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Part of the book series: Contemporary Clinical Neuroscience ((CCNE))

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Abstract

By definition, rest tremor is an involuntary oscillation occurring while the body segment is maintained at rest, fully supported against gravity. To look for a rest tremor, the patient is seated with the upper limbs relaxed and the forearms on the thighs, or the patient is lying horizontally in complete repose. Rest tremor is typically in the 3–6 Hz frequency range and may reach high levels of severity. Rest tremor is usually asymmetrical, in general starting distally in the arms and legs. Typically, tremor in the upper limbs reminds the ‘pill rolling’ movement. Lips and jaw can be affected, with a rhythmic clicking of teeth. Head and trunk are usually spared. Rest tremor may disappear or subside with action (posture, movement, maintaining an isometric force, exerting a specific task) and is associated with reciprocal activation in antagonistic muscles. In some cases, patients can reduce the tremor by holding one hand with the other or crossing the legs. Rest tremor often increases with mental stress (i.e. counting backwards) or contralateral motion (Froment manoeuvre). However, this feature is not specific. Rest tremor disappears during sleep, as most tremulous disorders. In addition to the clinical features, we discuss the pathogenesis and the therapies of rest tremor.

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References

  • Abbruzzese G. Malattie del sistema extrapiramidale. In: Loeb C, Favale E, editors. Neurologia di Fazio Loeb. Roma: Società Editrice Universo; 2003.

    Google Scholar 

  • Abbruzzese G, Barone P, Lopiano L, Stocchi F. The current evidence for the use of safinamide for the treatment of Parkinson’s disease. Drug Des Devel Ther. 2021;15:2507–17.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alborghetti M, Nicoletti F. Different generations of type-B monoamine oxidase inhibitors in parkinson’s disease: from bench to bedside. Curr Neuropharmacol. 2018;16:1–13.

    Google Scholar 

  • Antonini A, Moeller JR, Nakamura T, Spetsieris P, Dhawan V, Eidelberg D. The metabolic anatomy of tremor in Parkinson’s disease. Neurology. 1998;51:803–10.

    Article  CAS  PubMed  Google Scholar 

  • Belvisi D, Conte A, Bologna M, Bloise MC, Suppa A, Formica A, Costanzo M, Cardone P, Fabbrini G, Berardelli A. Re-emergent tremor in Parkinson's disease. Parkinsonism Relat Disord. 2017;36:41–6.

    Article  PubMed  Google Scholar 

  • Benninger DH, Thees S, Kollias SS, Bassetti CL, Waldvogel D. Morphological differences in Parkinson’s disease with and without rest tremor. J Neurol. 2009;256(2):256–63.

    Article  PubMed  Google Scholar 

  • Ben-Pazi H, Bergman H, Goldberg JA, Giladi N, Hansel D, Reches A, Simon ES. Synchrony of rest tremor in multiple limbs in parkinson’s disease: evidence for multiple oscillators. J Neural Transm. 2001;108(3):287–96.

    Article  CAS  PubMed  Google Scholar 

  • Bergman H, Wichmann T, De Long M. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science. 1990;249:1436–8.

    Article  CAS  PubMed  Google Scholar 

  • Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, Raethjen J, Stamelou M, Testa CM. Deuschl G; tremor task force of the International Parkinson and Movement Disorder Society. Consensus statement on the classification of tremors. From the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018;33(1):75–87.

    Article  PubMed  Google Scholar 

  • Bonneville F, Bloch F, Kurys E, du Montcel ST, Welter ML, Bonnet AM, Agid Y, Dormont D, Houeto JL. Camptocormia and Parkinson’s disease: MR imaging. Eur Radiol. 2008;18(8):1710–9.

    Article  PubMed  Google Scholar 

  • Bostan AC, Dum RP, Strick PL. The basal ganglia communicate with the cerebellum. Proc Natl Acad Sci U S A. 2010;107(18):8452–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Caligiore D, Pezzulo G, Baldassarre G, Bostan AC, Strick PL, Doya K, Helmich RC, Dirkx M, Houk J, Jörntell H, Lago-Rodriguez A, Galea JM, Miall RC, Popa T, Kishore A, Verschure PF, Zucca R, Herreros I. Consensus paper: towards a systems-level view of cerebellar function: the interplay between cerebellum, basal ganglia, and cortex. Cerebellum. 2017;16(1):203–29.

