Holmes tremor associated with two different etiologies

Objectives: Holmes tremor is a rare debilitating movement disorder characterized by low-frequency tremor at rest and during postural and intentional conditions. We aimed to present two cases of Holmes tremor with two different etiologies including brain abscess and multiple sclerosis. Cases presentation: A 6-year-old girl, who was followed up with mild left hemiparesis due to brain abscess, was admitted to our unit with left arm tremor in the third month of brain abscess. Neurological examination exhibited mild left hemiparesis, and 4-5 Hz frequency tremor at rest and during intentional condition. Cranial MRI showed atrophy in the right thalamus, and resection cavity in the right frontal lobe. She was treated with clonazepam and trihexyphenidyl. A significant decrease was observed in the severity and frequency of tremor. The other patient is a 16-year-old boy followed up with the diagnosis of multiple sclerosis. He was admitted to our unit with right-sided tremor in the second month of diagnosis of multiple sclerosis. Neurological examination revealed slow proximal right-sided tremor and dystonic posturing of the left leg. Cranial MRI showed multiple hyperintense lesions on juxtacortical, cortical and periventricular areas, posterior limb of the internal capsule, and thalamus on T2 and FLAIR sequences. Tremor improved significantly within 2 months with copaxone and levodopa treatment. Conclusion: Depending on the underlying causes, Holmes tremor often persists despite various combined therapies. However, in our cases, tremor responded well to pharmacological interventions.
Keywords: Brain abscess, Holmes tremor, multiple sclerosis, thalamic