Tremor in Parkinson's Disease

Abstract

Tremor is one of the most visible and distressing symptoms of Parkinson's disease (PD), ranking high among patients' most bothersome features. While levodopa is the most effective pharmacological therapy, approximately half of patients report insufficient tremor control, and refractory tremor remains a major therapeutic challenge. The psychosocial impact of tremor is profound: its visibility leads to embarrassment, stigma, and emotional distress, while its interference with daily activities and professional life compounds disability. Prevalence studies suggest that nearly all individuals with PD experience tremor at some point, though its severity fluctuates over time and may plateau or improve in later disease stages. Tremor pathophysiology differs from bradykinesia and rigidity, involving both basal ganglia and cerebello-thalamo-cortical circuits, supporting the “dimmer-switch” model. Management strategies include dopaminergic and nondopaminergic medications, deep brain stimulation, and emerging interventions such as MR-guided focused ultrasound. Optimizing therapy remains crucial to alleviating tremor-related burden in PD.

Keywords

PD - tremor - pathophysiology - treatment

Publication History

Received: 28 August 2025

Accepted: 09 December 2025

Article published online:
19 December 2025

• References

• 1 Lerner A, Mammen JR, Tyo M. et al. Fox insight: most bothersome symptoms in early-stage Parkinson's disease. Mov Disord Clin Pract 2024; 2025: 1-6
• 2 Politis M, Wu K, Molloy S, GBain P, Chaudhuri KR, Piccini P. Parkinson's disease symptoms: the patient's perspective. Mov Disord 2010; 25 (11) 1646-1651
• 3 Hauser RA, Skarpaas TC, Merriam A. et al. Burden of tremor in Parkinson's disease: A survey study. J Parkinsons Dis 2025; 15 (03) 541-551
• 4 Port RJ, Rumsby M, Brown G, Harrison IF, Amjad A, Bale CJ. People with Parkinson's disease: what symptoms do they most want to improve and how does this change with disease duration?. J Parkinsons Dis 2021; 11 (02) 715-724
• 5 Heusinkveld LE, Hacker ML, Turchan M, Davis TL, Charles D. Impact of tremor on patients with early stage Parkinson's disease. Front Neurol 2018; 9 (628) 628
• 6 Hou M, Mao X, Hou X, Li K. Stigma and associated correlates of elderly patients with Parkinson's disease. Front Psychiatry 2021; 12 (708960): 708960
• 7 Pirker W, Katzenschlager R, Hallett M, Poewe W. Pharmacological treatment of tremor in Parkinson's disease revisited. J Parkinsons Dis 2023; 13 (02) 127-144
• 8 Louis ED. More time with tremor: the experience of essential tremor versus Parkinson's disease patients. Mov Disord Clin Pract 2016; 3 (01) 36-42
• 9 Zhou H, Shen C, Chen J. et al. Tremor and clinical fluctuation are related to sleep disorders in Chinese patients with Parkinson's disease. Transl Neurodegener 2014; 3 (01) 21
• 10 Louis ED, Machado DG. Tremor-related quality of life: a comparison of essential tremor vs. Parkinson's disease patients. Parkinsonism Relat Disord 2015; 21 (07) 729-735
• 11 Pasquini J, Deuschl G, Pecori A, Salvadori S, Ceravolo R, Pavese N. The clinical profile of tremor in Parkinson's disease. Mov Disord Clin Pract 2023; 10 (10) 1496-1506
