PT  - JOURNAL ARTICLE
AU  - Seidel, S
AU  - Kasprian, G
AU  - Leutmezer, F
AU  - Prayer, D
AU  - Auff, E
TI  - Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes’ tremor
AID  - 10.1136/jnnp.2008.146324
DP  - 2009 Aug 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 921--923
VI  - 80
IP  - 8
4099  - http://jnnp.bmj.com/content/80/8/921.short
4100  - http://jnnp.bmj.com/content/80/8/921.full
SO  - J Neurol Neurosurg Psychiatry2009 Aug 01; 80
AB  - Holmes’ tremor is an unusual combination of rest, postural and kinetic tremor of the extremities. Medical treatment of this condition still remains unsatisfactory. The case of a 20-year-old female patient is reported who developed right-sided Holmes’ tremor 9 months after a left-sided, cavernoma induced midbrain/pontine haemorrhage at the age of 16 years. Beta-CIT single photon emission computed tomography revealed abolished dopamine transporter activity in the left basal ganglia and striatum, in accordance with missing ipsilateral tegmento-frontal connectivity (medial forebrain bundle), demonstrated by diffusion tensor MRI. Tractography showed reduced fibre connectivity of the superior and middle cerebellar peduncles on the lesioned side. Administration of pramipexole and L-DOPA led to a clinically significant reduction in tremor severity. In conclusion, our results support the notion that Holmes’ tremor was a result of diminished striatal dopaminergic input in our patient.