Paradoxical aspects of parkinsonian tremor

Although resting tremor is the most identifiable sign of Parkinson's disease, its underlying basis appears to be the most complex of the cardinal signs. The variable relationship of resting tremor to other symptoms of PD has implications for diagnosis, prognosis, medical and surgical treatment. Structural lesions very rarely cause classic resting tremor, with likely contributions to tremor by a network of neurons both within and outside the basal ganglia. Patients with only resting tremor show dopaminergic deficits with radioligand imaging, but severity of tremor correlates poorly in such dopamine imaging studies. Correlation of tremor severity to changes in radioligand studies is also limited by the use of mostly qualitative measures of tremor severity. A complex pharmacologic basis of parkinsonian resting tremor is supported by treatment studies. Although levodopa is clearly effective for resting tremor, several agents have shown efficacy that appears to be superior or additive to that of levodopa including anticholinergics, clozapine, pramipexole, and budipine. Although the thalamus has the greatest body of evidence supporting its role as an effective target for surgical treatment of tremor, recent studies suggest that the subthalamic nucleus may be a reasonable alternative target for patients with Parkinson's disease and severe tremor as the predominant symptom. © 2007 Movement Disorder Society

[1]  M. Guttman Double-blind comparison of pramipexole and bromocriptine treatment with placebo in advanced Parkinson's disease. International Pramipexole-Bromocriptine Study Group. , 1997, Neurology.

[2]  J. Dichgans,et al.  Tremorlytic activity of budipine: a quantitative study with long-term tremor recordings. , 1995, Clinical neuropharmacology.

[3]  W. Koller,et al.  Adjuvant therapy of parkinsonian tremor. , 1987, Archives of neurology.

[4]  Mark Hallett,et al.  Parkinson revisited: pathophysiology of motor signs. , 2003, Advances in neurology.

[5]  T. Baumann,et al.  Tremor control after pallidotomy in patients with Parkinson's disease: correlation with microrecording findings. , 1997, Neurosurgical focus.

[6]  M. Guttman Double-blind comparison of pramipexole and bromocriptine treatment with placebo in advanced Parkinson's disease , 1997, Neurology.

[7]  A L Benabid,et al.  Subthalamic nucleus stimulation in tremor dominant parkinsonian patients with previous thalamic surgery , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[8]  Seth Love,et al.  Unilateral subthalamotomy in the treatment of Parkinson's disease. , 2003, Brain : a journal of neurology.

[9]  P. Thompson,et al.  Isolated tremor and disruption of the nigrostriatal dopaminergic system , 1992, Neurology.

[10]  J. Lieberman,et al.  Clozapine-induced agranulocytosis. Incidence and risk factors in the United States. , 1993, The New England journal of medicine.

[11]  M. Atay,et al.  Impairment, disability, and life satisfaction in Parkinson's disease , 2003, Disability and rehabilitation.

[12]  O. Rascol,et al.  Ropinirole in the treatment of early Parkinson's disease: A 6‐month interim report of a 5‐year levodopa‐controlled study , 1998, Movement disorders : official journal of the Movement Disorder Society.

[13]  S. Gill,et al.  Stimulation of the subthalamic region for essential tremor. , 2004, Journal of neurosurgery.

[14]  Gordon H Baltuch,et al.  Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. , 2003, Journal of neurosurgery.

[15]  J. Kulisevsky,et al.  Unilateral parkinsonism and stereotyped movements following a right lenticular infarction , 1996, Movement disorders : official journal of the Movement Disorder Society.

[16]  P. Hogarth,et al.  Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. , 2005, Archives of neurology.

[17]  J. Dichgans,et al.  Tremorlytic activity of budipine in Parkinson's disease. , 1999, Journal of neural transmission. Supplementum.

[18]  J. Wit,et al.  Catch-Up Growth and Endocrine Changes in Childhood Celiac Disease , 2002, Hormone Research in Paediatrics.

[19]  K. Lyons,et al.  Long‐term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor , 2001, Movement disorders : official journal of the Movement Disorder Society.

[20]  Oliver Pogarell,et al.  Prospective study of presynaptic dopaminergic imaging in patients with mild parkinsonism and tremor disorders: Part 1. Baseline and 3‐month observations , 2003, Movement disorders : official journal of the Movement Disorder Society.

[21]  W. Pirker,et al.  Correlation of dopamine transporter imaging with parkinsonian motor handicap: How close is it? , 2003, Movement disorders : official journal of the Movement Disorder Society.

[22]  Claude Nahmias,et al.  Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL‐PET study , 2003, Annals of neurology.

