DEAR READER: Familial refers to a hereditary disease or disorder seen in some families and not in others — thus, your genetic tremor. Essential tremor affects millions of people across the United States. It is a disorder of the nervous system that causes involuntary tremor or shaking, primarily seen in the hands, head and eyelids but never the feet or legs. Other signs and symptoms are generally not observed when a person is asleep. It differs from other disorders such as Parkinson’s or disorders that are the result of head trauma.

Essential tremor is commonly observed in the elderly. It is not dangerous; however, it can affect a person’s ability to pick up a cup of coffee, eat with a fork, apply makeup, shave and a host of other day-to-day activities we so commonly take for granted. Symptoms can be worsened by such things as temperature extremes, caffeine, emotional stress and fatigue.

Mysoline (primidone) is an anticonvulsant prescribed to control specific types of seizures. It works by reducing abnormal electrical activity in the brain. The medication may help control your tremor, but it will not cure it.

I don’t know the reason your physician prescribed the Mysoline, but you might speak with him or her about a trial switch to propranolol, a beta blocker used to treat tremor, hypertension, rhythm disorders of the heart and migraine headaches. As with all drugs, this medication carries the potential for side effects, including edema of the feet and ankles, nausea, constipation, diarrhea, shortness of breath and cardiac arrhythmias. It should not be taken by anyone who has been diagnosed with a second- or third-degree heart block.

I sound like a broken record when I often repeat that a drug manufactured for one reason can be successfully prescribed for another. Therefore, I don’t at all question the reason your physician chose one medication over another. The real concern here is that what was once working no longer is. Make an appointment, and express your concerns. It appears time for a change.

To provide related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Essential tremor can be caused by several conditions, including anxiety and stress. It is often confused with Parkinson’s disease, and affects almost 15 percent of people over the age of 65.

The Xanax you have been prescribed is in a group of drugs called benzodiazepines. I can only assume your physician prescribed it because he or she believes the tremor is caused by anxiety. Other prescription drugs that have shown promise include beta blockers commonly used for hypertension, some epilepsy drugs and Botox. Without knowing you personally, I cannot say whether the medication is doing you any harm; but should you choose a trial of alternatives, you might consider avoiding caffeine, excessive amounts of alcohol and stress. Hypnosis, massage, acupuncture, physical therapy or biofeedback might be of assistance.