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Mapping holmes tremor circuit using the human brain connectome.

Juho Joutsa1,2,3, Ludy C Shih3,4,5, Michael D Fox3,5,6

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Holmes tremor, a movement disorder, arises from a connected brain circuit. Targeting this circuit, including the globus pallidus, may offer improved therapeutic options for patients.

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Area of Science:

  • Neuroscience
  • Movement Disorders
  • Neurosurgery

Background:

  • Holmes tremor is a movement disorder with unclear neuroanatomical origins and limited treatment options.
  • Lesions causing Holmes tremor can manifest in various brain locations.
  • Identifying a consistent brain circuit is crucial for understanding and treating the disorder.

Observation:

  • A systematic review identified 36 lesions associated with Holmes tremor across diverse brain regions.
  • Resting-state functional connectivity MRI data from 1,000 healthy volunteers revealed a common circuit connecting these lesion sites.
  • Key nodes within this circuit include the red nucleus, thalamus, globus pallidus, and cerebellum.

Findings:

  • All identified lesion locations connected to a single, coherent brain circuit.
  • Effective neurosurgical treatments targeted areas within this identified Holmes tremor circuit.
  • Established deep brain stimulation targets like the ventral intermediate nucleus and subthalamic nucleus were outside this circuit, unlike the globus pallidus.

Implications:

  • The identified connected brain circuit provides a refined neuroanatomical substrate for Holmes tremor.
  • This circuit represents a potential therapeutic target for developing improved treatment strategies.
  • Understanding this circuit may guide future neurosurgical interventions for Holmes tremor.