[23]  R R Tasker,et al.  Deep brain stimulation is preferable to thalamotomy for tremor suppression. , 1998, Surgical neurology.

[24]  K. Mewes,et al.  The Subthalamic Nucleus and Tremor in Parkinson's Disease , 2008, Movement disorders : official journal of the Movement Disorder Society.

[25]  I. Hamada,et al.  Hemorrhagic complication of stereotactic surgery in patients with movement disorders. , 2003, Journal of neurosurgery.

[26]  Z. Faulkes,et al.  A map of distal leg motor neurons in the thoracic ganglia of four decapod crustacean species. , 1997, Brain, behavior and evolution.

[27]  Devin K. Binder,et al.  Hemorrhagic Complications of Microelectrode-Guided Deep Brain Stimulation , 2004, Stereotactic and Functional Neurosurgery.

[28]  H. Reichmann Budipine in Parkinson's tremor , 2006, Journal of the Neurological Sciences.

[29]  A L Benabid,et al.  Treatment of tremor in Parkinson's disease by subthalamic nucleus stimulation , 1998, Movement disorders : official journal of the Movement Disorder Society.

[30]  G. Deuschl,et al.  Tremors in Parkinson's Disease: Symptom Analysis and Rating , 1994, Clinical neuropharmacology.

[31]  L. Murri,et al.  Clozapine in Parkinson's disease tremor , 1997, Neurology.

[32]  R. Gross,et al.  Clozapine in the treatment of tremor in Parkinson's disease. , 1995, Acta neurologica Scandinavica.

[33]  P. Amarenco,et al.  Tremor in Parkinson's disease and serotonergic dysfunction An 11 C-WAY 100635 PET study , 2003 .

[34]  R. K. Simpson,et al.  Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson's disease tremor , 1998, Neurology.

[35]  R. Elble Tremor and dopamine agonists , 2002, Neurology.

[36]  E. Jansen Clozapine in the treatment of tremor in Parkinson's disease , 1994, Acta neurologica Scandinavica.

[37]  D. Brooks,et al.  Long duration asymmetrical postural tremor is likely to predict development of Parkinson’s disease and not essential tremor: clinical follow up study of 13 cases , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[38]  J. C. Stoof,et al.  Rigidity decreases resting tremor intensity in Parkinson's disease: A [123I]β‐CIT SPECT study in early, nonmedicated patients , 2001, Movement disorders : official journal of the Movement Disorder Society.

[39]  A. Schrag,et al.  Ropinirole for the treatment of tremor in early Parkinson's disease , 2002, European journal of neurology.

[40]  P. Gonzalez-Alegre Monomelic parkinsonian tremor caused by contralateral substantia nigra stroke. , 2007, Parkinsonism & related disorders.

[41]  V. Dhawan,et al.  The metabolic anatomy of tremor in Parkinson's disease , 1998, Neurology.

[42]  K. Lyons,et al.  Long term safety and efficacy of unilateral deep brain stimulation of the thalamus for parkinsonian tremor , 2001, Journal of neurology, neurosurgery, and psychiatry.

[43]  D Meier,et al.  Pramipexole in patients with Parkinson's disease and marked drug resistant tremor: a randomised, double blind, placebo controlled multicentre study , 2002, Journal of neurology, neurosurgery, and psychiatry.

[44]  D. Vaillancourt,et al.  Effects of subthalamic nucleus stimulation and medication on resting and postural tremor in Parkinson's disease. , 2004, Brain : a journal of neurology.

[45]  G. Canter,et al.  A CRITICAL ANALYSIS OF THE EFFECTS OF TRIHEXYPHENIDYL (ARTANE) ON THE COMPONENTS OF THE PARKINSONIAN SYNDROME , 1964, The Journal of nervous and mental disease.

[46]  H. Freund,et al.  The cerebral oscillatory network of parkinsonian resting tremor. , 2003, Brain : a journal of neurology.

[47]  P. Bain,et al.  Randomized, double‐blind, 3‐month parallel study of the effects of pramipexole, pergolide, and placebo on parkinsonian tremor , 2003, Movement disorders : official journal of the Movement Disorder Society.

[48]  C. Tanner,et al.  Levodopa and the progression of Parkinson's disease. , 2004, The New England journal of medicine.

[49]  J. Carr Tremor in Parkinson's disease. , 2002, Parkinsonism & related disorders.

[50]  L. J. Doshay Five-year study of benztropine (cogentin) methanesulfonate; outcome in three hundred two cases of paralysis agitans. , 1956, Journal of the American Medical Association.

[51]  C. Adler,et al.  Ropinirole for the treatment of early Parkinson's disease , 1997, Neurology.

[52]  P. Krack,et al.  Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. , 2001, The New England journal of medicine.

[53]  C. Lozza,et al.  The Metabolic Substrates of Bradykinesia and Tremor in Uncomplicated Parkinson's Disease , 2002, NeuroImage.

[54]  W. Poewe,et al.  Reduction of parkinsonian signs in patients with Parkinson's disease by dopaminergic versus anticholinergic single‐dose challenges , 1999, Movement disorders : official journal of the Movement Disorder Society.

[55]  Joffroy Aj Pathophysiology of parkinsonian tremor. , 1969 .

[56]  D. S. Russell,et al.  Benign tremulous parkinsonism. , 2006, Archives of neurology.

[57]  Tom Robinson,et al.  Vascular parkinsonism--an important cause of parkinsonism in older people. , 2005, Age and ageing.

[58]  J. Friedman,et al.  Efficacy of pramipexole, a novel dopamine agonist, as monotherapy in mild to moderate Parkinson's disease , 1997, Neurology.

[59]  I. McKeith,et al.  SIC Task Force appraisal of clinical diagnostic criteria for parkinsonian disorders , 2003, Movement disorders : official journal of the Movement Disorder Society.

[60]  W. Weiner,et al.  Parkinson's disease: an open label trial of pergolide in patients failing bromocriptine therapy. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[61]  J. Jankovic,et al.  A multicenter double‐blind placebo‐controlled trial of pergolide as an adjunct to sinemet® in Parkinson's disease , 1994 .

[62]  W. Oertel,et al.  Pramipexole, a nonergot dopamine agonist, is effective against rest tremor in intermediate to advanced Parkinson's disease. , 1999, Clinical neuropharmacology.

[63]  K. Byth,et al.  Postural tremor of Parkinson's disease. , 1994, Clinical neuropharmacology.

[64]  J. Krauss,et al.  Parkinsonism and rest tremor secondary to supratentorial tumours sparing the basal ganglia , 2005, Acta Neurochirurgica.

[65]  T. Ishikawa,et al.  Assessment of disease severity in parkinsonism with fluorine-18-fluorodeoxyglucose and PET. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[66]  G. Deuschl,et al.  Monosymptomatic resting tremor and Parkinson's disease: A multitracer positron emission tomographic study , 2002, Movement disorders : official journal of the Movement Disorder Society.

[67]  A. Lees,et al.  Anticholinergics for symptomatic management of Parkinson's disease. , 2002, The Cochrane database of systematic reviews.

[68]  J. Friedman,et al.  Benztropine versus clozapine for the treatment of tremor in Parkinson's disease , 1997, Neurology.

[69]  W. Koller,et al.  Pharmacologic treatment of parkinsonian tremor. , 1986, Archives of neurology.

[70]  K. Marder,et al.  Progression of parkinsonian signs in Parkinson disease. , 1999, Archives of neurology.

[71]  Adjuvant treatment of Parkinson's disease with budipine: a double-blind trial versus placebo , 1987, Journal of Neurology.

[72]  J L Vitek,et al.  Role of the thalamus in parkinsonian tremor: evidence from studies in patients and primate models. , 1993, Stereotactic and functional neurosurgery.

[73]  H. Przuntek,et al.  Budipine provides additional benefit in patients with Parkinson disease receiving a stable optimum dopaminergic drug regimen. , 2002, Archives of neurology.

[74]  H. Reichmann,et al.  Kinetic tremor in Parkinson’s disease – an underrated symptom , 2006, Journal of Neural Transmission.

[75]  M. S. Lee,et al.  A patient with a resting tremor and a lacunar infarction at the border between the thalamus and the internal capsule , 1993, Movement disorders : official journal of the Movement Disorder Society.

[76]  M. Hennerici,et al.  Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson’s disease , 2007, Journal of Neurology.

[77]  Marwan Hariz,et al.  Long‐term efficacy of thalamic deep brain stimulation for tremor: Double‐blind assessments , 2003, Movement disorders : official journal of the Movement Disorder Society.

[78]  D. Brooks,et al.  Tremor in Parkinson’s disease and serotonergic dysfunction , 2003, Neurology.

[79]  Klaus Mewes,et al.  Randomized trial of pallidotomy versus medical therapy for Parkinson's disease , 2003, Annals of neurology.

[80]  A. Lieberman,et al.  Clinical evaluation of pramipexole in advanced Parkinson's disease: Results of a double-blind, placebo-controlled, parallel-group study , 1997, Neurology.

[81]  R. Uitti,et al.  Thalamic deep brain stimulation for tremor-predominant Parkinson's disease. , 2003, Parkinsonism & related disorders.