Holmes’ or functional tremor?

Tommaso Bocci, Gianluca Ardolino, Laura Parenti, Davide Barloscio, Anna De Rosa, Alberto Priori, Ferdinando Sartucci

Research output: Contribution to journalArticle

Abstract

Objective: Holmes tremor is a rare kind of hyperkinetic movement disorder, clinically characterized by irregular, monolateral, high-amplitude jerks, sharing a quite similar frequency with those observed in Parkinson's disease; its generation likely relies on a combined involvement of cerebello-thalamic and nigrostriatal pathways. Methods: We report the case of a man with a combined resting-postural-kinetic tremor. Neuroimaging revealed an intracranial dermoid cyst at the right pontocerebellar angle with brainstem dislocation. We performed an extensive electrophysiological assessment from the extensor digitorum communis (EDC) and flexor carpi radialis (FCR) muscles. Results: Both the spontaneous variability of tremor frequency and frequency entrainment argued against an organic aetiology. Polymyography revealed: 1) a paradoxical increase of tremor amplitude with mass loading; 2) jerks’ synchronization between antagonistic muscles during voluntary contralateral motor performances; 3) tremor inhibition while asking the patient to make a ballistic movement. Conclusions: We suggest a complete psychogenic genesis or, at least in part, a possible co-existence of a rubral tremor with functional traits. Significance: Here, we propose a simple and fast test battery for an early diagnosis of functional tremor. Our results prompt further studies to re-define electrodiagnostic criteria in hyperkinetic movement disorders, possibly updating the floating border between organic and psychogenic disease.

Original languageEnglish
Pages (from-to)104-106
Number of pages3
JournalClinical Neurophysiology Practice
Volume3
DOIs
Publication statusPublished - Jan 1 2018

Keywords

  • Functional tremor
  • Holmes tremor
  • Neurophysiology
  • Psychogenic tremor
  • Rubral tremor
  • Surface polymyography

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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  • Cite this

    Bocci, T., Ardolino, G., Parenti, L., Barloscio, D., De Rosa, A., Priori, A., & Sartucci, F. (2018). Holmes’ or functional tremor? Clinical Neurophysiology Practice, 3, 104-106. https://doi.org/10.1016/j.cnp.2018.03.006