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Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases
Gabriela B Raina1, Maria G Cersosimo1, Silvia S Folgar1
1From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
Insights
Vascular lesions, particularly in the thalamus or midbrain, are the most common cause of Holmes tremor (HT). Levodopa and thalamic surgery show promise in treating this neurological condition.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Holmes tremor (HT) is a rare movement disorder characterized by a combination of resting, intention, and postural tremor.
- Understanding the etiology, clinical presentation, and treatment outcomes of HT is crucial for effective patient management.
Purpose of the Study:
- To delineate the clinical characteristics, underlying causes, neuroimaging findings, and treatment efficacy in a cohort of 29 patients diagnosed with Holmes tremor.
Main Methods:
- A retrospective analysis was conducted, reviewing medical records and video data of patients with a confirmed diagnosis of Holmes tremor.
- Data collected included patient demographics, lesion etiology, latency to tremor onset, associated neurological signs, and treatment responses.
Main Results:
- Vascular lesions (ischemic or hemorrhagic) were the predominant cause (48.3%) of HT, followed by traumatic brain injury (17.24%).
- Commonly associated symptoms included hemiparesis (62%), ataxia (51.7%), and hypoesthesia (27.58%).
- Neuroimaging revealed lesions in the thalamus, midbrain, or cerebellum in 82.7% of patients. Levodopa was effective in 54.16% of treated patients, and thalamotomy yielded excellent results in 3 patients.
Conclusions:
- Vascular insults affecting the mesencephalon and/or thalamus are the primary drivers of Holmes tremor.
- Pharmacological treatment with levodopa and surgical intervention via unilateral thalamotomy appear to be effective therapeutic strategies for HT.
Objective:
To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT).
Methods:
A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis.
Results:
A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results.
Conclusions:
The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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