).
If these treatments prove ineffective, benzodiazepines (alprazolam 0.75–1.5 mg/day) or clonazepam (0.5–4 mg/day) may offer some relief.