The Pathophysiology of Essential Tremor and Parkinson's Tremor

Overview

Journal Curr Neurol Neurosci Rep

Specialty Neurology

Date 2013 Jul 30

PMID 23893097

Citations 106

Authors

Rick C Helmich

Ivan Toni

Gunther Deuschl

Bastiaan R Bloem

Affiliations

Soon will be listed here.

Abstract

We review recent evidence about the pathophysiology of essential tremor and tremor in Parkinson's disease. We believe that a network perspective is necessary to understand this common neurological symptom, and that knowledge of cerebral network dysfunction in tremor disorders will help to develop new therapies. Both essential tremor and Parkinson's tremor are associated with increased activity in the cerebellothalamocortical circuit. However, different pathophysiological mechanisms lead to tremulous activity within this circuit. In Parkinson's disease, evidence suggests that dopaminergic dysfunction of the pallidum triggers increased activity in the cerebellothalamocortical circuit. In essential tremor, GABAergic dysfunction of the cerebellar dentate nucleus and brain stem, possibly caused by neurodegeneration in these regions, may lead to tremulous activity within the cerebellothalamocortical circuit. In both disorders, network parameters such as the strength and directionality of interregional coupling are crucially altered. Exciting new research uses these network parameters to develop network-based therapies, such as closed-loop deep brain stimulation and transcranial magnetic or direct current stimulation.

Citing Articles

Multimodal Magnetic Resonance Findings in Parkinson's Disease With "Antecedent Essential Tremor": A Case Series of a Large Kindred.

Kong Y, Yao L, Xiao X, Chen A, Wang K, Yan H Neuropsychiatr Dis Treat. 2025; 21:79-92.

PMID: 39871882 PMC: 11769848. DOI: 10.2147/NDT.S498644.

Tremor in the Age of Omics: An Overview of the Transcriptomic Landscape of Essential Tremor.

Aboasali F, Castonguay C, Medeiros M, Dion P, Rouleau G Cerebellum. 2025; 24(2):35.

PMID: 39853640 DOI: 10.1007/s12311-025-01793-3.

Microstructural abnormalities of the dentato-rubro-thalamo-cortical tract in tremor dominant Parkinson's disease and essential tremor plus syndrome.

Prasad S, Rajan A, Bharath R, Saini J, Pal P Neuroradiology. 2025; .

PMID: 39831961 DOI: 10.1007/s00234-025-03542-z.

Neurophysiological Features of Tremor during Walking in Parkinson's Disease.

Costanzo M, Marchet F, Leodori G, Cutrona C, De Bartolo M, Vivacqua G Mov Disord Clin Pract. 2024; 12(2):226-230.

PMID: 39628141 PMC: 11802656. DOI: 10.1002/mdc3.14293.

Limited Potential of Repetitive Transcranial Magnetic Stimulation for Treatment of Essential Tremor: A Systematic Review.

Bishay A, Guo A, Desai R, Mushinski S, Au A, Swenson A NeuroSci. 2024; 5(4):523-533.

PMID: 39585106 PMC: 11587431. DOI: 10.3390/neurosci5040038.

References

Louis E, Faust P, Ma K, Yu M, Cortes E, Vonsattel J . Torpedoes in the cerebellar vermis in essential tremor cases vs. controls. Cerebellum. 2011; 10(4):812-9. DOI: 10.1007/s12311-011-0291-0. View

Llinas R . The intrinsic electrophysiological properties of mammalian neurons: insights into central nervous system function. Science. 1988; 242(4886):1654-64. DOI: 10.1126/science.3059497. View

Atkinson J, Collins D, Bertrand G, Peters T, Pike G, Sadikot A . Optimal location of thalamotomy lesions for tremor associated with Parkinson disease: a probabilistic analysis based on postoperative magnetic resonance imaging and an integrated digital atlas. J Neurosurg. 2002; 96(5):854-66. DOI: 10.3171/jns.2002.96.5.0854. View

Loane C, Wu K, Bain P, Brooks D, Piccini P, Politis M . Serotonergic loss in motor circuitries correlates with severity of action-postural tremor in PD. Neurology. 2013; 80(20):1850-5. PMC: 3908354. DOI: 10.1212/WNL.0b013e318292a31d. View

