Revisiting the Clinical Phenomenology of “Cerebellar Tremor”: Beyond the Intention Tremor

Lenka, Abhishek; Louis, Elan D.

doi:10.1007/s12311-018-0994-6

Cited by 16 publications

(18 citation statements)

References 108 publications

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“…Notably, this kinetic tremor "was less prominent" in most of his cases with local lesions of the cerebellum than in patients with "the primary atrophies (Table 1) (2)." In other words, this type of tremor is prominent in degenerative cerebellar ataxia (CA), suggesting that its developments might be dependent on cerebellar residual functions.…”

Section: Kinetic Tremor In Holmes' Classic Studymentioning

confidence: 95%

“…This classification of cerebellar tremor by Holmes appears to be used until the 1970s. However, distinction of these two types of tremors are getting rarer in recent textbooks and review articles (2).…”

Section: After Holmesmentioning

confidence: 99%

“…Cerebellar tremors include diverse phenotypes ( 2 ). However, Louis ( 3 ) pointed out that, nowadays, “cerebellar tremor is equated exclusively with intention tremor” in an “oversimplified manner” ( 4 ).…”

Section: Section I Phenomenology Of Cerebellar Tremorsmentioning

confidence: 99%

“…However, Louis ( 3 ) pointed out that, nowadays, “cerebellar tremor is equated exclusively with intention tremor” in an “oversimplified manner” ( 4 ). Besides, pathomechanisms underlying essential tremor (ET) have been a focus of debate ( 2 ), and thereby roles of IO have likely been overstressed in tremor pathogenesis ( 5 ). Due to such a simplification, seminal works by Gordon Holmes appear to be underestimated.…”

Section: Section I Phenomenology Of Cerebellar Tremorsmentioning

confidence: 99%

“…For example, he described that “at the moment when a hand grasps the glass: when the first clumsy movement is over there may be a few oscillations of pronation and supination occurs, but the patient can grasp the glass without jerking.” This classification of cerebellar tremor by Holmes appears to be used until the 1970s. However, distinction of these two types of tremors are getting rarer in recent textbooks and review articles ( 2 ).…”

Section: Section I Phenomenology Of Cerebellar Tremorsmentioning

confidence: 99%

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Pathophysiology of Cerebellar Tremor: The Forward Model-Related Tremor and the Inferior Olive Oscillation-Related Tremor

et al. 2021

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Lesions in the Guillain–Mollaret (G–M) triangle frequently cause various types of tremors or tremor-like movements. Nevertheless, we know relatively little about their generation mechanisms. The deep cerebellar nuclei (DCN), which is a primary node of the triangle, has two main output paths: the primary excitatory path to the thalamus, the red nucleus (RN), and other brain stem nuclei, and the secondary inhibitory path to the inferior olive (IO). The inhibitory path contributes to the dentato-olivo-cerebellar loop (the short loop), while the excitatory path contributes to the cerebrocerebellar loop (the long loop). We propose a novel hypothesis: each loop contributes to physiologically distinct type of tremors or tremor-like movements. One type of irregular tremor-like movement is caused by a lesion in the cerebrocerebellar loop, which includes the primary path. A lesion in this loop affects the cerebellar forward model and deteriorates its accuracy of prediction and compensation of the feedback delay, resulting in irregular instability of voluntary motor control, i.e., cerebellar ataxia (CA). Therefore, this type of tremor, such as kinetic tremor, is usually associated with other symptoms of CA such as dysmetria. We call this type of tremor forward model-related tremor. The second type of regular tremor appears to be correlated with synchronized oscillation of IO neurons due, at least in animal models, to reduced degrees of freedom in IO activities. The regular burst activity of IO neurons is precisely transmitted along the cerebellocerebral path to the motor cortex before inducing rhythmical reciprocal activities of agonists and antagonists, i.e., tremor. We call this type of tremor IO-oscillation-related tremor. Although this type of regular tremor does not necessarily accompany ataxia, the aberrant IO activities (i.e., aberrant CS activities) may induce secondary maladaptation of cerebellar forward models through aberrant patterns of long-term depression (LTD) and/or long-term potentiation (LTP) of the cerebellar circuitry. Although our hypothesis does not cover all tremors or tremor-like movement disorders, our approach integrates the latest theories of cerebellar physiology and provides explanations how various lesions in or around the G–M triangle results in tremors or tremor-like movements. We propose that tremor results from errors in predictions carried out by the cerebellar circuitry.

