The Pathophysiology of Essential Tremor and Parkinson’s Tremor

• Published in: Current neurology and neuroscience reports Vol. 13; no. 9; p. 378
• Main Authors: Helmich, Rick C., Toni, Ivan, Deuschl, Günther, Bloem, Bastiaan R.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.09.2013; Springer Nature B.V
• Subjects: Animals; Dystonia; Electric Stimulation Therapy - methods; Essential Tremor - complications; Essential Tremor - physiopathology; Essential Tremor - therapy; gamma-Aminobutyric Acid - metabolism; Humans; Hypotheses; Medical imaging; Medicine; Medicine & Public Health; Movement Disorders - physiopathology; Nerve Net - physiopathology; Neurodegeneration; Neuroimaging; Neuroimaging (DJ Brooks); Neurology; Neurosciences; Parkinson Disease - complications; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Parkinson's disease; Pathophysiology; Physiology; Topical Collection on Neuroimaging; Tremor (Muscular contraction); New York; United States > US; Cerebellum; Neuroimaging; Resting tremor; Basal ganglia; Thalamus; Essential tremor; Parkinson’s disease
• ISSN: 1528-4042; 1534-6293
• DOI: 10.1007/s11910-013-0378-8

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.