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The Pathophysiology of Essential Tremor and Parkinson’s Tremor

  • Neuroimaging (DJ Brooks)
  • Published:
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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.

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Compliance with Ethics Guidelines

Conflict of Interest

Rick C. Helmich has received payment from GlaxoSmithKline for a lecture and has received travel/accommodation expenses covered or reimbursed by the Movement Disorders Society for a lecture at the Movement Disorders Society conference in Sydney. He has received grant support from the Netherlands Brain Foundation (Hersenstichting Nederland).

Ivan Toni declares that he has no conflict of interest.

Günther Deuschl has been a consultant for TEVA, Medtronic, Novartis, and Sapiens, has been employed by the German government, has received grant support from the German Research Council, the German Ministry of Education and Research, and Medtronic, has received honoraria from TEVA, Medtronic, Novartis, and Sapiens, has received royalties from Thieme, is President of the Movement Disorder Society, and is Past President of the German Society of Neurology.

Bastiaan R. Bloem is a board member of Movement Disorders and Physiotherapy Canada, has been a consultant for Boehringer Ingelheim, GlaxoSmithKline, Danone, and Solvay, has received grant support from the Netherlands Organization for Scientific Research, the Michael J. Fox Foundation, the Princess Beatrix Foundation, Stichting International Parkinson Fonds, and Alkemade Keuls Fonds, and has received travel/accommodation expenses covered or reimbursed by various international conferences.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands

    Rick C. Helmich & Ivan Toni

  2. Department of Neurology, Christian Albrecht University, Kiel, Germany

    Günther Deuschl

  3. Department of Neurology and Parkinson Centre Nijmegen (ParC), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Rick C. Helmich & Bastiaan R. Bloem

Authors
  1. Rick C. Helmich
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  2. Ivan Toni
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  3. Günther Deuschl
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  4. Bastiaan R. Bloem
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Corresponding author

Correspondence to Rick C. Helmich.

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This article is part of the Topical Collection on Neuroimaging

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Helmich, R.C., Toni, I., Deuschl, G. et al. The Pathophysiology of Essential Tremor and Parkinson’s Tremor. Curr Neurol Neurosci Rep 13, 378 (2013). https://doi.org/10.1007/s11910-013-0378-8

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  • DOI: https://doi.org/10.1007/s11910-013-0378-8

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