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Revisiting the Clinical Phenomenology of “Cerebellar Tremor”: Beyond the Intention Tremor

  • Abhishek Lenka
  • Elan D. LouisEmail author
Review

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

Tremor Cerebellar tremor Intention tremor Postural tremor Kinetic tremor Rest tremor 

Notes

Funding Information

Dr. Louis has received research support from the National Institutes of Health: NINDS #R01 NS094607 (principal investigator), NINDS #R01 NS073872 (principal investigator), NINDS #R01 NS086736 (principal investigator), NINDS #R01 NS085136 (principal investigator), and NINDS #R01 NS088257 (principal investigator). He has also received support from the Claire O’Neil Essential Tremor Research Fund (Yale University).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 1.Department of NeurologyMedStar Georgetown University HospitalWashingtonUSA
  2. 2.Division of Movement Disorders, Department of Neurology, Yale School of MedicineYale UniversityNew HavenUSA
  3. 3.Department of Chronic Disease Epidemiology, Yale School of Public HealthYale UniversityNew HavenUSA
  4. 4.Department of Neurology, Center for Neuroepidemiology and Clinical Neurological Research, Yale School of MedicineYale UniversityNew HavenUSA

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