Case report of holmes tremor and brief literature review

Abstract

Introduction: Holmes Tremor is a slow frequency tremor, with an irregular presentation of rest and intention tremor, with postural component not obligatory. The Holmes tremor physiopathology, although not completely elucidated, can be explained by lesions in both basal ganglia-thalamo-cortical loop and cerebellum-thalamo cortical loop, and can be treated with a conservative approach– pharmacological treatment – or with surgery. It is reported a case that a surgery was elected as treatment, that resulted in a stimulation of the Ventralis Intermedius (Vim) and Zona Incerta (ZI). Case Presentation: Female patient, 41 years old, with Holmes Tremor involving both upper limbs, more predominant on the right side, and affecting more the proximal than the distal region of the limb. The tremor was both of rest and action, exacerbated by movement, anxiety, and stress. Due to functional impairment and failure of conservative neurological treatment with pharmacotherapy, a neurosurgical procedure was requested for implantation of two electrodes, targeting the Vim and ZI, on the left side for tremor control. Conclusion: Holmes Tremor is a complex syndrome and has its pathophysiology not so well elucidated. The case report describes an implantation of an electrode that had positive outcomes for the patient.