Holmes’ Midbrain Tremor

  • Roongroj Bhidayasiri
  • Daniel Tarsy
Part of the Current Clinical Neurology book series (CCNEU)


Holmes’ tremor, also known as thalamic, midbrain, or rubral tremor, is characterized by a combination of irregular resting, postural, and intention tremors of large amplitude and slow frequency of less than 4.5 Hz. The tremor predominantly affects the proximal upper extremities unilaterally and is often markedly activated by goal-directed movements. Etiology is usually a structural lesion of the brainstem, cerebellum, or thalamus as a result of stroke, vascular malformation, tumor, multiple sclerosis, trauma, or infection. There may be a variable delay of 2 weeks to 2 years between the precipitating event and the initial appearance of tremor.

Supplementary material

Holmes midbrain tremor.mp4 (MP4 5,548KB)

Clip 1: the patient exhibits severe postural tremor of the left arm. Not shown are equally severe resting and kinetic tremor. Clip 2: the patient attempts goal-directed arm movements but is unable to carry them out (Video contribution from Dr. Parnsiri Chairangsaris, Pramongkutklao Hospital, Thailand).


  1. 1.
    Deuschl G, Bain P, Brin M, et al. Consensus statement of the Movement Disorder Society on tremor. Mov Disord. 1998;13 Suppl 3:2–23.PubMedGoogle Scholar
  2. 2.
    Gajos GA, Bogucki A, Schinwelski M, et al. The clinical and neuroimaging studies in Holmes tremor. Acta Neurol Scand. 2010;122:360–6.PubMedGoogle Scholar
  3. 3.
    Paviour DC, Jager HR, Wilkinson L, et al. Holmes’ tremor: application of modern neuroimaging technique. Mov Disord. 2006;21:2260–2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Roongroj Bhidayasiri
    • 1
    • 2
  • Daniel Tarsy
    • 3
  1. 1.Chulalongkorn Center of Excellence on Parkinson’s Disease and Related DisordersChulalongkorn University HospitalBangkokThailand
  2. 2.Department of NeurologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of NeurologyHarvard Medical School Beth Israel Deaconess Medical CenterBostonUSA

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