Holmes’s Tremor
Holmes’s Tremor
Holmes’s tremor, also known as rubral tremor, or midbrain tremor, has been defined as a rest and intention tremor, of frequency < 4.5 Hz. The rest tremor may resemble parkinsonian tremor, and is exacerbated by sustained postures and voluntary movements. Hence there are features of rest, postural and kinetic (intention) tremor. Once attributed to lesions of the red nucleus (hence "rubral"), the anatomical substrate is now thought to be interruption of fibers of the superior cerebellar peduncle (hence "midbrain") carrying cerebellothalamic and/or cerebello-olivary projections; lesions of the ipsilateral cerebellar dentate nucleus may produce a similar clinical picture. Recognized causes include multiple sclerosis, head injury and stroke. If a causative lesion is defined, there is typically a delay before tremor appearance (4 weeks to 2 years).
References
Alusi SH, Worthington J, Glickman S, Bain PG. A study of tremor in multiple sclerosis. Brain 2001; 124: 720-730
Deuschl G, Bain P, Brin M and an Ad Hoc Scientific Committee. Consensus statement of the Movement Disorder Society on tremor. Movement Disorders 1998; 13(suppl3): 2-23
Cross References
