Treatment of holmes tremor

Abstract

Holmes tremor (HT) is an irregular, slow frequency tremor that is present at rest, posture, and intention, usually following an insult to the brainstem, thalamus, or cerebellum. Treatment of HT is often challenging. Levodopa has been the main approach, while antiepileptic medications have also been used with varying success. Botulinum toxin injection may be considered in pharmacologically refractory cases, as well as deep brain stimulation (DBS) of the ventral intermedius nucleus (VIM) of the thalamus or the globus pallidus internus (GPi).