• 12 Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K. Clinical correlates of action tremor in Parkinson disease. Arch Neurol 2001; 58 (10) 1630-1634
• 13 Kim HT, Edwards MJ, Lakshmi Narsimhan R, Bhatia KP. Hyperthyroidism exaggerating Parkinsonian tremor: a clinical lesson. Parkinsonism Relat Disord 2005; 11 (05) 331-332
• 14 Minár M, Valkovič P. Thyroid-induced worsening of Parkinsonian tremor resistant to drugs and subthalamic nucleus deep brain stimulation. Case Rep Neurol Med 2014; 2014: 489275
• 15 Mohammadzadeh N, Friedman JH. Winter cold exposure often increases tremor in Parkinson's disease. Parkinsonism Relat Disord 2024; 124 (March): 107021
• 16 Oertel W, Poewe W, Wolters E. et al. Effects of rivastigmine on tremor and other motor symptoms in patients with Parkinson's disease dementia: a retrospective analysis of a double-blind trial and an open-label extension. Drug Saf 2008; 31 (01) 79-94
• 17 Gurevich TY, Shabtai H, Korczyn AD, Simon ES, Giladi N. Effect of rivastigmine on tremor in patients with Parkinson's disease and dementia. Mov Disord 2006; 21 (10) 1663-1666
• 18 Maidment I, Fox C, Boustani M. Cholinesterase inhibitors for Parkinson's disease dementia. Cochrane Database Syst Rev 2006; 2006 (01) CD004747
• 19 Blakemore RL, MacAskill MR, Myall DJ, Anderson TJ. Volitional suppression of Parkinsonian resting tremor. Mov Disord Clin Pract 2019; 6 (06) 470-478
• 20 Fearon C, Lees AJ, McKinley JJ. et al. On the emergence of tremor in prodromal Parkinson's disease. J Parkinsons Dis 2021; 11 (01) 261-269
• 21 van der Heide A, Trenkwalder C, Bloem BR, Helmich RC. The last straw: how stress can unmask Parkinson's disease. J Parkinsons Dis 2024; 14 (04) 889-893
• 22 Gironell A, Kulisevsky J, Pascual-Sedano B, Pagonabarraga X. “Prodromic” tremor: prevalence and clinical correlates. Mov Disord 2007; 22 (08) 1203-1204
• 23 Kohat AK, Ng SYE, Wong ASY. et al. Stability of MDS-UPDRS motor subtypes over three years in early Parkinson's disease. Front Neurol 2021; 12 (704906): 704906
• 24 Lee JW, Song YS, Kim H, Ku BD, Lee WW. Alteration of tremor dominant and postural instability gait difficulty subtypes during the progression of Parkinson's disease: analysis of the PPMI cohort. Front Neurol 2019; 10 (471) 471
• 25 von Coelln R, Gruber-Baldini AL, Reich SG, Armstrong MJ, Savitt JM, Shulman LM. The inconsistency and instability of Parkinson's disease motor subtypes. Parkinsonism Relat Disord 2021; 88: 13-18
• 26 Deuschl G, Papengut F, Hellriegel H. The phenomenology of Parkinsonian tremor. Parkinsonism Relat Disord 2012; 18 (Suppl. 01) S87-S89
• 27 Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson's disease: from pathophysiology to advanced therapies. Tremor Other Hyperkinet Mov (N Y) 2022; 12 (01) 29
• 28 Selikhova M, Williams DR, Kempster PA, Holton JL, Revesz T, Lees AJ. A clinico-pathological study of subtypes in Parkinson's disease. Brain 2009; 132 (Pt 11): 2947-2957
• 29 Kipfer S, Stephan MA, Schüpbach WMM, Ballinari P, Kaelin-Lang A. Resting tremor in Parkinson disease: a negative predictor of levodopa-induced dyskinesia. Arch Neurol 2011; 68 (08) 1037-1039
