title: Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases.
abstract: OBJECTIVE
  To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT).
  
  
  METHODS
  A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis.
  
  
  RESULTS
  A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results.
  
  
  CONCLUSIONS
  The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Gabriela B
authors: GB
authors: Raina
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Maria G
authors: MG
authors: Cersosimo
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Silvia S
authors: SS
authors: Folgar
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Juan C
authors: JC
authors: Giugni
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Cristian
authors: C
authors: Calandra
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Juan P
authors: JP
authors: Paviolo
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Veronica A
authors: VA
authors: Tkachuk
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Carlos
authors: C
authors: Zuñiga Ramirez
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Andrea L
authors: AL
authors: Tschopp
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Daniela S
authors: DS
authors: Calvo
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Luis A
authors: LA
authors: Pellene
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Marcela C
authors: MC
authors: Uribe Roca
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Miriam
authors: M
authors: Velez
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Rolando J
authors: RJ
authors: Giannaula
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
authors: Manuel M
authors: MM
authors: Fernandez Pardal
authors: From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru. fmicheli@fibertel.com.ar.
authors: Federico E
authors: FE
authors: Micheli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008636:Mesencephalon / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011612:Psychosurgery / Q000379:methods; D012189:Retrospective Studies; D013788:Thalamus / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014202:Tremor / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D007980:Levodopa