Ann Rehabil Med.  2014 Oct;38(5):694-697. 10.5535/arm.2014.38.5.694.

Effect of Ultrasonography-Guided Botulinum Toxin Type A Injection in Holmes' Tremor Secondary to Pontine Hemorrhage: Case Report

Affiliations
  • 1Department of Rehabilitation Medicine, Rehabilitation Hospital, National Rehabilitation Center, Seoul, Korea. asfreelyas@gmail.com
  • 2Division of Education & Public Relations, National Rehabilitation Center, Seoul, Korea.

Abstract

Holmes' tremor is a low-frequency rest and intentional tremor secondary to various insults, including cerebral ischemia, hemorrhage, trauma, or neoplasm. Pharmacologic treatment is usually unsuccessful, and some cases require surgical intervention. We report a rare case of Holmes' tremor secondary to left pontine hemorrhage in a 29-year-old Asian male patient who developed 1.6-Hz postural and rest tremor of the right hand. He responded markedly to ultrasonography-guided botulinum toxin type A injection. To our knowledge, this is the first report of Homes' tremor treated with ultrasonography-guided botulinum toxin type A injection with favorable results.

Keyword

Tremor; Botulinum toxins; Ultrasonography

MeSH Terms

Adult
Asian Continental Ancestry Group
Botulinum Toxins
Botulinum Toxins, Type A*
Brain Ischemia
Hand
Hemorrhage*
Humans
Male
Tremor*
Ultrasonography
Botulinum Toxins
Botulinum Toxins, Type A

Figure

  • Fig. 1 (A) Axial fluid-attenuated inversion recovery and (B) T2-weighted magnetic resonance imaging scans (inset) showing acute intracerebral hemorrhage in the left pons (arrow).

  • Fig. 2 Ultrasonographic image of the right second flexor digitorum superficialis (FDS2). The needle (arrowheads) is advanced into the FDS2 under real-time ultrasonography guidance.


Reference

1. Holmes G. On certain tremors in organic cerebral lesions. Brain. 1904; 27:327–375.
Article
2. Deuschl G, Bergman H. Pathophysiology of nonparkinsonian tremors. Mov Disord. 2002; 17(Suppl 3):S41–S48. PMID: 11948754.
Article
3. Acar G, Acar F, Bir LS, Kizilay Z, Cırak B. Vim stimulation in Holmes' tremor secondary to subarachnoid hemorrhage. Neurol Res. 2010; 32:992–994. PMID: 20546686.
Article
4. Seidel S, Kasprian G, Leutmezer F, Prayer D, Auff E. Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes' tremor. J Neurol Neurosurg Psychiatry. 2009; 80:921–923. PMID: 18450789.
Article
5. Kim MC, Son BC, Miyagi Y, Kang JK. Vim thalamotomy for Holmes' tremor secondary to midbrain tumour. J Neurol Neurosurg Psychiatry. 2002; 73:453–455. PMID: 12235320.
Article
6. Striano P, Elefante A, Coppola A, Tortora F, Zara F, Minetti C, et al. Dramatic response to levetiracetam in post-ischaemic Holmes' tremor. J Neurol Neurosurg Psychiatry. 2007; 78:438–439. PMID: 17369598.
Article
7. Zeuner KE, Deuschl G. An update on tremors. Curr Opin Neurol. 2012; 25:475–482. PMID: 22772877.
Article
8. Simpson DM, Blitzer A, Brashear A, Comella C, Dubinsky R, Hallett M, et al. Assessment : Botulinum neurotoxin for the treatment of movement disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008; 70:1699–1706. PMID: 18458230.
9. Cartwright MS, Demar S, Griffin LP, Balakrishnan N, Harris JM, Walker FO. Validity and reliability of nerve and muscle ultrasound. Muscle Nerve. 2013; 47:515–521. PMID: 23400913.
Article
10. Wissel J, Ward AB, Erztgaard P, Bensmail D, Hecht MJ, Lejeune TM, et al. European consensus table on the use of botulinum toxin type A in adult spasticity. J Rehabil Med. 2009; 41:13–25. PMID: 19197564.
Article
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr