Disappearance of essential tremor after frontal cortical infarct

Abstract

We present a patient with essential tremor who spontaneously improved after a sensorimotor stroke related to a small cortical infarct near by the left precentral region of the brain. This finding supports the presence of cortical or transcortical motor loops that are likely involved in essential tremor and suggests a possible link with the cerebellar-thalamic-cortical pathway.

Bilateral stimulation of the caudal zona incerta nucleus for tremor control

“…The transmission of oscillations along both pathways is supported by clinical, imaging74 – 78 and electrophysiology data 79. These oscillations probably result from excessive electrotonic coupling between dendrites of the IO neurons via GABA-mediated gap junctions 80 – 82…”

Disappearance of essential tremor after stroke

“…Kim JS et al5 reported a case with familial ET, where the patient suffered from a right hand sensory‐motor deficit resulting from a small frontal precentral stroke demonstrated by an MRI. The right‐hand tremor totally disappeared after the stroke, although there prevailed a mild weakness and sensory deficit.…”

Marked reduction of tremor in essential tremor after putaminal infarct

“…Neurophysiological studies suggest the involvement of a central oscillator within the olivocerebellothalamocortical circuit 3. In line with this, vascular lesions of the cerebellum, pons, thalamus, corona radiata and frontal cortex have been reported to result in unilateral resolution of tremor 4. To date, the commonest target for control of tremor using stereotactic lesions or deep brain stimulation (DBS) surgery is the thalamic ventral intermediate (Vim) nucleus (the cerebellar-receiving area of the thalamus) 5.…”