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Holmes tremor: an updated review
Efstratios-Stylianos Pyrgelis1, Eleni Agapiou2, Efthalia Angelopoulou3
11st Department of Neurology, "Eginition" Hospital, School of medicine, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave, 11528, Athens, Greece. stratospyrg@yahoo.gr.
Insights
Holmes tremor is a rare movement disorder affecting the brain. Diagnosis relies on imaging like MRI, and new research may improve its challenging treatment.
Area of Science:
- Neurology
- Movement Disorders
Background:
- Holmes tremor is a rare, high-amplitude, low-frequency movement disorder.
- It involves rest, intention, and postural tremor components.
- Pathophysiology links to dopaminergic nigrostriatal and cerebellothalamocortical pathways.
Purpose of the Study:
- To review the characteristics, diagnosis, and management of Holmes tremor.
- To highlight the role of neuroimaging and functional studies.
- To discuss the challenges and future directions in treating this condition.
Main Methods:
- Clinical examination findings.
- Neurophysiological assessments.
- Neuroimaging studies including MRI and dopamine transporter imaging (123I-FP CIT).
Main Results:
- MRI is crucial for lesion localization and etiology identification.
- Dopamine transporter imaging assesses nigrostriatal pathway integrity.
- Etiologies include cerebrovascular events, tumors, demyelination, and infections.
Conclusions:
- Holmes tremor diagnosis integrates clinical, neurophysiological, and imaging data.
- Despite available treatments, management remains challenging.
- Advancements in understanding neural circuits, genetics, and molecular aspects promise improved clinical evaluation and management.
Abstract:
Holmes tremor is a rare movement disorder with rest, intention and postural components, characterized by high amplitude and low frequency. It occurs mainly as a result of impairment of dopaminergic nigrostriatal system and cerebellothalamocortical or dentato-rubro-olivary pathways. The aetiologies of this tremor vary widely, including cerebrovascular events, tumours, demyelination and infections. Diagnosis is based on clinical examination, neurophysiological and neuroimaging studies. Magnetic resonance imaging (MRI) scan of the brain is the gold standard method for revealing the location and potential cause of the lesion, whereas dopamine transporter single photon emission with the use of 123I-FP CIT is useful in assessing the functional integrity of the nigrostriatal pathway. Although various treatment options are available, including pharmacological agents, deep brain stimulation and regional surgical techniques, its treatment remains challenging. Our deeper understanding of the disruption of associated neural brain circuits combined with recent genetic and molecular evidence will drastically improve its clinical evaluation and management.
