Tremor management strategies in Parkinson's disease: optimizing patient care

Along with bradykinesia and rigidity, tremor is one of the cardinal motor symptoms of Parkinson's disease (PD), often the first symptom to be noticed by the patient and their relatives. While bradykinesia and rigidity usually respond to dopaminergic therapies, tremor is often refractory to these medications and can cause significant disability in many patients. This variability of response appears to be related to different mechanisms/neurochemical abnormalities underlying the occurrence of tremor in PD patients.Here, we will discuss types of tremors in PD, the current understanding of the neurochemistry underlying Parkinsonian tremor, as possible targets for treatment, and the role of imaging and wearable devices to improve tremor management in these patients. We will summarize pharmacological strategies and more complex approaches, such as Deep Brain Stimulation and Magnetic Resonance guided Focussed Ultrasound, currently used in the management of PD patients with tremor. The role of non-pharmacological strategies will also be appraised.