The cerebellar involvement in essential tremor: the connecting roads

Camargo, Carlos Henrique Ferreira; Coutinho, Léo; Zubko, Luís Eduardo B.M.; Franklin, Gustavo L.; Teive, Hélio Afonso Ghizoni

doi:10.1055/s-0045-1812324

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Review Article • Arq. Neuro-Psiquiatr. 83 (10) • 2025 • https://doi.org/10.1055/s-0045-1812324 linkcopy

The cerebellar involvement in essential tremor: the connecting roads

Authorship SCIMAGO INSTITUTIONS RANKINGS

Essential tremor (ET) is the most prevalent movement disorder globally, affecting about 1% of the general population and 5% of those aged over 65 years. Characterized by involuntary, rhythmic oscillations, it primarily manifests as postural and kinetic tremors, predominantly in the upper limbs. Genetic studies, neuropathological examinations, neurophysiological assessments, and various neuroimaging techniques have demonstrated functional, neurotransmitter-related, and structural abnormalities within the cerebello-thalamo-cortical circuit. These findings collectively portray ET as a neurodegenerative syndrome with diverse etiologies and clinical manifestations, highlighting the involvement of the cerebellum.

Keywords
Essential Tremor; Cerebellum; Purkinje Cells; Inferior Olivary Complex; Cholinergic Antagonists

2018 MDS consensus statement on the classification of tremor diagnostic criteria for essential tremor
Isolated tremor syndrome of bilateral upper limb action tremor. At least 3 years of duration. With or without tremor in other locations (e.g., the head, voice, or lower limbs). Absence of other neurological signs, such as dystonia, ataxia, or parkinsonism.
Definition of ET-Plus: Tremor with the characteristics of ET and additional neurological signs of uncertain significance such as impaired tandem gait, questionable dystonic posturing, memory impairment, or other neurologic signs of unknown significance that do not suffice to make an additional syndrome classification or diagnosis. Cases of ET with tremor at rest should be classified here.
Exclusion criteria for ET and ET-Plus: Isolated focal tremors (voice, head). Orthostatic tremor with a frequency > 12 Hz. Task- and position-specific tremors. Sudden onset and step-wise deterioration.

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[TFN1] Abbreviations: ET, essential tremor; MDS, Movement Disorders Society.