• 30 Gigante AF, Pellicciari R, Iliceto G. et al. Rest tremor in Parkinson's disease: Body distribution and time of appearance. J Neurol Sci 2017; 375: 215-219
• 31 van den Berg KRE, Johansson ME, Dirkx MF, Bloem BR, Helmich RC. Changes in action tremor in Parkinson's disease over time: clinical and neuroimaging correlates. Mov Disord 2025; 40 (02) 292-304
• 32 Hallett M. Parkinson's disease tremor: pathophysiology. Parkinsonism Relat Disord 2012; 18 (Suppl. 01) S85-S86
• 33 Zach H, Dirkx M, Bloem BR, Helmich RC. The clinical evaluation of Parkinson's tremor. J Parkinsons Dis 2015; 5 (03) 471-474
• 34 Park S, Choi JH, Yoon WT, Lee JY. Unilateral resting tremor in a thigh muscle in Parkinson's disease. Tremor Other Hyperkinet Mov (N Y) 2020; 10 (01) 44
• 35 Ou R, Wei Q, Hou Y. et al. Facial tremor in patients with Parkinson's disease: prevalence, determinants and impacts on disease progression. BMC Neurol 2021; 21 (01) 86
• 36 Jaulent P, Laurencin C, Robert H, Thobois S. Parkinson's disease revealed by a resting tongue tremor. Mov Disord Clin Pract 2015; 2 (04) 432-433
• 37 Gan J, Xie-Brustolin J, Gervais-Bernard H, Vallet AE, Broussolle E, Thobois S. Possible Parkinson's disease revealed by a pure head resting tremor. J Neurol Sci 2009; 279 (1-2): 121-123
• 38 Neuville RS, Morenkova AE. Abdominal tremor in idiopathic Parkinson's disease: a case report. Tremor Other Hyperkinet Mov (N Y) 2024; 14 (01) 4
• 39 Tanaka N, Hayashi T, Tsuji S, Iwata A. Abdominal tremor in Parkinson's disease. Mov Disord Clin Pract 2015; 2 (01) 104-105
• 40 Rajalingam R, Breen DP, Chen R. et al. The clinical significance of lower limb tremors. Parkinsonism Relat Disord 2019; 65: 165-171
• 41 Roze E, Coêlho-Braga MC, Gayraud D. et al. Head tremor in Parkinson's disease. Mov Disord 2006; 21 (08) 1245-1248
• 42 Kaski D, Bronstein AM. Ocular tremor in Parkinson's disease: discussion, debate, and controversy. Front Neurol 2017; 8 (134) 134
• 43 Chahine LM, Arbatti L, Hosamath A. et al. Internal tremor in people with Parkinson's disease: demographic characteristics and comorbid symptoms. Clin Park Relat Disord 2023; 9: 100229
• 44 Cochrane GD, Rizvi S, Abrantes A, Crabtree B, Cahill J, Friedman JH. Internal tremor in Parkinson's disease, multiple sclerosis, and essential tremor. Parkinsonism Relat Disord 2015; 21 (10) 1145-1147
• 45 Pasquini J, Ceravolo R, Qamhawi Z. et al. Progression of tremor in early stages of Parkinson's disease: a clinical and neuroimaging study. Brain 2018; 141 (03) 811-821
• 46 Gironell A, Pascual-Sedano B, Aracil I, Marín-Lahoz J, Pagonabarraga J, Kulisevsky J. Tremor types in Parkinson disease: a descriptive study using a new classification. Parkinsons Dis 2018; 2018: 4327597
• 47 Gigante AF, Bruno G, Iliceto G. et al. Action tremor in Parkinson's disease: frequency and relationship to motor and non-motor signs. Eur J Neurol 2015; 22 (02) 223-228
• 48 Dirkx MF, Zach H, Bloem BR, Hallett M, Helmich RC. The nature of postural tremor in Parkinson disease. Neurology 2018; 90 (13) e1095-e1103
• 49 Swinnen BEKS, de Bie RMA, Hallett M, Helmich RC, Buijink AWG. Reconstructing Re-emergent Tremor. Mov Disord Clin Pract 2023; 10 (09) 1293-1296
