[Head tremor].
BACKGROUND
Head tremor, either as an isolated symptom or as part of a symptomatic complex, occurs in patients with different neurological diseases. Little research has been carried out to analyse the clinical features of this neurological symptom.


OBJECTIVE
To review the symptomatology, aetiology and therapeutics of brain tremors.


METHODS
Two main types of brain tremor can be distinguished: tremor of the whole brain (holocephalic tremor) and segmented brain tremor (tremor of the jaw, tongue, chin, soft palate, task-specific, orthostatic orolingual and undetermined). Essential tremor, the main cause of brain tremor, and dystonic tremor give rise to holocephalic-type tremor in the vast majority of cases. Brain tremor in Parkinsonism is characteristically of the segmented type. The effectiveness of the pharmacological treatment of brain tremor is very limited. Botulinum toxin is a promising therapy for brain tremors of any causation. In severe cases of brain tremor, functional surgery by means of deep brain stimulation of the intermediate ventral thalamic nucleus is useful, but must be performed bilaterally.


CONCLUSIONS
The semiological characteristics of brain tremor are a valuable aid in the aetiological diagnosis. Pharmacological therapy is very limited. Botulinum toxin and functional surgery of the intermediate ventral thalamic nucleus are useful in selected patients.
Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España. agironell@santpau.cat
Alexandre
A
Gironell
Bàrbara
B
Vives
Javier
J
Pagonabarraga
D001905:Botulinum Toxins / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006257:Head / Q000503:physiopathology*; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy; D014202:Tremor / Q000145:classification / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy
D001905:Botulinum Toxins