Neurological Sciences

, Volume 36, Issue 10, pp 1935–1936 | Cite as

Botulinum toxin type A for Holmes tremor secondary to thalamic hemorrhage

  • Pamela Latino
  • Francesco E. Pontieri
  • Francesco Orzi
  • Morena GiovannelliEmail author
Letter to the Editor

Dear Editor,

Holmes tremor (HT) is a low-frequency rest and intentional tremor frequently affecting the upper limb. The tremor, typically aggravated by movements, may in addition show an intrinsic postural component. It develops weeks to months after the onset of focal lesions of the brainstem, cerebellum and thalamus [1]. The response to a number of pharmacological agents consistently employed in the clinical practice, including levodopa, dopamine agonists, levetiracetam, clonazepam, zonisamide and propranolol, is rather unsatisfactory [2]. In drug-refractory cases, thalamotomy or deep brain stimulation of the nucleus ventralis intermedius of the thalamus may prove useful, but neurosurgical approaches, although potentially beneficial, are limited or avoided for being invasive and expensive [2].

Herewith, we report on a subject suffering for HT secondary to thalamic hemorrhage. The patient showed a good response to treatment with botulinum toxin type A (BoNT-A).

A 45-year-old,...


Deep Brain Stimulation Levetiracetam Essential Tremor Zonisamide Botulinum Toxin Type 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors report no sources of fundings and no conflict of interests.

Informed consent

Informed consent was obtained from the participant of the study.

Supplementary material

Supplementary material 1 (AVI 23878 kb). A video accompanying this article is available in the supporting information here. Video. Pre-therapy session: resting, postural and kinetic tremor of the right arm. The tremor was irregular, of large amplitude, mostly proximal (involving the deltoid, biceps and triceps brachii), and accompanied by athetoid movements at the right hand. Post-therapy session: significant reduction of tremor severity, in particular of resting and postural components


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Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • Pamela Latino
    • 1
    • 2
  • Francesco E. Pontieri
    • 1
    • 2
    • 3
  • Francesco Orzi
    • 1
    • 2
  • Morena Giovannelli
    • 2
    Email author
  1. 1.Department of Neuroscience, Mental Health and Sensory Organs (NESMOS)Sapienza UniversityRomeItaly
  2. 2.Unit of NeurologySant’Andrea HospitalRomeItaly
  3. 3.IRCCS Santa Lucia FoundationRomeItaly

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