Essential Tremor

A 62-year-old woman presents with a tremor that affects both of her hands, which started in her early 50s. She reports that the tremor started slowly and symmetrically and has progressed gradually. The tremor affects her fine-motor movements and results in impaired handwriting, which is often illegible, and difficulty in such activities as eating soup and putting on a necklace. The tremor gets worse with stress. Her mother had a similar tremor. She has a more recent history of depression, which is now well controlled with fluoxetine and bupropion. The neurologic examination shows a postural and action tremor of both hands in the medium (4 to 8 Hz) frequency range with postural tremor amplitudes of 1 to 3 cm bilaterally; the examination is otherwise unremarkable. How would you evaluate and treat the patient?