Peduncular 'Rubral' Tremor and Dopaminergic Denervation

Rémy, Philippe; Recondo, A. De; Defer, Gilles; Loc’h, Christian; Amarenco, Pierre; Planté‐Bordeneuve, Violaine; Dao-Castellana, M H; Bendriem, B.; Crouzel, C.; Clanet, M.; Rondot, Pierre; Samson, Yves

doi:10.1212/wnl.45.3.472

Cited by 155 publications

(112 citation statements)

References 16 publications

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“…Clinical and PET studies have also demonstrated that postural and resting tremors occur when the nigrostriatal system is involved. 34 These observations support the notion that the mechanisms of HT differ from those invoked to explain essential tremor. Since different pathophysiological mechanisms appear to underlie these tremors, it follows that different treatment strategies may be needed.…”

Section: Target Of Stimulation For Htsupporting

confidence: 65%

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

Kobayashi¹,

Katayama²,

Oshima³

et al. 2014

JNS

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Object Holmes' tremor (HT) is generally considered to be a symptomatic tremor associated with lesions of the cerebellum, midbrain, or thalamus. Deep brain stimulation (DBS) therapy for essential tremor and parkinsonian tremor has proved quite successful. In contrast, surgical treatment outcomes for HT have often been disappointing. The use of 2 ipsilateral DBS electrodes implanted in parallel within the thalamus for severe essential tremor has been reported. Since dual-lead stimulation within a single target can cover a wider area than single-lead stimulation, it produces greater effects. On the other hand, DBS of the subthalamic area (SA) was recently reported to be effective for refractory tremor. Methods The authors implanted 2 DBS electrodes (one at the nucleus ventralis oralis/nucleus ventralis intermedius and the other at the SA) in 4 patients with HT. For more than 2 years after implantation, each patient's tremor was evaluated using a tremor rating scale under the following 4 conditions of stimulation: “on” for both thalamus and SA DBS; “off” for both thalamus and SA DBS; “on” for thalamus and “off” for SA DBS; and “on” for SA and “off” for thalamus DBS. Results The tremor in all patients was improved for more than 2 years (mean 25.8 ± 3.5 months). Stimulation with 2 electrodes exerted greater effect on the tremor than did 1-electrode stimulation. Interestingly, in all patients progressive effects were observed, and in one patient treated with DBS for 1 year, tremor did not appear even while stimulation was temporarily switched off, suggesting irreversible improvement effects. The presence of both resting and intentional/action tremor implies combined destruction of the pallidothalamic and cerebellothalamic pathways in HT. A larger stimulation area may thus be required for HT patients. Multitarget, dual-lead stimulation permits coverage of the wide area needed to suppress the tremor without adverse effects of stimulation. Some reorganization of the neural network may be involved in the development of HT because the tremor appears several months after the primary insult. The mechanism underlying the absence of tremor while stimulation was temporarily off remains unclear, but the DBS may have normalized the abnormal neural network. Conclusions The authors successfully treated patients with severe HT by using dual-electrode DBS over a long period. Such DBS may offer an effective and safe treatment modality for intractable HT.

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Section: Target Of Stimulation For Htsupporting

confidence: 65%

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

Kobayashi¹,

Katayama²,

Oshima³

et al. 2014

JNS

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“…The lesions causing Holmes tremor are frequently located in the area of the substantia nigra and nigrostriatal fibers, suggesting dopaminergic denervation as possibly contributory 11 . In six patients with a contralateral tremor following a peduncular lesion was found a marked decrease of [18F]-fluorodopa uptake in the striatum ipsilateral to the lesion without significant changes in the D2-specific binding 11 . These results indicate an important involvement of the nigral dopaminergic system in peduncular tremors that appears to be independent of postsynaptic dopamine receptors.…”

Section: Discussionmentioning

confidence: 99%

Holmes tremor in association with bilateral hypertrophic olivary degeneration and palatal tremor: chronological considerations. Case report

Rieder

Rebouças

Ferreira

2003

Arq. Neuro-Psiquiatr.

