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Chapter 39 - Primary and Secondary Tremors

from Section 3: - Hyperkinetic Movement Disorders

Published online by Cambridge University Press:  07 January 2025

By
Fabian Büchele
Edited by
Erik Ch. Wolters  and
Christian R. Baumann
Erik Ch. Wolters
Affiliation:
Universität Zürich
Christian R. Baumann
Affiliation:
Universität Zürich
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Summary

Tremor is clinically defined by an involuntary rhythmic oscillatory movement of a body part. The most recent 2-axis classification scheme describes a clinical tremor syndrome in axis 1, mainly relying on tremor characteristics (body distribution, activation condition, tremor frequency, regularity, amplitude) and associated signs (isolated versus combined tremor syndromes). Based on further diagnostic tests (blood analysis, imaging, neurophysiology, genetic testing) the etiology is then described in axis 2, which may be acquired, genetic or idiopathic. The most common axis 1 isolated tremor syndromes are essential tremor and enhanced physiologic tremor, characterized by bilateral action tremor of the arms. Combined tremor syndromes relate to the accompanying neurologic sign or are described phenomenologically. These tremor syndromes relate to hyperoscillatory states of distinct networks, with the so-called cerebellar network playing a central role. Depending on the degree of disturbance as well as the additional involvement of other networks, specific tremor phenotypes emerge.

Keywords

Primary tremorssecondary tremorstremor classificationessential tremoressential tremor plusParkinson tremordystonic tremorenhanced physiologic tremor
Type
Chapter
Information
International Compendium of Movement Disorders , pp. 476 - 498
Publisher: Cambridge University Press
Print publication year: 2025

