Holmes tremor after brainstem hemorrhage, treated with levodopa

Jae Hyun Woo, Bo Young Hong, Joon Sung Kim, Seok Ho Moon, Soo Yeon Kim, Hye Young Han, Dong Yoon Park, Seong Hoon Lim

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Holmes tremor is a rare movement phenomenon, with atypical low-frequency tremor at rest and when changing postures, often related to brainstem pathology. We report a 70-year-old female patient who was presented with dystonic head and upper limb tremor after brainstem hemorrhage. The patient had experienced a sudden onset of left hemiparesis and right facial paralysis. Brain magnetic resonance imaging showed an acute hemorrhage from the brachium pontis through the dorsal midbrain on the right side. Several months later, the patient developed resting tremor of the head and left arm, which was exacerbated by a sitting posture and intentional movement. The tremor showed a regular low-frequency (1-2 Hz) for the bilateral sternocleidomastoid and cervical paraspinal muscles at rest. The patient's symptoms did not respond to propranolol or clonazepam, but gradually improved with levodopa administration. Although various remedies were attempted, overall, the results were poor. We suggest that levodopa might be a useful remedy for Holmes tremor. The curative or relieving effect of the dopaminergic agent in Holmes tremor needs more research.

Original languageEnglish (US)
Pages (from-to)591-594
Number of pages4
JournalAnnals of Rehabilitation Medicine
Issue number4
StatePublished - 2013
Externally publishedYes


  • Holmes tremor
  • Levodopa
  • Traumatic brain stem hemorrhage

ASJC Scopus subject areas

  • Rehabilitation


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