    Article  PubMed  Google Scholar 

  • Christakos CN, Erimaki S, Anagnostou E, Anastasopoulos D. Tremor-related motor unit firing in Parkinson’s disease: implications for tremor genesis. J Physiol. 2009;587(Pt 20):4811–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Crosby NJ, Deane KH, Clarke CE. Beta-blocker therapy for tremor in Parkinson’s disease. Cochrane Database Syst Rev. 2003;1:CD003361.

    Google Scholar 

  • Deuschl G, Raethjen J, Baron R, Lindemann M, Wilms H, Krack P. The pathophysiology of parkinsonian tremor: a review. J Neurol. 2000;247(Suppl 5):V33–48.

    Article  PubMed  Google Scholar 

  • Fasano A, Llinas M, Munhoz RP, Hlasny E, Kucharczyk W, Lozano AM. MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes. Neurology. 2017;89(8):771–5.

    Article  PubMed  Google Scholar 

  • Findley LJ, Koller WC. Handbook of tremor disorders. New York: Marcel Dekker; 1995.

    Google Scholar 

  • Fishman PS. Paradoxical aspects of parkinsonian tremor. Mov Disord. 2008;23(2):168–73.

    Article  PubMed  Google Scholar 

  • Fois AF, Chang FC, Barnett R, London K, Mahant N, Ha A, Aldaajani Z, Cruse B, Morales-Briceno H, Ma KK, Farlow D, Fung VS. Rest tremor correlates with reduced contralateral striatal dopamine transporter binding in Parkinson’s disease. Parkinsonism Relat Disord. 2021;85:102–8.

    Article  CAS  PubMed  Google Scholar 

  • Foltynie T, Brayne C, Barker RA. The heterogeneity of idiopathic Parkinson’s disease. J Neurol. 2002;249:138–45.

    Article  PubMed  Google Scholar 

  • Gigante AF, Pellicciari R, Iliceto G, Liuzzi D, Mancino PV, Custodero GE, Guido M, Livrea P, Defazio G. Rest tremor in Parkinson’s disease: Body distribution and time of appearance. J Neurol Sci. 2017;15(375):215–9.

    Article  Google Scholar 

  • Gupta N, Pandey S. Rest tremor in dystonia: epidemiology, differential diagnosis, and pathophysiology. Neurol Sci. 2020;41(9):2377–2388.

    Article  PubMed  Google Scholar 

  • Habib-ur-Rehman. Diagnosis and management of tremor. Arch Intern Med. 2000;160(16):2438–44.

    Article  CAS  PubMed  Google Scholar 

  • Hellmann MA, Melamed E, Steinmetz AP, Djaldetti R. Unilateral lower limb rest tremor is not necessarily a presenting symptom of Parkinson’s disease. Mov Disord. 2010;25(7):924–7.

    Article  PubMed  Google Scholar 

  • Helmich R. The cerebral basis of Parkinsonian tremor: A network perspective. Mov Disord. 2018;33(2):219–231.

    Google Scholar 

  • Henderson JM, Yiannikas C, Morris JG, Einstein R, Jackson D, Byth K. Postural tremor of Parkinson’s disease. Clin Neuropharmacol. 1994;17(3):277–85.

    Article  CAS  PubMed  Google Scholar 

  • Hirschmann J, Butz M, Hartmann CJ, Hoogenboom N, Özkurt TE, Vesper J, Wojtecki L, Schnitzler A. Parkinsonian rest tremor is associated with modulations of subthalamic high-frequency oscillations. Mov Disord. 2016;31(10):1551–9.

    Article  CAS  PubMed  Google Scholar 

  • Hopfensperger KJ, Busenbark K, Koller WC. Midbrain tremor. In: Findley LJ, Koller WC, editors. Handbook of tremor disorders. New York: Marcel Dekker; 1995. p. 455–9.

    Google Scholar 

  • Italian Neurological Society; Italian Society of Clinical Neurophysiology. Guidelines for the treatment of Parkinson’s disease 2002. The diagnosis of Parkinson’s disease. Neurol Sci. 2003;24(3):S157–64.

    Google Scholar 

  • Jellinger KA. Post mortem studies in Parkinson’s disease – is it possible to detect brain areas for specific symptoms? J Neural Transm. (Supplement). 1999:1–29.

    Google Scholar 

  • Jiménez MC, Vingerhoets FJ. Tremor revisited: treatment of PD tremor. Parkinsonism Relat Disord. 2012;18(Suppl 1):S93–5.