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-Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubro-olivary pathway and presents clinically as palatal tremor. We present a 48 year old male patient who developed Holmes' tremor and bilateral HOD five months after brainstem hemorrhage. The severe rest tremor was refractory to pharmacotherapy and botulinum toxin injections, but was markedly reduced after thalamotomy. Magnetic resonance imaging permitted visualization of HOD, which appeared as a characteristic high signal intensity in the inferior olivary nuclei on T2-and proton-density-weighted images. Enlargement of the inferior olivary nuclei was also noted. Palatal tremor was absent in that moment and appears about two months later. The delayed-onset between insult and tremor following structural lesions of the brain suggest that compensatory or secondary changes in nervous system function must contribute to tremor genesis. The literature and imaging findings of this uncommon condition are reviewed.KEY WORDS: rubral tremor, midbrain tremor, Holmes' tremor, myorhythmia, palatal myoclonus. T T T T Tremor de Holmes em associação com degeneração olivar hipertrófica bilateral e tremor palatal: remor de Holmes em associação com degeneração olivar hipertrófica bilateral e tremor palatal: remor de Holmes em associação com degeneração olivar hipertrófica bilateral e tremor palatal: remor de Holmes em associação com degeneração olivar hipertrófica bilateral e tremor palatal: remor de Holmes em associação com degeneração olivar hipertrófica bilateral e tremor palatal: considerações cronológicas. Relato de caso considerações cronológicas. Relato de caso considerações cronológicas. Relato de caso considerações cronológicas. Relato de caso considerações cronológicas. Relato de caso RESUMO -Degeneração olivar hipertrófica (DOH) é um tipo raro de degeneração neuronal envolvendo o trato dento-rubro-olivar e se apresenta clinicamente como tremor palatal. Relatamos o caso de um homem de 48 anos que desenvolveu tremor de Holmes e DOH bilateral cinco meses após hemorragia em tronco encefálico. O intenso tremor de repouso foi refratário a farmacoterapia e injeções de toxina botulínica, mas foi enormemente reduzido após talamotomia. Ressonância magnética permitiu a visualização da DOH, que apareceu como um sinal intenso característico na oliva inferior em imagens ponderadas em T2 e densidade de prótons. Aumento do complexo olivar inferior também foi percebido. O tremor palatal era ausente naquele momento e apareceu cerca de dois meses depois. O início tardio do tremor após a lesão estrutural sugere que alterações compensatórias ou secundárias no sistema nervoso devem contribuir para a gênese do tremor. A literatura e os achados radiológicos dessa patologia incomum são revisados. PALAVRAS-CHAVE: tremor rubral, tremor mesencefálico, tremor de Holmes, miorritmia, mioclonus palatal.

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“…Medical treatment of Holmes tremor has thus far met with limited success in individual cases in which levodopa, anticholinergic agents, propanolol, clonazepam, and glutethimide were used 14,17,25,[29][30][31][32] and did not lead to satisfactory clinical benefits in the cases in the present study. In selected cases DBS and thermocoagulation may offer an alternative therapeutic strategy.…”

Section: Discussionmentioning

confidence: 60%

“…It is generally agreed that lesions of these pathways account for the tremor exacerbation during posture and kinetic action. 11,18,32 The resting tremor might have been caused by additional damage to the nigrostriatal pathway, 25,32 which was also involved in the two patients we studied.…”

Section: Discussionmentioning

confidence: 94%

Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions

Nikkhah¹,

Prokop²,

Hellwig³

et al. 2004

FOC

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Peduncular 'Rubral' Tremor and Dopaminergic Denervation

Cited by 155 publications

References 16 publications

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

Holmes tremor in association with bilateral hypertrophic olivary degeneration and palatal tremor: chronological considerations. Case report

Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions

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