<![CDATA[Essential tremor is the most common involuntary movement disorder in neurology and substantially impairs quality of life and activities of daily living. The understanding and management of this disorder have changed considerably in recent years. This review aims to provide a comprehensive overview of contemporary management strategies for essential tremor. A narrative literature review was conducted by searching databases such as PubMed, Scopus, and Cochrane Library for English-language randomized controlled trials, meta-analyses, and clinical guidelines published up to 2026. The review analyzed the 2026 Movement Disorder Society Evidence-Based Medicine guideline, recent randomized clinical trials of precision pharmacological therapies, and comparative studies evaluating neuromodulation and surgical interventions. Current evidence indicates that the long-term effectiveness of conventional pharmacological therapies, including propranolol and primidone, remains uncertain because previous studies were limited by short follow-up periods and subjective outcome measures. In contrast, targeted pharmacological therapy with ulixacaltamide demonstrated significant improvements in tremor severity and functional outcomes in phase III clinical trials. Non-invasive neuromodulation using transcutaneous afferent patterned stimulation has also emerged as an effective therapeutic option for selected patients. Among surgical interventions, magnetic resonance-guided focused ultrasound provides substantial and durable tremor reduction comparable to deep brain stimulation while offering a less invasive alternative, although it is associated with a distinct profile of neurological adverse events. Contemporary management of essential tremor is shifting from empirical pharmacological treatment toward precision medicine, evidence-based neuromodulation, and individualized therapeutic strategies that optimize clinical outcomes and patient quality of life.]]>
