Essential tremor is a very common movement disorder characterised by postural rhythmic oscillatory movements. The disorder may effect almost any body part, is gradually progressive and may be severely debilitating.First-line medical treatment usually involves propranolol or other nonselective &bgr;-adrenoceptor antagonists, or primidone. Both of these approaches reduce tremor severity in approximately 70% of patients, but tend to lose efficacy over time. Other promising medicines that have been less rigorously evaluated include benzodiazepines, calcium antagonists, carbonic anhydrase inhibitors, gabapentin, clozapine and low-dose theophylline. Botulinum toxin injected into the affected muscles helps some patients, and contralateral tremor can be dramatically reduced by surgical thalamotomy or deep brain thalamic stimulation.Recent advances in our understanding of tremor mechanisms should greatly facilitate rational therapy in the near future.