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References

Louis, ED, Ferreira, JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord 2010;25:534–541.CrossRefGoogle Scholar
Hopfner, F, Höglinger, GU, Kuhlenbäumer, G, et al. β-adrenoreceptors and the risk of Parkinson’s disease. Lancet Neurol 2020;19:247–254.CrossRefGoogle ScholarPubMed
Bhatia, KP, Bain, P, Bajaj, N, et al. Consensus statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord 2018;33:75–87.CrossRefGoogle ScholarPubMed
Albanese, A, Giovanni, MD, Lalli, S. Dystonia: diagnosis and management. Eur J Neurol 2019;26:5–17.CrossRefGoogle ScholarPubMed
Hopfner, F, Helmich, RC. The etiology of essential tremor: genes versus environment. Parkinsonism Relat Disord 2018;46:S92–S96.CrossRefGoogle ScholarPubMed
Louis, ED. Essential tremors: a family of neurodegenerative disorders? Arch Neurol 2009;66:1202–1208.CrossRefGoogle ScholarPubMed
Hopfner, F, Deuschl, G. Is essential tremor a single entity? Eur J Neurol 2018;25:71–82.CrossRefGoogle ScholarPubMed
Frucht, SJ, Riboldi, GM. Alcohol-responsive hyperkinetic movement disorders – a mechanistic hypothesis. Tremor Hyperkinetic Mov (NY) 2020;10:47.CrossRefGoogle ScholarPubMed
Kosmowska, B, Wardas, J. The pathophysiology and treatment of essential tremor: the role of adenosine and dopamine receptors in animal models. Biomolecules 2021;11:1813.CrossRefGoogle ScholarPubMed
Dallapiazza, RF, Lee, DJ, Vloo, PD, et al. Outcomes from stereotactic surgery for essential tremor. J Neurol Neurosurg Psychiatry 2019;90:474–482.CrossRefGoogle ScholarPubMed
Deuschl, G, Becktepe, JS, Dirkx, M, et al. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022;136:93–129.CrossRefGoogle ScholarPubMed
Artusi, CA, Farooqi, A, Romagnolo, A, et al. Deep brain stimulation in uncommon tremor disorders: indications, targets, and programming. J Neurol 2018;265:2473–2493.CrossRefGoogle ScholarPubMed
Cury, RG, Fraix, V, Castrioto, A, et al. Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia. Neurology 2017;89:1416–1423.CrossRefGoogle ScholarPubMed
Helmich, RC, Toni, I, Deuschl, G, Bloem, BR. The pathophysiology of essential tremor and Parkinson’s tremor. Curr Neurol Neurosci Rep 2013;13:378.CrossRefGoogle ScholarPubMed
Kirke, DN, Battistella, G, Kumar, V, et al. Neural correlates of dystonic tremor: a multimodal study of voice tremor in spasmodic dysphonia. Brain Imaging Behav 2017;11:166–175.CrossRefGoogle ScholarPubMed
Hedera, P, Phibbs, FT, Dolhun, R, et al. Surgical targets for dystonic tremor: considerations between the globus pallidus and ventral intermediate thalamic nucleus. Parkinsonism Relat Disord 2013;19:684–686.CrossRefGoogle ScholarPubMed
Whitney, D, Bhatti, D, Torres-Russotto, D. Orthostatic tremor: pathophysiology guiding treatment. Curr Treat Options Neurol 2018;20:35.CrossRefGoogle ScholarPubMed
Panyakaew, P, Jinnah, HA, Shaikh, AG. Clinical features, pathophysiology, treatment, and controversies of tremor in dystonia. J Neurol Sci 2022;435:120199.CrossRefGoogle ScholarPubMed
van de Wardt, J, van der Stouwe, AMM, Dirkx, M, et al. Systematic clinical approach for diagnosing upper limb tremor. J Neurol Neurosurg Psychiatry 2020;91:822–830.CrossRefGoogle ScholarPubMed
Hopfner, F, Ahlf, A, Lorenz, D, et al. Early- and late-onset essential tremor patients represent clinically distinct subgroups. Mov Disord 2016;31:1560–1566.CrossRefGoogle ScholarPubMed
Lee, A, Sarva, H. Approach to tremor disorders. Semin Neurol 2021;41:731–743.Google ScholarPubMed
Hopfner, F, Erhart, T, Knudsen, K, et al. Testing for alcohol sensitivity of tremor amplitude in a large cohort with essential tremor. Parkinsonism Relat Disord 2015;21:848–851.CrossRefGoogle Scholar
Papengut, F, Raethjen, J, Binder, A, Deuschl, G. Rest tremor suppression may separate essential from parkinsonian rest tremor. Parkinsonism Relat Disord 2013; 19:693–697.CrossRefGoogle ScholarPubMed
Helmich, RC. The cerebral basis of parkinsonian tremor: a network perspective. Mov Disord 2018;33:219–231.CrossRefGoogle ScholarPubMed
Elble, R, Bain, P, Forjaz, MJ, et al. Task force report: scales for screening and evaluating tremor: critique and recommendations. Mov Disord 2013;28:1793–1800.CrossRefGoogle ScholarPubMed
Louis, ED, Bares, M, Benito-Leon, J, et al. Essential tremor-plus: a controversial new concept. Lancet Neurol 2020;19:266–270.CrossRefGoogle ScholarPubMed