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Section: Kinetic Tremor In Holmes' Classic Studymentioning

confidence: 95%

Section: After Holmesmentioning

confidence: 99%

Section: Section I Phenomenology Of Cerebellar Tremorsmentioning

confidence: 99%

Section: Section I Phenomenology Of Cerebellar Tremorsmentioning

confidence: 99%

Section: Section I Phenomenology Of Cerebellar Tremorsmentioning

confidence: 99%

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Pathophysiology of Cerebellar Tremor: The Forward Model-Related Tremor and the Inferior Olive Oscillation-Related Tremor

et al. 2021

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Multifeature quantitative motor assessment of upper limb ataxia including drawing and reaching

Hermle,

Schubert,

Barallon

et al. 2024

Ann Clin Transl Neurol

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ObjectiveVoluntary upper limb movements are an ecologically important yet insufficiently explored digital‐motor outcome domain for trials in degenerative ataxia. We extended and validated the trial‐ready quantitative motor assessment battery “Q‐Motor” for upper limb movements with clinician‐reported, patient‐focused, and performance outcomes of ataxia.MethodsExploratory single‐center cross‐sectional assessment in 94 subjects (46 cross‐genotype ataxia patients; 48 matched controls), comprising five tasks measured by force transducer and/or position field: Finger Tapping, diadochokinesia, grip‐lift, and—as novel implementations—Spiral Drawing, and Target Reaching. Digital‐motor measures were selected if they discriminated from controls (AUC >0.7) and correlated—with at least one strong correlation (rho ≥0.6)—to the Scale for the Assessment and Rating of Ataxia (SARA), activities of daily living (FARS‐ADL), and the Nine‐Hole Peg Test (9HPT).ResultsSix movement features with 69 measures met selection criteria, including speed and variability in all tasks, stability in grip‐lift, and efficiency in Target Reaching. The novel drawing/reaching tasks best captured impairment in dexterity (|rho9HPT| ≤0.81) and FARS‐ADL upper limb items (|rhoADLul| ≤0.64), particularly by kinematic analysis of smoothness (SPARC). Target hit rate, a composite of speed and endpoint precision, almost perfectly discriminated ataxia and controls (AUC: 0.97). Selected measures in all tasks discriminated between mild, moderate, and severe impairment (SARA upper limb composite: 0–2/>2–4/>4–6) and correlated with severity in the trial‐relevant mild ataxia stage (SARA ≤10, n = 20).InterpretationQ‐Motor assessment captures multiple features of impaired upper limb movements in degenerative ataxia. Validation with key clinical outcome domains provides the basis for evaluation in longitudinal studies and clinical trial settings.

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Cerebellar Lesions and Tremor

Kovács,

Kamondi

2023

Contemporary Clinical Neuroscience

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Revisiting the Clinical Phenomenology of “Cerebellar Tremor”: Beyond the Intention Tremor

Cited by 16 publications

References 108 publications

Pathophysiology of Cerebellar Tremor: The Forward Model-Related Tremor and the Inferior Olive Oscillation-Related Tremor

Pathophysiology of Cerebellar Tremor: The Forward Model-Related Tremor and the Inferior Olive Oscillation-Related Tremor

Multifeature quantitative motor assessment of upper limb ataxia including drawing and reaching

Cerebellar Lesions and Tremor

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