Tremor disorders.

PURPOSE OF REVIEW: The pathophysiology of tremor disorders is reviewed in the context of pharmacologic and surgical treatment.

RECENT FINDINGS: The anatomical origin and pathophysiologic mechanism of tremorogenic oscillation are unknown for all tremor disorders. Except for Parkinson tremor and rhythmic cortical myoclonus, the discovery of drugs for tremor disorders has been largely serendipitous. The cerebellothalamocortical pathway is involved in essentially all pathologic tremors, and stereotactic destruction or deep brain stimulation of the ventrolateral thalamus has been efficacious in all tremor disorders, despite widely varying tremor pathophysiology. The ventrolateral thalamocortical loop appears to amplify all forms of tremor deleteriously, regardless of origin.

SUMMARY: A better understanding of pathophysiology of the thalamocortical loop in tremorogenesis could lead to better pharmacotherapy for most or all forms of pathologic tremor.