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Cerebellum. 2018 Dec 18. doi: 10.1007/s12311-018-0994-6. [Epub ahead of print]

Revisiting the Clinical Phenomenology of "Cerebellar Tremor": Beyond the Intention Tremor.

Author information

1
Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA.
2
Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. elan.louis@yale.edu.
3
Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA. elan.louis@yale.edu.
4
Department of Neurology, Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, 15 York Street, PO Box 208018, New Haven, CT, 06520-8018, USA. elan.louis@yale.edu.

Abstract

Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is a central feature of a range of diseases resulting from pathological changes in the cerebellum. Interestingly, in modern times, the terms "cerebellar tremor" and "intention tremor" are often used synonymously and interchangeably. However, "cerebellar tremor" (i.e., tremors of cerebellar origin) do not always present exclusively as intention tremor. In this article, we comprehensively revisit the clinical phenomenology of tremors observed in various diseases that are based in the cerebellum. By this, we mean diseases for which the cerebellum and its various connections are often seen as playing a central and defining role. These include spinocerebellar ataxias, essential tremor, orthostatic tremor, dystonia, acute cerebellitis, cerebellar tumors, paraneoplastic cerebellar degeneration, and cerebellar strokes. The theme of this article is to highlight, through published data available in the current literature, that the clinical phenomenology of tremor of cerebellar origin is heterogeneous, and it extends beyond that of intention tremor to include postural tremors, kinetic tremor, rest tremor, and orthostatic tremor. This heterogeneity is consistent with the seminal work of Gordon Holmes, in which he described a variety of tremors aside from intention tremor in the setting of cerebellar lesions. In the end, it would seem that the notion that intention tremor is the sole signature of cerebellar lesions is an over-simplification and is not correct. Future studies are warranted to identify and further characterize the heterogeneity of tremors arising from the various cerebellar etiologies.

KEYWORDS:

Cerebellar tremor; Intention tremor; Kinetic tremor; Postural tremor; Rest tremor; Tremor

PMID:
30565088
DOI:
10.1007/s12311-018-0994-6

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