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:

• Mechanical oscillations: Occurs in limbs, could be limited to a particular joint
• Reflex oscillations: Originates from afferent muscle spindles
• Central neuronal pacemaker: Involves thalamus, basal ganglia, inferior olive.
• Cerebellar Oscillations: Disturbance in feedforward or feedback loops in cerebellum resulting in oscillations.

Pathogenesis

• It is understood that tremor is the result of oscillations produced by the above-mentioned mechanisms.
• Following are some common causes of tremor and the mechanisms they originate from:

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

[Disease name] is transmitted in [mode of genetic transmission] pattern.

OR

Genes involved in the pathogenesis of [disease name] include:

• [Gene1]
• [Gene2]
• [Gene3]

OR

The development of [disease name] is the result of multiple genetic mutations such as:

• [Mutation 1]
• [Mutation 2]
• [Mutation 3]

Associated Conditions

Conditions associated with [disease name] include:

• [Condition 1]
• [Condition 2]
• [Condition 3]

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].