Objective：To investigate the efficacy and safety of topiramate in the treatment of essential tremor. Methods：80 patients were collected who were clinically diagnosed as essential tremor in the outpatient and inpatient department of Lianyungang second people’s Hospital from October 2017 to December 2019. Every subject was randomly treated with topiramate or propranolol for 4 weeks. The essential tremor rating assessment scale（TETRAS）score was used before and 4 weeks after treatment to assess the efficacy and adverse effect of drugs were also evaluated. Results：Finally，80 patients were enrolled in the study. After drug treatment，the tremor score in topiramate group was significantly lower than that in propranolol group（P < 0.05）. The total effective rate in topiramate group and propranolol group was respectively 92.50% and 72.50%. The difference about curative effect between the two groups was statistically significant（22.5% vs. 45.0%，P < 0.05）. The adverse effect in topiramate group was significantly less than that in propranolol group（P < 0.05）. Conclusion：Topiramate is an effective and safe drug in the treatment of essential tremor with mild side effects，so it can be used as first choice for essential tremor therapy.