title: Vim thalamotomy in a patient with Holmes' tremor and palatal tremor - Pathophysiological considerations.
abstract: BACKGROUND
  We peformed a ventral intermediate nucleus (Vim) thalamotomy in a patient with Holmes' tremor and palatal tremor. The frequencies of these movement disorders were 4 Hz and 3 Hz, respectively. Vim thalamotomy stopped the Holmes' tremor but not the palatal tremor. Our observations suggest different mechanisms for these two involuntary movements.
  
  
  METHODS
  A 57-arm 11 months after a pontine hemorrhage. Transoral carotid ultrasonography revealed periodic motion of her posterior pharyngeal wall with a frequency of 3 Hz. Recording of neuronal activities in the thalamus revealed a 4Hz rhythmic discharge time that was associated with her tremor in the contralateral arm. A left Vim thalamotomy was performed. The resting tremor of the upper limb stopped, but the kinetic tremor recurred 6 months after the thalamotomy. No effect was observed on her palatal tremor.
  
  
  CONCLUSIONS
  The different effects of Vim thalamotomy on the Holmes' tremor and palatal tremor suggest different oscillation sources for these two involuntary movements.
authors: Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan. f2maki@marianna-u.ac.jp.
authors: Futaba
authors: F
authors: Maki
authors: Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan. sumito.sato.6572@gmail.com.
authors: Sumito
authors: S
authors: Sato
authors: Department of Neurosurgery, Tokyo Metropolitan Matsuzawa hospital, Tokyo, Japan. katsuwatanabe-nsu@umin.ac.jp.
authors: Katsushige
authors: K
authors: Watanabe
authors: Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan. s2yanagi@marianna-u.ac.jp.
authors: Toshiyuki
authors: T
authors: Yanagisawa
authors: Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan. y2hagiwara@marianna-u.ac.jp.
authors: Yuta
authors: Y
authors: Hagiwara
authors: Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan. shimi-taka@marianna-u.ac.jp.
authors: Takahiro
authors: T
authors: Shimizu
authors: Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan. hasegawa-neuro1@marianna-u.ac.jp.
authors: Yasuhiro
authors: Y
authors: Hasegawa
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009434:Neural Pathways / Q000503:physiopathology; D009847:Olivary Nucleus / Q000503:physiopathology; D010156:Palatal Muscles / Q000503:physiopathology; D010507:Periodicity; D010609:Pharyngeal Muscles / Q000503:physiopathology; D065821:Pontine Tegmentum; D014202:Tremor / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D034941:Upper Extremity / Q000503:physiopathology; D020651:Ventral Thalamic Nuclei / Q000601:surgery*