Article thumbnail

Holmes’ or functional tremor?

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


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. Keywords: Holmes tremor, Rubral tremor, Functional tremor, Psychogenic tremor, Surface polymyography, Neurophysiolog

Topics: Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Publisher: Elsevier
DOI identifier: 10.1016/j.cnp.2018.03.006
OAI identifier:
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • (external link)
  • (external link)
  • (external link)
  • Suggested articles

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.