Rapid wrist movements in patients with essential tremor : the critical role of the second agonist burst

Ballistic wrist flexion movements towards 15, 30 and 60° visual targets were studied in a group of 17 patients with hereditary essential tremor. Compared with age-matched normal subjects ( n = 16), there were three main kinematic differences: patients overshot the target a little more; the kinematic profile of their movements was more ‘asymmetric’ due to higher peak decelerations; and their movements initiated tremor. Ballistic movements performed by patients with essential tremor were associated with a triphasic pattern of agonist—antagonist—agonist muscle activity similar to that of normal subjects. The duration and size of each EMG burst was normal. The onset latency of the antagonist EMG burst was also normal, but the onset of the second agonist EMG burst was delayed. The delay in the onset of the second agonist EMG activity resulted in unopposed action of the antagonist muscle in the second half of each movement. As a result, deceleration occurred too rapidly as the hand returned past the target leading to a series of damped oscillations around the point of aim. The onset latency of the second agonist EMG burst correlated significantly with the tremor period; the longer the period the later the burst. We speculate that the delay in the second agonist burst reflects an abnormality in the timing of anticipatory muscle activity in essential tremor and that this may involve cerebellar mechanisms.