    Article  PubMed  Google Scholar 

  • Kalra S, Grosset DG, Benamer HT. Differentiating vascular parkinsonism from idiopathic Parkinson’s disease: a systematic review. Mov Disord. 2010;25(2):149–56.

    Article  PubMed  Google Scholar 

  • Kelly RM, Strick PL. Cerebellar loops with motor cortex and prefrontal cortex of a nonhuman primate. J Neurosci. 2003;23:8432–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kinnerup MB, Sommerauer M, Damholdt MF, Schaldemose JL, Ismail R, Terkelsen AJ, Stær K, Hansen A, Fedorova TD, Knudsen K, Skjærbæk C, Borghammer P, Pavese N, Brooks DJ, Nahimi A. Preserved noradrenergic function in Parkinson's disease patients with rest tremor. Neurobiol Dis. 2021;152:105295.

    Article  CAS  PubMed  Google Scholar 

  • Kraus PH, Lemke MR, Reichmann H. Kinetic tremor in Parkinson’s disease–an underrated symptom. J Neural Transm. 2006;113(7):845–53.

    Article  CAS  PubMed  Google Scholar 

  • Kulisevsky J. Emerging role of safinamide in parkinson’s disease therapy. Eur Neurol Rev. 2014;9(2):108–12.

    Article  Google Scholar 

  • Lake W, Hedera P, Konrad P. Deep brain stimulation for treatment of tremor. Neurosurg Clin N Am. 2019;30(2):147–59.

    Article  PubMed  Google Scholar 

  • Leodori G, Belvisi D, De Bartolo MI, Fabbrini A, Costanzo M, Vial F, Conte A, Hallett M, Berardelli A. Re-emergent tremor in parkinson’s disease: The role of the motor cortex. Mov Disord. 2020;35(6):1002–1011.

    Google Scholar 

  • Leodori G, De Bartolo MI, Fabbrini A, Costanzo M, Mancuso M, Belvisi D, Conte A, Fabbrini G, Berardelli A. The role of the motor cortex in tremor suppression in parkinson’s disease. J Parkinsons Dis. 2022;12(6):1957–1963.

    Google Scholar 

  • Lin F, Wu D, Yu J, Weng H, Chen L, Meng F, Chen Y, Ye Q, Cai G. Comparison of efficacy of deep brain stimulation and focused ultrasound in parkinsonian tremor: a systematic review and network meta-analysis. J Neurol Neurosurg Psychiatry. 2021:jnnp-2020-323656.

    Google Scholar 

  • Llinas R, Paré D. Role of intrinsic neuronal oscillations and network ensembles in the genesis of normal and pathological tremors. In: Findley LJ, Koller WC, editors. Handbook of tremor disorders. New York: Marcel Dekker; 1995.

    Google Scholar 

  • Louis ED, Asabere N, Agnew A, et al. Rest tremor in advanced essential tremor: a post-mortem study of nine cases. J Neurol Neurosurg Psychiatry. 2011;82(3):261–5.

    Article  PubMed  Google Scholar 

  • Magerkurth C, Schnitzer R, Braune S. Symptoms of autonomic failure in Parkinson’s disease: prevalence and impact on daily life. Clin Auton Res. 2005;15(2):76–82.

    Article  PubMed  Google Scholar 

  • Marshall VL, Reininger CB, Marquardt M, et al. Parkinson’s disease is overdiagnosed clinically at baseline in diagnostically uncertain cases: a 3-year European multicenter study with repeat [123I]FP-CIT SPECT. Mov Disord. 2009;24:500–8.

    Article  PubMed  Google Scholar 

  • Monaco EA III, Shin SS, Niranjan A, Lunsford LD. Radiosurgical thalamotomy. Prog Neurol Surg. 2018;33:135–48.

    Article  PubMed  Google Scholar 

  • Niemann N, Jankovic J. Botulinum toxin for the treatment of hand tremor. Toxins (Basel). 2018;10(7):299.

    Article  PubMed  Google Scholar 

  • Nisticò R, Pirritano D, Salsone M, Novellino F, Del Giudice F, Morelli M, Trotta M, Bilotti G, Condino F, Cherubini A, Valentino P, Quattrone A. Synchronous pattern distinguishes resting tremor associated with essential tremor from rest tremor of Parkinson’s disease. Parkinsonism Relat Disord. 2011;17(1):30–3.

    Article  PubMed  Google Scholar 

  • Parkinson Study Group. A randomized placebo-controlled trial of rasagiline in levodopa-treated patients with Parkinson disease and motor fluctuations: the PRESTO study. Arch Neurol. 2005;62(2):241–8.

    Article  Google Scholar 

  • Piao YS, Mori F, Hayashi S, Tanji K, Yoshimoto M, Kakita A, Wakabayashi K, Takahashi H. Alpha-synuclein pathology affecting Bergmann glia of the cerebellum in patients with alphasynucleinopathies. Acta Neuropathol. 2003;105:403–9.

    Article  PubMed  Google Scholar 

  • Pollok B, Gross J, Dirks M, Timmermann L, Schnitzler A. The cerebral oscillatory network of voluntary tremor. J Physiol. 2004;554(Pt 3):871–8.

    Article  CAS  PubMed  Google Scholar 

  • Raethjen J, Lindemann M, Schmaljohann H, Wenzelburger R, Pfister G, Deuschl G. Multiple oscillators are causing parkinsonian and essential tremor. Mov Disord. 2000;15(1):84–94.

    Article  CAS  PubMed  Google Scholar 

  • Raethjen J, Pohle S, Govindan RB, Morsnowski A, Wenzelburger R, Deuschl G. Parkinsonian action tremor: interference with object manipulation and lacking levodopa response. Exp Neurol. 2005;194(1):151–60.

    Article  CAS  PubMed  Google Scholar 

  • Rajput AH, Sitte HH, Rajput AH, Fenton ME, Pifl C, Hornykiewicz O. Globus pallidus dopamine and Parkinson motor subtypes. Clinical and brain biochemical correlation. Neurology. 2008;70(16 Pt 2):1403–10.

    Article  CAS  PubMed  Google Scholar 

  • Reck C, Himmel M, Florin E, Maarouf M, Sturm V, Wojtecki L, Schnitzler A, Fink GR, Timmermann L. Coherence analysis of local field potentials in the subthalamic nucleus: differences in parkinsonian rest and postural tremor. Eur J Neurosci. 2010;32(7):1202–14.

    Article  PubMed  Google Scholar 

  • Shakkottai VG, Batla A, Bhatia K, Dauer WT, Dresel C, Niethammer M, Eidelberg D, Raike RS, Smith Y, Jinnah HA, Hess EJ, Meunier S, Hallett M, Fremont R, Khodakhah K, LeDoux MS, Popa T, Gallea C, Lehericy S, Bostan AC, Strick PL. Current opinions and areas of consensus on the role of the cerebellum in dystonia. Cerebellum. 2017;16(2):577–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thanvi B, Lo N, Robinson T. Vascular parkinsonism–an important cause of parkinsonism in older people. Age Ageing. 2005;34(2):114–9.

    Article  PubMed  Google Scholar 

  • The Parkinson Study Group. Dopamine transporter brain imaging to assess the effects of pramipexole vs. levodopa on Parkinson disease progression. JAMA. 2002;287:1653–61.

    Article  Google Scholar 

  • Timmermann L, Gross J, Dirks M, Volkmann J, Freund HJ, Schnitzler A. The cerebral oscillatory network of parkinsonian resting tremor. Brain. 2003;126:199–212.

    Article  PubMed  Google Scholar 

  • Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, Middelkoop HA, van Hilten JJ. Cognitive impairment in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2007;78(11):1182–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Weinberger M, Hutchison WD, Lozano AM, Hodaie M, Dostrovsky JO. Increased gamma oscillatory activity in the subthalamic nucleus during tremor in Parkinson’s disease patients. J Neurophysiol. 2009;101(2):789–802.

    Article  CAS  PubMed  Google Scholar 

  • Whone AL, Watts RL, Stoessl AJ, et al. Slower progression of Parkinson’s disease with ropinirole versus levodopa: the REALPET study. Ann Neurol. 2003;54:93–101.

    Article  CAS  PubMed  Google Scholar 

  • Wüllner U, Schmitz-Hübsch T, Abele M, Antony G, Bauer P, Eggert K. Features of probable multiple system atrophy patients identified among 4770 patients with parkinsonism enrolled in the multicentre registry of the German Competence Network on Parkinson’s disease. J Neural Transm. 2007;114(9):1161–5.

    Article  PubMed  Google Scholar 

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Grimaldi, G., Manto, M. (2023). Rest Tremor. In: Grimaldi, G., Manto, M. (eds) Mechanisms and Emerging Therapies in Tremor Disorders. Contemporary Clinical Neuroscience. Springer, Cham. https://doi.org/10.1007/978-3-031-26128-2_6

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