Thalamic versus midbrain tremor; two distinct types of Holmes' Tremor: a review of 17 cases

Nsengiyumva, N, Barakat, A, Macerollo, A ORCID: 0000-0003-4322-2706, Pullicino, R, Bleakley, A, Bonello, M ORCID: 0000-0002-0080-3976, Ellis, RJB and Alusi, SH (2021) Thalamic versus midbrain tremor; two distinct types of Holmes' Tremor: a review of 17 cases. JOURNAL OF NEUROLOGY, 268 (11). pp. 4152-4162.

Text
Holmes Tremor Final Alusi (1) revised for submission 2.docx - Author Accepted Manuscript
Download (69kB)

Official URL: http://dx.doi.org/10.1007/s00415-021-10491-z

Abstract

<h4>Introduction</h4>Holmes Tremor (HT) is a unique and debilitating movement disorder. It usually results from lesions of the midbrain and its connection but can also result from posterior thalamic injury. Clinical examination can help lesion localization between these two areas. We studied the clinical features and their radiological correlations to distinguish midbrain HT (HT-m) from thalamic HT (HT-t).<h4>Methods</h4>Retrospective review of 17 patients with a HT-type presentation was conducted. Tremor characteristics, associated clinical signs and radiological findings were studied.<h4>Results</h4>Eleven patients had a myorythmic rest tremor, large amplitude proximal tremor with goal-directed worsening, with or without mild distal dystonic posturing, representing HT-m. Six patients had slow, large amplitude proximal tremors and distal choreathetoid movements, significant proximal/distal dystonic posturing, associated with proprioceptive sensory loss, representing HT-t. Haemorrhagic lesions were the predominant cause of HT-m; whereas, ischaemia was more commonly associated with HT-t.<h4>Conclusion</h4>When assessing patients with HT, attentiveness to the presence of associated signs in the affected limb, such as a proprioceptive sensory deficits and additional movement disorders, can aid lesion localisation, which can have implications for management.

Item Type:	Article
Uncontrolled Keywords:	Holmes&apos, Tremor, Thalamic tremor, Stroke
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Clinical Directorate Faculty of Health and Life Sciences > Faculty Management Office
Depositing User:	Symplectic Admin
Date Deposited:	18 May 2021 09:09
Last Modified:	18 Jan 2023 22:46
DOI:	10.1007/s00415-021-10491-z
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3123146