Panyakaew, P, Cho, HJ, Lee, SW, Wu, T, Hallett, M. The pathophysiology of dystonic tremors and comparison with essential tremor. J Neurosci 2020;40:9317–9326.CrossRefGoogle ScholarPubMed
Balachandar, A, Fasano, A. Characterizing orthostatic tremor using a smartphone application. Tremor Hyperkinetic Mov NY 2017;7:488.CrossRefGoogle ScholarPubMed
Deuschl, G, Bain, P, Brin, M. Consensus statement of the Movement Disorder Society on tremor. Mov Disord 1998;13:2–23.CrossRefGoogle ScholarPubMed
Fearon, C, Espay, AJ, Lang, AE, et al. Soft signs in movement disorders: friends or foes? J Neurol Neurosurg Psychiatry 2019;90:961–962.CrossRefGoogle ScholarPubMed
Rajalingam, R, Breen, DP, Lang, AE, Fasano, A. Essential tremor plus is more common than essential tremor: insights from the reclassification of a cohort of patients with lower limb tremor. Parkinsonism Relat Disord 2018;56:109–110.CrossRefGoogle ScholarPubMed
Louis, ED. Twelve clinical pearls to help distinguish essential tremor from other tremors. Expert Rev Neurother 2014;14:1057–1065.CrossRefGoogle ScholarPubMed
Louis, ED. Essential tremor: a nuanced approach to the clinical features. Pract Neurol 2019;19:389–398.CrossRefGoogle ScholarPubMed
Deuschl, G, Petersen, I, Lorenz, D, Christensen, K. Tremor in the elderly: essential and aging-related tremor. Mov Disord 2015;30:1327–1334.CrossRefGoogle ScholarPubMed
Köllensperger, M, Geser, F, Seppi, K, et al. Red flags for multiple system atrophy. Mov Disord 2008;23:1093–1099.CrossRefGoogle ScholarPubMed
Morgan, JC, Sethi, KD. Drug-induced tremors. Lancet Neurol 2005;4:866–876.CrossRefGoogle ScholarPubMed
Kern, DS, Lang, AE. Successful treatment of functional palatal tremor: insights into pathogenesis and management. Mov Disord 2015;30:875–876.CrossRefGoogle Scholar
Becktepe, JS, Goevert, F, Deuschl, G. Seltene Tremorsyndrome. Nervenarzt 2018;89:386–393.CrossRefGoogle Scholar
Helmich, RC, Hallett, M, Deuschl, G, Toni, I, Bloem, BR. Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits? Brain 2012;135:3206–3226.CrossRefGoogle ScholarPubMed
Kulkarni, O, LaFaver, K, Tarsy, D. The “floating door sign” in Parkinson’s disease. Parkinsonism Relat Disord 2013;19:825–826.CrossRefGoogle Scholar
Agnew, A, Frucht, SJ, Louis, ED. Supine head tremor: a clinical comparison of essential tremor and spasmodic torticollis patients. J Neurol Neurosurg Psychiatry 2012;83:179–181.CrossRefGoogle ScholarPubMed
Lenka, A, Louis, ED. Revisiting the clinical phenomenology of “cerebellar tremor”: beyond the intention tremor. Cerebellum 2019;18:565–574.CrossRefGoogle ScholarPubMed
Louis, ED, Kerridge, CA, Chatterjee, D, et al. Contextualizing the pathology in the essential tremor cerebellar cortex: a patholog-omics approach. Acta Neuropathol 2019;138:859–876.CrossRefGoogle ScholarPubMed
Rao, A.K., Louis, E.D., Ataxic Gait in Essential Tremor: A Disease-Associated Feature?, Tremor Hyperkinetic Mov. 9 (2019).Google ScholarPubMed
Máñez-Miró, JU, Martínez-Fernández, R, del Alamo, M, et al. Focused ultrasound thalamotomy for multiple sclerosis–associated tremor. Mult Scler 2020;26:855–858.CrossRefGoogle ScholarPubMed
Merchant, SH, Kuo, S-H, Qiping, Y, et al. Objective predictors of ‘early tolerance’ to ventral intermediate nucleus of thalamus deep brain stimulation in essential tremor patients. Clin Neurophysiol 2018;129:1628–1633.CrossRefGoogle ScholarPubMed
Raina, GB, Cersosimo, MG, Folgar, SS, et al. Holmes tremor. Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016;86:931–938.CrossRefGoogle Scholar
Baizabal‐Carvallo, JF, Cardoso, F, Jankovic, J. Myorhythmia: phenomenology, etiology, and treatment. Mov Disord 2015;30:171–179.CrossRefGoogle ScholarPubMed
Růžička, E, Jech, R, Zárubová, K, Roth, J, Urgošík, D. VIM thalamic stimulation for tremor in a patient with IgM paraproteinaemic demyelinating neuropathy. Mov Disord 2003;18:1192–1195.CrossRefGoogle Scholar
Schwingenschuh, P, Espay, AJ. Functional tremor. J Neurol Sci 2022;435:120208.CrossRefGoogle ScholarPubMed
Rajput, A. Tremor on neurological disease. In: Wolters, ECh, Baumann, CR, eds. Parkinson Disease and Other Movement Disorders. Motor Behavioural Disorders and Behavioural Motor Disorders. Amsterdam: VU University Press; 2014: 679–500.Google Scholar

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