Abstract
Transcranial magnetic stimulation (TMS) is a painless, non-invasive, and established brain stimulation technique to investigate human brain function. Over the last three decades, TMS has shed insight into the pathophysiology of many neurological disorders. Tremor is an involuntary, rhythmic oscillatory movement disorder commonly related to pathological oscillations propagated via the cerebello-thalamo-cortical pathway. Although tremor is the most common movement disorder and recent imaging studies have enhanced our understanding of the critical pathogenic networks, the underlying pathophysiology of different tremor syndromes is complex and still not fully understood. TMS has been used as a tool to further our understanding of tremor pathophysiology. In addition, repetitive TMS (rTMS) that can modulate brain functions through plasticity effects has been targeted to the tremor network to gain potential therapeutic benefits. However, evidence is available for only a few studies that included small patient samples with limited clinical follow-up. This review aims to discuss the role of TMS in advancing the pathophysiological understanding as well as emerging applications of rTMS for treating individual tremor syndromes. The review will focus on essential tremor, Parkinson's disease tremor, dystonic tremor syndrome, orthostatic tremor, and functional tremor.
Highlights
Tremor is the most common movement disorder, defined as an “involuntary, rhythmic, oscillatory movement of a body part” [1]
Single pulse Transcranial magnetic stimulation (TMS) paradigms have been helpful in demonstrating the brain circuitry that is likely involved in the generation of tremor
Single pulse TMS targeted to the primary motor cortex has resulted in tremor reset for both essential tremor (ET) and rest tremor in Parkinson’s disease (PD) [13, 14, 20, 27, 29] as well as for re-emergent tremor in PD [34], suggesting similar circuitry involved in the generation of these two tremor syndromes
Summary
Tremor is the most common movement disorder, defined as an “involuntary, rhythmic, oscillatory movement of a body part” [1]. TMS produces a magnetic field that induces a transient focal electric field in the targeted brain region. It can identify brain circuits involved in motor control and motor disorders and is an appealing technique for studying pathological tremors. It has shown promise as a potential treatment for tremors due to its ability to modulate the underlying pathological circuitry and brain functions. The current narrative review will discuss the role of TMS in understanding the pathophysiology and treatment for essential tremor (ET), Parkinson’s disease (PD) tremor, dystonic tremor syndrome (DTS), and the less common or rare tremor syndromes such as orthostatic tremor (OT) and functional tremor
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