Postischemic delayed Holmes' tremor responding to low-dose cabergoline

Akkuş, Dilek; Diramali, Azize Banu

doi:10.1002/mds.20862

Cited by 17 publications

(13 citation statements)

References 5 publications

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“…As previously reported,4 5 dopaminergic treatment seems to be beneficial in the treatment of Holmes’ tremor. Our patient responded to a combination of 2.8 mg pramipexole and 600 mg L-DOPA daily with a marked decrease in the resting, postural and intentional tremor component (fig 1F).…”

Section: Discussionsupporting

confidence: 67%

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Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes' tremor

Seidel

Kasprian

Leutmezer

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

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Holmes' tremor is an unusual combination of rest, postural and kinetic tremor of the extremities. Medical treatment of this condition still remains unsatisfactory. The case of a 20-year-old female patient is reported who developed right-sided Holmes' tremor 9 months after a left-sided, cavernoma induced midbrain/pontine haemorrhage at the age of 16 years. Beta-CIT single photon emission computed tomography revealed abolished dopamine transporter activity in the left basal ganglia and striatum, in accordance with missing ipsilateral tegmento-frontal connectivity (medial forebrain bundle), demonstrated by diffusion tensor MRI. Tractography showed reduced fibre connectivity of the superior and middle cerebellar peduncles on the lesioned side. Administration of pramipexole and L-DOPA led to a clinically significant reduction in tremor severity. In conclusion, our results support the notion that Holmes' tremor was a result of diminished striatal dopaminergic input in our patient.

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Section: Discussionsupporting

confidence: 67%

“…Post-ischaemic Holmes’ tremor was almost completely abolished by cabergoline in a single patient 5. Unfortunately, no SPECT data were provided.…”

Section: Discussionmentioning

confidence: 95%

Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes' tremor

Seidel

Kasprian

Leutmezer

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

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“…It has been noted that the therapeutic response to levodopa varies in other case reports. Some cases showed relief with single or combined use of drugs such as propranolol, valproate, clonazepam, levodopa, cabergoline, and/or anticholinergics [7,9], and one case has a spontaneous resolution of tremor [3]. Surgical intervention may be considered if all medical treatments fail.…”

Section: Discussionmentioning

confidence: 97%

99mTc-TRODAT-1 SPECT study in evaluation of Holmes tremor after thalamic hemorrhage

2009

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Holmes tremor is also known as rubral or midbrain tremor. The tremor usually involves lesions near the red nucleus and the nerve fiber tracts originating in the cerebellum and the substantia nigra. We report a case of a 62-year-old woman who presented with Holmes tremor 5 months after a left thalamic hemorrhage, with a partial recovery 3 years later. Sequential technetium-(99m)TRODAT-1 single-photon emission computed tomography (SPECT) of the patient's brain revealed partially improved tracer uptake reduction in the striatums, particularly on the left side. We propose that involvement of both the nigrostriatal and the dentate-rubro-thalamic pathways are essential in the pathogenesis of Holmes tremor after a thalamic lesion, and regeneration of the nigrostriatal system is possible in this type of tremor after the initial degeneration. The (99m)Tc-TRODAT-1 SPECT study is a useful and convenient tool for evaluating the nigrostriatal dopamine function in patients with Holmes tremor.

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“…Holmes tremor may respond to levodopa, trihexyphenidyl, clonazepam, cabergoline, levetiracetam, bromocriptine, and piribedil, as well as zonisamide, 2,5,12,53,[59][60][61]63 but pharmacotherapy is often unsatisfactory. The success of thalamotomy and chronic thalamic stimulation in essential tremor and parkinsonian tremor led to their application in HT 6,52 and other uncommon tremors.…”

Section: Prior Surgical Approaches To Htmentioning

confidence: 99%

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

Kilbane

Ramirez‐Zamora

Ryapolova-Webb

et al. 2015

JNS

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OBJECT Holmes tremor (HT) is characterized by irregular, low-frequency (< 4.5 Hz) tremor occurring at rest, with posture, and with certain actions, often affecting proximal muscles. Previous reports have tended to highlight the use of thalamic deep brain stimulation (DBS) in cases of medication-refractory HT. In this study, the authors report the clinical outcome and analysis of single-unit recordings in patients with medication-refractory HT treated with globus pallidus internus (GPi) DBS. METHODS The authors retrospectively reviewed the medical charts of 4 patients treated with pallidal DBS for medication-refractory HT at the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center. Clinical outcomes were measured at baseline and after surgery using an abbreviated motor-severity Fahn-Tolosa-Marin (FTM) tremor rating scale. Intraoperative microelectrode recordings were performed with patients in the awake state. The neurophysiological characteristics identified in HT were then also compared with characteristics previously described in Parkinson's disease (PD) studied at the authors' institution. RESULTS The mean percentage improvement in tremor motor severity was 78.87% (range 59.9%–94.4%) as measured using the FTM tremor rating scale, with an average length of follow-up of 33.75 months (range 18–52 months). Twenty-eight GPi neurons were recorded intraoperatively in the resting state and 13 of these were also recorded during contralateral voluntary arm movement. The mean firing rate at rest in HT was 56.2 ± 28.5 Hz, and 63.5 ± 19.4 Hz with action, much lower than the GPi recordings in PD. GPi unit oscillations of 2–8 Hz were prominent in both patients with HT and those with PD, but in HT, unlike PD, these oscillations were not suppressed by voluntary movement. CONCLUSIONS The efficacy of GPi DBS exceeded that reported in prior studies of ventrolateral thalamus DBS and suggest GPi may be a better target for treating HT. These clinical and neurophysiological findings help illuminate evolving models of HT and highlight the importance of cerebellar–basal ganglia interactions.

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Postischemic delayed Holmes' tremor responding to low-dose cabergoline

Cited by 17 publications

References 5 publications

Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes' tremor

Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes' tremor

99mTc-TRODAT-1 SPECT study in evaluation of Holmes tremor after thalamic hemorrhage

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

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