• 50 Kang SY, Song S-K, Kim J-S, Sohn YH. Unilateral standing leg tremor as the initial manifestation of Parkinson disease. J Mov Disord 2009; 2 (01) 29-32
• 51 Lee SY, Chung EJ, Kim YJ, Kim SJ. Dopa responsive slow orthostatic tremor in Parkinson's disease. J Mov Disord 2011; 4 (02) 82-84
• 52 Thomas A, Bonanni L, Antonini A, Barone P, Onofrj M. Dopa-responsive pseudo-orthostatic tremor in Parkinsonism. Mov Disord 2007; 22 (11) 1652-1656
• 53 Apartis E, Tison F, Arné P, Jedynak CP, Vidailhet M. Fast orthostatic tremor in Parkinson's disease mimicking primary orthostatic tremor. Mov Disord 2001; 16 (06) 1133-1136
• 54 Yoo SW, Choi KE, So J, Lee KS, Kim JS. Pseudo-orthostatic tremor in idiopathic Parkinson's disease: could it be re-emergent tremor?. Neurol Sci 2019; 40 (03) 621-623
• 55 Raethjen J, Pohle S, Govindan RB, Morsnowski A, Wenzelburger R, Deuschl G. Parkinsonian action tremor: interference with object manipulation and lacking levodopa response. Exp Neurol 2005; 194 (01) 151-160
• 56 Gupta HV. Re-emergent kinetic tremor in Parkinson's disease. tremor and other hyperkinetic movements. Tremor Other Hyperkinet Mov (N Y) 2016; 6: 370
• 57 Battista JP, Greene PE. Improvement of primary writing tremor in Parkinson's disease with carbidopa/levodopa. Tremor Other Hyperkinet Mov (N Y) 2015; 5 (345) 345
• 58 Mascia MM, Orofino G, Cimino P, Cadeddu G, Ercoli T, Defazio G. Writing tremor in Parkinson's disease: frequency and associated clinical features. J Neural Transm (Vienna) 2022; 129 (12) 1481-1485
• 59 Burne JA, Hayes MW, Fung VSC, Yiannikas C, Boljevac D. The contribution of tremor studies to diagnosis of Parkinsonian and essential tremor: a statistical evaluation. J Clin Neurosci 2002; 9 (03) 237-242
• 60 Hunker CJ, Abbs JH. Uniform frequency of Parkinsonian resting tremor in the lips, jaw, tongue, and index finger. Mov Disord 1990; 5 (01) 71-77
• 61 Farkas Z, Csillik A, Szirmai I, Kamondi A. Asymmetry of tremor intensity and frequency in Parkinson's disease and essential tremor. Parkinsonism Relat Disord 2006; 12 (01) 49-55
• 62 Wilken M, Bruno V, Rossi M, Ameghino L, Deuschl G, Merello M. Sensitivity and specificity of different hand positions to assess upper limb rest tremor. Mov Disord 2019; 34 (04) 575-579
• 63 Raethjen J, Austermann K, Witt K, Zeuner KE, Papengut F, Deuschl G. Provocation of Parkinsonian tremor. Mov Disord 2008; 23 (07) 1019-1023
• 64 Costanzo M, Marchet F, Leodori G. et al. Neurophysiological features of tremor during walking in Parkinson's disease. Mov Disord Clin Pract 2025; 12 (02) 226-230
• 65 Costanzo M, Cutrona C, Leodori G. et al. Distal upper limb tremor during walking in Parkinson's disease. Mov Disord Clin Pract 2023; 10 (08) 1198-1202
• 66 Schwingenschuh P, Ruge D, Edwards MJ. et al. Distinguishing SWEDDs patients with asymmetric resting tremor from Parkinson's disease: a clinical and electrophysiological study. Mov Disord 2010; 25 (05) 560-569
• 67 Papengut F, Raethjen J, Binder A, Deuschl G. Rest tremor suppression may separate essential from Parkinsonian rest tremor. Parkinsonism Relat Disord 2013; 19 (07) 693-697
