Tremor pathophysiology: lessons from neuroimaging

A. M. Madelein van der Stouwe, Freek Nieuwhof, Rick C. Helmich*

*Bijbehorende auteur voor dit werk

    OnderzoeksoutputAcademicpeer review

    29 Citaten (Scopus)
    142 Downloads (Pure)


    PURPOSE OF REVIEW: We discuss the latest neuroimaging studies investigating the pathophysiology of Parkinson's tremor, essential tremor, dystonic tremor and Holmes tremor. RECENT FINDINGS: Parkinson's tremor is associated with increased activity in the cerebello-thalamo-cortical circuit, with interindividual differences depending on the clinical dopamine response of the tremor. Although dopamine-resistant Parkinson's tremor arises from a larger contribution of the (dopamine-insensitive) cerebellum, dopamine-responsive tremor may be explained by thalamic dopamine depletion. In essential tremor, deep brain stimulation normalizes cerebellar overactivity, which fits with the cerebellar oscillator hypothesis. On the other hand, disconnection of the dentate nucleus and abnormal white matter microstructural integrity support a decoupling of the cerebellum in essential tremor. In dystonic tremor, there is evidence for involvement of both cerebellum and basal ganglia, although this may depend on the clinical phenotype. Finally, in Holmes tremor, different causal lesions map to a common network consisting of the red nucleus, internal globus pallidus, thalamus, cerebellum and pontomedullary junction. SUMMARY: The pathophysiology of all investigated tremors involves the cerebello-thalamo-cortical pathway, and clinical and pathophysiological features overlap among tremor disorders. We draw the outlines of a hypothetical pathophysiological axis, which may be used besides clinical features and cause in future tremor classifications.

    Originele taal-2English
    Pagina's (van-tot)474-481
    Aantal pagina's8
    TijdschriftCurrent opinion in neurology
    Nummer van het tijdschrift4
    StatusPublished - 1-aug-2020

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