To characterize the Essential Tremor (ET) patient population, explore how US physicians perceive goals and efficacy of ET pharmacotherapy, and determine medications prescribed by neurologists versus primary care physicians (PCPs).

Forty PCPs and 61 neurologists, including 24 movement disorder specialists (MDS), completed a questionnaire with 7-point Likert items (1=not important/low association, 7=extremely important/strong association) exploring treatment goals and perceived efficacy of medications used in patients with ET under their management.

Surveyed physicians reported seeing ≈3,000 patients with ET each month in total. 51% were ≥65 years of age; only 3% were ≤18 years of age. Overall, 57% of patients were reported to have moderate/severe ET (neurologists: 61% vs. PCPs: 53%; P=0.17). The most prescribed medications were propranolol (34%), primidone (27%), topiramate (11%), gabapentin (11%), clonazepam (10%), and atenolol (10%). Compared to neurologists, PCPs prescribed primidone to a lower proportion of patients and atenolol to a higher proportion (P<0.05). Across physicians, treatment goals rated as most important were maintaining quality of life, maintaining function, reducing hand tremor, tolerability, long-term efficacy, patient compliance, and slowing disease progression (mean importance ≥6.0). The importance of long-term efficacy and patient compliance were rated higher by neurologists than PCPs (P<0.01). Both neurologists and PCPs rated medications as having limited-to-moderate effect (mean range: 1.8-4.9) on top-rated attributes, with variation by physician type and medication.

Most surveyed physicians prioritized patient function and well-being in the treatment of adults with ET. Although PCPs and neurologists differ partly in treatment patterns, goals, and perception of drug efficacies, the overall consensus is that current medications are inadequate in addressing patient-relevant outcomes, highlighting an unmet need for more effective pharmacotherapy.