Depends on what you mean by "resistant". Increasing doses of propranolol and primidone, as tolerated, is the simplest move. Other pharmacologic treatments like Topiramate and Gabapentin are sometimes tried but rarely effective. Simultaneous with this you'll want to refer the patient to OT for assist...

I've had a couple of patients try this orthotic: readi-steadi.com.

Botox injection by a movement disorders specialist should also be considered for patients who want to avoid or delay DBS evaluation.

I used all above: Primidone Beta Blockers GBP TPX Clonazepam Botox 50-100 units in finger flexors and sometimes BR Weighted devices Focused US from Neuravive insightec.com. They have centers in NYU and Brigham and Women's Hospital in New England areas. I also met a neurologist with ET a...