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| Clinical characteristics of Holmes tremor and its diagnosis and treatment |
| LYU Xinhuang, HONG Qian, TONG Qiuling, LI Jing, ZHANG Yang, CHEN Weian |
| Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China |
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| Cite this article: |
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LYU Xinhuang,HONG Qian,TONG Qiuling, et al. Clinical characteristics of Holmes tremor and its diagnosis and treatment[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2020, 50(8): 632-636.
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Abstract Objective: To explore the clinical characteristics, etiology, imaging manifestations and treatment of Holmes tremor (HT). Methods: A retrospective analysis of the medical records and videos of 6 HT patients in the First Affiliated Hospital of Wenzhou Medical University from September 2015 to June 2018 was made. Results: A total of 2 females and 4 males were included, aged ranging 14-67 years at the moment of CNS insult. Etiology showed hemorrhage in 3 cases, infarction in 1 case, traumatic brain injury in 1 case, and optic neuromyelitis spectrum disease in 1 case. The median latency from lesion to tremor onset was 2 months (ranging from 14 days to 8 months). Symptoms/signs associated with HT included hemiplegia in 4 cases, ataxia in 3 cases, hypoesthesia in 3 cases, dystonia in 2 cases, cranial nerve involvement, dysarsaras and palatal clonus in 1 case. MRI showed lesions in midbrain 5 cases, thalamus 4 cases, and pontine in 1 case. In the short term, levodopa treatment significantly relieved 1 case and moderately relieved 2 cases: in 3 cases with combined treatment of clonazepam, 2 cases were significantly alleviated, but ineffective in 1 case. Three-year follow-up of 3 cases showed decline in effect. Conclusion: The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Levodopa and clonazepam have a certain therapeutic effect in the short term, but the long-term therapeutic effect is decreased.
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