Albin R, Young A, Penney J . The functional anatomy of basal ganglia disorders. Trends Neurosci. 1989; 12(10):366-75. DOI: 10.1016/0166-2236(89)90074-x. View

Raethjen J, Deuschl G . The oscillating central network of Essential tremor. Clin Neurophysiol. 2011; 123(1):61-4. DOI: 10.1016/j.clinph.2011.09.024. View

Zhou J, Gennatas E, Kramer J, Miller B, Seeley W . Predicting regional neurodegeneration from the healthy brain functional connectome. Neuron. 2012; 73(6):1216-27. PMC: 3361461. DOI: 10.1016/j.neuron.2012.03.004. View

Benabid A, Pollak P, Gervason C, Hoffmann D, Gao D, Hommel M . Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet. 1991; 337(8738):403-6. DOI: 10.1016/0140-6736(91)91175-t. View

Sandvik U, Koskinen L, Lundquist A, Blomstedt P . Thalamic and subthalamic deep brain stimulation for essential tremor: where is the optimal target?. Neurosurgery. 2012; 70(4):840-5. DOI: 10.1227/NEU.0b013e318236a809. View

10.

Louis E, Faust P, Vonsattel J, Honig L, Rajput A, Robinson C . Neuropathological changes in essential tremor: 33 cases compared with 21 controls. Brain. 2007; 130(Pt 12):3297-307. DOI: 10.1093/brain/awm266. View

11.

Magnin M, Morel A, Jeanmonod D . Single-unit analysis of the pallidum, thalamus and subthalamic nucleus in parkinsonian patients. Neuroscience. 2000; 96(3):549-64. DOI: 10.1016/s0306-4522(99)00583-7. View

12.

Thier S, Kuhlenbaumer G, Lorenz D, Nothnagel M, Nebel A, Christensen K . GABA(A) receptor- and GABA transporter polymorphisms and risk for essential tremor. Eur J Neurol. 2011; 18(8):1098-100. DOI: 10.1111/j.1468-1331.2010.03308.x. View

13.

Bergman H, FEINGOLD A, Nini A, Raz A, Slovin H, Abeles M . Physiological aspects of information processing in the basal ganglia of normal and parkinsonian primates. Trends Neurosci. 1998; 21(1):32-8. DOI: 10.1016/s0166-2236(97)01151-x. View

14.

Zirh T, Lenz F, Reich S, Dougherty P . Patterns of bursting occurring in thalamic cells during parkinsonian tremor. Neuroscience. 1998; 83(1):107-21. DOI: 10.1016/s0306-4522(97)00295-9. View

15.

Contarino M, Speelman J, de Bie R, Schuurman P, van den Munckhof P . Bilateral cerebellorubrothalamic fibers stimulation for essential tremor?. Mov Disord. 2011; 26(7):1366-7. DOI: 10.1002/mds.23542. View

16.

Coria F, Gimenez-Garcia M, Samaranch L, Mora F, Sampol-Bas C, Pastor P . Nigrostriatal dopaminergic function in subjects with isolated action tremor. Parkinsonism Relat Disord. 2011; 18(1):49-53. DOI: 10.1016/j.parkreldis.2011.08.025. View

17.

Wang S, Aziz T, Stein J, Liu X . Time-frequency analysis of transient neuromuscular events: dynamic changes in activity of the subthalamic nucleus and forearm muscles related to the intermittent resting tremor. J Neurosci Methods. 2005; 145(1-2):151-8. DOI: 10.1016/j.jneumeth.2004.12.009. View

18.

Sanchez-Gonzalez M, Garcia-Cabezas M, Rico B, Cavada C . The primate thalamus is a key target for brain dopamine. J Neurosci. 2005; 25(26):6076-83. PMC: 6725054. DOI: 10.1523/JNEUROSCI.0968-05.2005. View

19.

Hughes A, Daniel S, Blankson S, Lees A . A clinicopathologic study of 100 cases of Parkinson's disease. Arch Neurol. 1993; 50(2):140-8. DOI: 10.1001/archneur.1993.00540020018011. View

20.

Helmich R, Hallett M, Deuschl G, Toni I, Bloem B . Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits?. Brain. 2012; 135(Pt 11):3206-26. PMC: 3501966. DOI: 10.1093/brain/aws023. View