Objective: To report a case of a patient with Holmes’ tremor following post-traumatic cerebellar lesion, who showed an excellent response to zonisamide.

Background: Holmes’ tremor is a symptom characterized by resting, postural, and intention tremor, which is mostly due to lesions in the red nucleus, dentatothalamic pathways, and inferior olives. Few drugs have been reported to be beneficial for Holmes’ tremor.

Methods: Case: A 66-year old right-handed man was referred to our hospital for intention tremor in the right hand. On examination, he presented with a 2-3 Hz action tremor in his right hand, which had a component of the re-emergent type, and predominantly involved the proximal muscles. He also presented with a 3 Hz mild resting tremor in his right hand and leg. Magnetic resonance imaging (MRI) showed an old hemorrhage in the right cerebellar hemisphere. The Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS) motor score was compared between pre and post administration of zonisamide.

Results: After administration of zonisamide, FTM-TRS score reduced from 52 to 24 points. He was able to write legible letters, connect tubes for tube feeding by himself, and walk with a cane.

Conclusions: In conclusion, zonisamide may be a therapeutic option for posttraumatic Holmes’ tremor.

We presented this report at The 33rd Annual Meeting of Japanese society of neurological therapeutics, November 26-28, 2015, and 5th Asian and Oceanian Parkinson’s disease and Movement Disorder Congress, March 11–13, 2016.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-zonisamide-on-post-traumatic-holmes-tremor/