Tremor

PURPOSE OF REVIEW: Tremor continuously attracts the attention of clinicians and basic researchers in search of pathophysiological, molecular and genetic mechanisms of the oscillatory activity. RECENT FINDINGS: A widespread dynamic network of cortical and subcortical oscillators taking part in tremor generation intermittently has been postulated. Essential tremor is accompanied by functional deficits but may also occur along with subtle cerebellar changes. According to recent epidemiological studies there may be a link of essential tremor with Parkinson's disease. Many of the epidemiologic studies suffer from small cohorts, small effects or the lack of a definite test for essential tremor leaving the diagnosis a pure clinical one. A very recent large genome-wide association study has revealed that the LINGO1 gene is associated with an increased risk for essential tremor. Topiramate is becoming the best-established second line treatment for essential tremor. Targets for deep brain stimulation in the grey matter below the ventral intermediate nucleus of the thalamus seem to be most effective. SUMMARY: New concepts of the central origin of tremors stimulate the search for new therapeutic targets for tremor suppression outside the basal ganglia and thalamus (e.g. cortex). The role of structural neurodegenerative changes in essential tremor remains an open question. Further studies on specific subgroups of patients are necessary.