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We read with interest the recent article by Josephs et al.¹ Like the experience at the Mayo Clinic, we have encountered patients with tremor-dominant Parkinson disease (PD), presenting with unilateral tremor, who have long and benign courses. Many of these patients have had minimal levodopa responsiveness except for modest improvement in segmental hypokinesia and perhaps tone. Several of these patients disabled by their tremor have now undergone subthalamic deep brain stimulation with near abolition of their tremor. We too believe that patients with tremor-dominant PD have long been ignored in the literature, often intermixed with those having rigid/akinetic disease in large series.

The question remains whether we are seeing a separate disease process, or just a variant of idiopathic PD. In general, tremor onset and tremor dominance in idiopathic PD confers benignity, while the absence of tremor often predicts a more rapidly progressive and debilitating disease.^2-3 We consider tremor-dominant PD . . . [Full Text of this Article]

AUTHOR INFORMATION

Gage Van Horn, MD; Mya C. Schiess, MD

RELATED ARTICLE

Benign Tremulous Parkinsonism
Keith A. Josephs, Joseph Y. Matsumoto, and J. Eric Ahlskog
Arch Neurol. 2006;63(3):354-357.
ABSTRACT | FULL TEXT