Holmes' tremor caused by coexisting Parkinson's disease in a case of spinocerebellar ataxia type 31

Holmes’ tremor (HT) is a low-frequency resting and intention tremor. Here, we report a case of SCA31 with an unusual presentation of HT. We traced it to the development of Parkinson's disease in the patient. L-dopa was insufficient for tremor, but zonisamide and ventralis intermedius thalamotomy were effective. Both cerebellar and dopaminergic system damages are thus required to express HT. This article is protected by copyright. All rights reserved.