The American Academy of Neurology has published its updated guideline for the treatment of essential tremor. Propranolol and primidone remain first options with a Level A recommendation (established as effective). Alprazolam, atenolol, gabapentin as monotherapy, sotalol, and topiramate are graded as Level B (probably effective), while nadolol, nimodipine, clonazepam, botulinum toxin a, deep brain stimulation, and thalamotomy remain as level C (possibly effective). There is not enough evidence to make a recommendation for gamma knife therapy. The new guideline also states that there is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozipine. Levetiracetam and 3,4 diaminopyridine are ineffective and flunarizine is probably ineffective. The guideline was published online in Neurology October 19, 2011 (doi: 10.1212/WNL.0b013e318236f0fd).