• 68 Jankovic J. How do I examine for re-emergent tremor?. Mov Disord Clin Pract 2016; 3 (02) 216-217
• 69 Malling ASB, Morberg BM, Wermuth L, Gredal O, Bech P, Jensen BR. The influence of posture duration on hand tremor during tasks with attention-distraction in persons with Parkinson's disease. J Neuroeng Rehabil 2019; 16 (01) 61
• 70 Mahendran S, Bichsel O, Gassert R, Baumann CR, Imbach LL, Waldvogel D. Differentiation of Parkinson's disease tremor and essential tremor based on a novel hand posture. Clin Park Relat Disord 2022; 7: 100146
• 71 Uchida K, Hirayama M, Yamashita F, Hori N, Nakamura T, Sobue G. Tremor is attenuated during walking in essential tremor with resting tremor but not Parkinsonian tremor. J Clin Neurosci 2011; 18 (09) 1224-1228
• 72 Schneider SA, Edwards MJ, Mir P. et al. Patients with adult-onset dystonic tremor resembling Parkinsonian tremor have scans without evidence of dopaminergic deficit (SWEDDs). Mov Disord 2007; 22 (15) 2210-2215
• 73 Pintér D, Forjaz MJ, Martinez-Martin P. et al. Which scale best detects treatment response of tremor in Parkinsonism?. J Parkinsons Dis 2020; 10 (01) 275-282
• 74 Forjaz MJ, Ayala A, Testa CM. et al; International Parkinson and Movement Disorder Society Tremor Rating Scale Task Force. Proposing a Parkinson's disease-specific tremor scale from the MDS-UPDRS. Mov Disord 2015; 30 (08) 1139-1143
• 75 Rodriguez F, Krauss P, Kluckert J. et al. Continuous and unconstrained tremor monitoring in Parkinson's disease using supervised machine learning and wearable sensors. Parkinsons Dis 2024; 2024: 5787563
• 76 Chen L, Cai G, Weng H. et al. More sensitive identification for bradykinesia compared to tremors in Parkinson's disease based on Parkinson's KinetiGraph (PKG). Front Aging Neurosci 2020; 12 (594701): 594701
• 77 Crowe C, Sica M, Kenny L. et al. Wearable-enabled algorithms for the estimation of Parkinson's symptoms evaluated in a continuous home monitoring setting using inertial sensors. IEEE Trans Neural Syst Rehabil Eng 2024; 32: 3828-3836
• 78 Dirkx MF, Bologna M. The pathophysiology of Parkinson's disease tremor. J Neurol Sci 2022; 435: 120196
• 79 Kish SJ, Shannak K, Hornykiewicz O. Uneven pattern of dopamine loss in the striatum of patients with idiopathic Parkinson's disease. Pathophysiologic and clinical implications. N Engl J Med 1988; 318 (14) 876-880
• 80 Eggers C, Kahraman D, Fink GR, Schmidt M, Timmermann L. Akinetic-rigid and tremor-dominant Parkinson's disease patients show different patterns of FP-CIT single photon emission computed tomography. Mov Disord 2011; 26 (03) 416-423
• 81 Jellinger KA. Neuropathology of sporadic Parkinson's disease: evaluation and changes of concepts. Mov Disord 2012; 27 (01) 8-30
• 82 Deutch AY, Elsworth JD, Goldstein M. et al. Preferential vulnerability of A8 dopamine neurons in the primate to the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Neurosci Lett 1986; 68 (01) 51-56
• 83 Sánchez-González MA, García-Cabezas MA, Rico B, Cavada C. The primate thalamus is a key target for brain dopamine. J Neurosci 2005; 25 (26) 6076-6083
• 84 Helmich RC, Janssen MJR, Oyen WJG, Bloem BR, Toni I. Pallidal dysfunction drives a cerebellothalamic circuit into Parkinson tremor. Ann Neurol 2011; 69 (02) 269-281
• 85 Dirkx MF, den Ouden HEM, Aarts E. et al. Dopamine controls Parkinson's tremor by inhibiting the cerebellar thalamus. Brain 2017; 140 (03) 721-734
• 86 Helmich RC, Van den Berg KRE, Panyakaew P. et al. Cerebello-cortical control of tremor rhythm and amplitude in Parkinson's disease. Mov Disord 2021; 36 (07) 1727-1729
• 87 Lauro PM, Lee S, Akbar U, Asaad WF. Subthalamic-cortical network reorganization during Parkinson's tremor. J Neurosci 2021; 41 (47) 9844-9858
• 88 Kelley CR, Kauffman JL. Parkinsonian tremor as unstable feedback in a physiologically consistent control framework. IEEE Trans Neural Syst Rehabil Eng 2024; 32: 2665-2675
• 89 DeLong MR, Wichmann T. Circuits and circuit disorders of the basal ganglia. Arch Neurol 2007; 64 (01) 20-24
• 90 Magnusson JL, Leventhal DK. Revisiting the “paradox of stereotaxic surgery”: insights into basal ganglia-thalamic interactions. Front Syst Neurosci 2021; 15: 725876
• 91 Hirschmann J, Abbasi O, Storzer L. et al. Longitudinal recordings reveal transient increase of alpha/low-beta power in the subthalamic nucleus associated with the onset of Parkinsonian rest tremor. Front Neurol 2019; 10 (145) 145
• 92 de Bie RMA, Katzenschlager R, Swinnen BEKS. et al. Update on treatments for Parkinson's disease motor fluctuations - an international Parkinson and movement disorder society evidence-based medicine review. Mov Disord 2025; 40 (05) 776-794
• 93 Yuill GM. Letter: Effect of levodopa on Parkinsonian tremor. BMJ 1976; 1 (6004) 283-284
• 94 Coppen A, Metcalfe M, Carroll JD, Morris JGL. Levodopa and L-tryptophan therapy in Parkinsonism. Lancet 1972; 1 (7752) 654-658
• 95 Swinnen BEKS, Frequin HL, Wiggerts Y, Espay AJ, Beudel M, de Bie RMA. Tremor is highly responsive to levodopa in advanced Parkinson's disease. Mov Disord Clin Pract 2025; 12 (01) 76-81
• 96 Wirth T, Ferreira F, Vijiaratnam N. et al. Parkinson's disease tremor differentially responds to levodopa and subthalamic stimulation. Mov Disord Clin Pract 2023; 10 (11) 1639-1649
• 97 Krack P, Pollak P, Limousin P, Benazzouz A, Benabid AL. Stimulation of subthalamic nucleus alleviates tremor in Parkinson's disease. Lancet 1997; 350 (9092) 1675
• 98 Frequin HL, Schouten J, Verschuur CVM. et al; LEAP Study Group. Levodopa response in patients with early Parkinson disease: further observations of the LEAP study. Neurology 2023; 100 (04) e367-e376
• 99 Mestre TA, Stebbins GT, Luo S, Goetz CG. Tremor is commonly responsive to levodopa along the natural history of Parkinson's disease. Mov Disord Clin Pract 2025; 12 (10) 1684-1685
• 100 Hellmann MA, Sabach T, Melamed E, Djaldetti R. Effect of subcutaneous apomorphine on tremor in idiopathic Parkinson's disease. Biomed Pharmacother 2008; 62 (04) 250-252
• 101 Schrag A, Keens J, Warner J. Ropinirole Study Group. Ropinirole for the treatment of tremor in early Parkinson's disease. Eur J Neurol 2002; 9 (03) 253-257
• 102 Navan P, Findley LJ, Jeffs JAR, Pearce RKB, Bain PG. Randomized, double-blind, 3-month parallel study of the effects of pramipexole, pergolide, and placebo on Parkinsonian tremor. Mov Disord 2003; 18 (11) 1324-1331
• 103 Negrotti A, Bizzarri G, Calzetti S. Long-term persistence of symptomatic effect of selegiline in Parkinson's disease. A two-months placebo-controlled withdrawal study. J Neural Transm (Vienna) 2001; 108 (02) 215-219
• 104 Jiménez MC, Vingerhoets FJG. Tremor revisited: treatment of PD tremor. Parkinsonism Relat Disord 2012; 18 (Suppl. 01) S93-S95
• 105 Fernandez HH, Robieson WZ, Chatamra K. et al. Effect of levodopa-carbidopa intestinal gel on resting tremors in patients with advanced Parkinson's disease. NPJ Parkinsons Dis 2016; 2 (16015): 16015
• 106 Schrag A, Schelosky L, Scholz U, Poewe W. Reduction of Parkinsonian signs in patients with Parkinson's disease by dopaminergic versus anticholinergic single-dose challenges. Mov Disord 1999; 14 (02) 252-255
• 107 Friedman JH, Koller WC, Lannon MC, Busenbark K, Swanson-Hyland E, Smith D. Benztropine versus clozapine for the treatment of tremor in Parkinson's disease. Neurology 1997; 48 (04) 1077-1081
• 108 Jansen EN. Clozapine in the treatment of tremor in Parkinson's disease. Acta Neurol Scand 1994; 89 (04) 262-265
• 109 Bonuccelli U, Ceravolo R, Salvetti S. et al. Clozapine in Parkinson's disease tremor. Effects of acute and chronic administration. Neurology 1997; 49 (06) 1587-1590
• 110 Yaw TK, Fox SH, Lang AE. Clozapine in Parkinsonian rest tremor: a review of outcomes, adverse reactions, and possible mechanisms of action. Mov Disord Clin Pract 2015; 3 (02) 116-124
• 111 Owen DAL, Marsden CD. Effect of adrenergic beta blockade on Parkinsonian tremor. Lancet 1966; 18 (03) 484
• 112 Thompson MK. Effect of oxprenolol on Parkinsonian tremor. Lancet 1972; 2 (7773) 388
• 113 Vas CJ. Propranolol in Parkinsonian tremor. Lancet 1966; 1 (7430) 182-183
• 114 Marsden CD, Parkes JD, Rees JE. Letter: propranolol in Parkinson's disease. Lancet 1974; 2 (7877) 410
• 115 Foster NL, Newman RP, LeWitt PA, Gillespie MM, Larsen TA, Chase TN. Peripheral beta-adrenergic blockade treatment of Parkinsonian tremor. Ann Neurol 1984; 16 (04) 505-508
• 116 van der Heide A, Wessel M, Papadopetraki D. et al. Propranolol reduces Parkinson's tremor and inhibits tremor-related activity in the motor cortex: a placebo-controlled crossover trial. Ann Neurol 2025; 97 (04) 741-752
• 117 Crosby NJ, Deane KH, Clarke CE. Beta-blocker therapy for tremor in Parkinson's disease. Cochrane Database Syst Rev 2003; 2003 (01) CD003361
• 118 Trosch RM, Pullman SL. Botulinum toxin A injections for the treatment of hand tremors. Mov Disord 1994; 9 (06) 601-609
• 119 Schneider SA, Edwards MJ, Cordivari C, Macleod WN, Bhatia KP. Botulinum toxin A may be efficacious as treatment for jaw tremor in Parkinson's disease. Mov Disord 2006; 21 (10) 1722-1724
• 120 Sturman MM, Vaillancourt DE, Metman LV, Bakay RAE, Corcos DM. Effects of subthalamic nucleus stimulation and medication on resting and postural tremor in Parkinson's disease. Brain 2004; 127 (Pt 9): 2131-2143
• 121 Katlowitz K, Ko M, Mogilner AY, Pourfar M. Effect of deep brain simulation on arm, leg, and chin tremor in Parkinson disease. J Neurosurg 2018; 131 (05) 1514-1519
