Tremor pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

It is thought that tremor is the result of a combination of different mechanisms that could result in oscillatory/rhythmic movement. These mechanisms are mechanical oscillations, reflex oscillations, central oscillations, and cerebellar oscillation. These mechanisms differ on the basis of their origin.

Pathophysiology

Physiology

The normal physiology of tremor is based on the four oscillatory centers: [1][2][3]

Pathogenesis

  • It is understood that tremor is the result of oscillations produced by the above-mentioned mechanisms.
  • The following are some common causes of tremor and the mechanisms from which they originate: [1]
Common Causes of Tremor Predominant Mechanism
Physiological tremor Mechanical and central
Psychogenic tremor Reflex (clonus)
Symptomatic palatal tremor Central (inferior olive)
Essential tremor Central and cerebellar (olivocerebellar circuits)
Parkinson's disease Central (basal ganglia)
Toxic and drug‐induced tremors Reflex

Genetics

Associated Conditions

Conditions associated with tremor include:

Gross Pathology

On gross pathology, Parkinson's disease has loss of dopamine pigment in the substantia nigra.

Microscopic Pathology

On microscopic histopathological analysis, Lewy bodies and Lewy neurites are found in neuronal cell bodies and neuronal cell processes, respectively in patients with Parkinson's disease.

References

  1. 1.0 1.1 Deuschl G, Raethjen J, Lindemann M, Krack P (2001). "The pathophysiology of tremor". Muscle Nerve. 24 (6): 716–35. doi:10.1002/mus.1063. PMID 11360255.
  2. Deuschl G, Krack P, Lauk M, Timmer J (1996). "Clinical neurophysiology of tremor". J Clin Neurophysiol. 13 (2): 110–21. doi:10.1097/00004691-199603000-00002. PMID 8849966.
  3. Elble RJ (1996). "Central mechanisms of tremor". J Clin Neurophysiol. 13 (2): 133–44. doi:10.1097/00004691-199603000-00004. PMID 8849968.
  4. Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Lorenzo-Betancor O, Pastor P, Agúndez JA (2013). "Update on genetics of essential tremor". Acta Neurol Scand. 128 (6): 359–71. doi:10.1111/ane.12148. PMID 23682623.
  5. Ala A, Walker AP, Ashkan K, Dooley JS, Schilsky ML (2007). "Wilson's disease". Lancet. 369 (9559): 397–408. doi:10.1016/S0140-6736(07)60196-2. PMID 17276780.