Botulinum toxin type A for Holmes tremor secondary to thalamic hemorrhage
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Holmes tremor (HT) is a low-frequency rest and intentional tremor frequently affecting the upper limb. The tremor, typically aggravated by movements, may in addition show an intrinsic postural component. It develops weeks to months after the onset of focal lesions of the brainstem, cerebellum and thalamus . The response to a number of pharmacological agents consistently employed in the clinical practice, including levodopa, dopamine agonists, levetiracetam, clonazepam, zonisamide and propranolol, is rather unsatisfactory . In drug-refractory cases, thalamotomy or deep brain stimulation of the nucleus ventralis intermedius of the thalamus may prove useful, but neurosurgical approaches, although potentially beneficial, are limited or avoided for being invasive and expensive .
Herewith, we report on a subject suffering for HT secondary to thalamic hemorrhage. The patient showed a good response to treatment with botulinum toxin type A (BoNT-A).
KeywordsDeep Brain Stimulation Levetiracetam Essential Tremor Zonisamide Botulinum Toxin Type
Conflict of interest
The authors report no sources of fundings and no conflict of interests.
Informed consent was obtained from the participant of the study.
Supplementary material 1 (AVI 23878 kb). A video accompanying this article is available in the supporting information here. Video. Pre-therapy session: resting, postural and kinetic tremor of the right arm. The tremor was irregular, of large amplitude, mostly proximal (involving the deltoid, biceps and triceps brachii), and accompanied by athetoid movements at the right hand. Post-therapy session: significant reduction of tremor severity, in particular of resting and postural components