• 122 Volonté MA, Clarizio G, Galantucci S. et al. Long term follow-up in advanced Parkinson's disease treated with DBS of the subthalamic nucleus. J Neurol 2021; 268 (08) 2821-2830
• 123 Millan SH, Hacker ML, Turchan M, Molinari AL, Currie AD, Charles D. Subthalamic nucleus deep brain stimulation in early stage Parkinson's disease is not associated with increased body mass index. Parkinsons Dis 2017; 2017: 7163801
• 124 Faraji AH, Richardson RM. Deep brain stimulation in early Parkinson's disease may slow rest tremor progression. Neurosurgery 2019; 84 (01) E13-E14
• 125 Krack P, Benazzouz A, Pollak P. et al. Treatment of tremor in Parkinson's disease by subthalamic nucleus stimulation. Mov Disord 1998; 13 (06) 907-914
• 126 Wong JK, Viswanathan VT, Nozile-Firth KS. et al. STN versus GPi deep brain stimulation for action and rest tremor in Parkinson's disease. Front Hum Neurosci 2020; 14 (578615): 578615
• 127 Goto S, Nishikawa S, Mita S, Ushio Y. Impact of posterior GPI pallidotomy on leg tremor in Parkinson's disease. Stereotact Funct Neurosurg 2002; 78 (02) 64-69
• 128 Lozano AM, Lang AE, Hutchison WD. Pallidotomy for tremor. Mov Disord 1998; 13 (Suppl. 03) 107-110
• 129 Braccia A, Golfrè Andreasi N, Ghielmetti F. et al. Magnetic resonance-guided focused ultrasound thalamotomy in a prospective cohort of 52 patients with Parkinson's disease: a possible critical role of age and lesion volume for predicting tremor relapse. Mov Disord 2025; 40 (03) 478-489
• 130 Golfrè Andreasi N, Cilia R, Romito LM. et al. Magnetic resonance-guided focused ultrasound thalamotomy may spare dopaminergic therapy in early-stage tremor-dominant Parkinson's disease: a pilot study. Mov Disord 2022; 37 (11) 2289-2295
• 131 Fasano A, De Vloo P, Llinas M. et al. Magnetic resonance imaging-guided focused ultrasound thalamotomy in Parkinson tremor: reoperation after benefit decay. Mov Disord 2018; 33 (05) 848-849
• 132 Maamary J, Peters J, Kyle K, Barnett Y, Jonker B, Tisch S. Effective subthalamic nucleus deep brain stimulation following MRgFUS for tremor dominant Parkinson's disease. Mov Disord Clin Pract 2023; 10 (03) 486-492
• 133 Monteiro JDS, ESilva BB, de Oliveira RR. et al. Magnetic resonance-guided focused ultrasound ventral intermediate thalamotomy for tremor-dominant Parkinson's disease: a systematic review and meta-analysis. Neurosurg Rev 2024; 47 (01) 701
• 134 Paschen S, Natera-Villalba E, Pineda-Pardo JA. et al. Comparative study of focused ultrasound unilateral thalamotomy and subthalamotomy for medication-refractory Parkinson's disease tremor. Mov Disord 2025; 40 (05) 823-833
• 135 Schlesinger I, Benyakov O, Erikh I, Suraiya S, Schiller Y. Parkinson's disease tremor is diminished with relaxation guided imagery. Mov Disord 2009; 24 (14) 2059-2062
• 136 Shahien M, Elaraby A, Gamal M. et al. Physical therapy interventions for the management of hand tremors in patients with Parkinson's disease: a systematic review. Neurol Sci 2023; 44 (02) 461-470
• 137 Scherer M, Steiner LA, Kalia SK. et al. Single-neuron bursts encode pathological oscillations in subcortical nuclei of patients with Parkinson's disease and essential tremor. Proc Natl Acad Sci U S A 2022; 119 (35) e2205881119