Milestones in Tremor Research: 10 Years Later

Abstract

Major progress has occurred during the last decade in the field of tremor. From the clinical standpoint, a new classification has completely revised the nosology of tremor syndromes and has re-conceptualized essential tremor as a syndrome rather than a single disease entity, fueling an ongoing enlightened debate. Significant advances have been obtained in terms of instrumental measurement of tremor, remarking on the possibility of developing novel treatment strategies based on tremor characteristics, namely tremor-phase. Moreover, a better understanding of the pathophysiological mechanisms has further led to the suggestion of refining the classification of tremor syndromes according to their driving underpinnings. Finally, surgical options such as deep brain stimulation and focused ultrasound thalamotomy are now part of the therapeutic portfolio for tremor, but several oral drugs, including long-chain alcohols, T-channel blockers, allosteric modulators of potassium channels, and of GABA-A receptors, are currently being tested and hold promise. This review will discuss the key milestones in tremor research of the last 10 years, with a focus on the most common tremor syndromes, namely essential tremor, dystonic tremor, and Parkinsonian tremor.

Keywords: MRgFUS; Parkinson's disease; dystonic tremor; essential tremor; sensors.

FIG. 1

Suggested pathophysiological mechanisms sustaining essential tremor, dystonic tremors, and parkinsonian tremors (whitened boxes indicate a possible but minor contribution; redrawn from van der Stouwe et al). ET, essential tremor; TAWD, tremor associated with dystonia; DT, dystonic tremor.