Task Specific Tremor in Parkinson's Disease Responds to Apomorphine

Tremor Other Hyperkinet Mov (N Y). 2023 Jun 2:13:20. doi: 10.5334/tohm.764. eCollection 2023.

Abstract

Background: Task specific tremor (TST) is a poorly understood entity without any standard treatments, that may subsequently develop tremor during additional tasks, later develop postural/kinetic tremor (essential tremor criteria), and later develop Parkinson's disease. The pathophysiology is not understood as it has features of tremor, dystonia, and parkinsonism.

Objectives: To assess response of TST to apomorphine and thus infer pathophysiology.

Methods: We administered sublingual apomorphine to 8 patients diagnosed with Parkinson's disease based on clinical criteria and dopamine imaging, who all initially presented with TST and later presented other parkinsonian signs and dopamine imaging deficits.

Results: Apomorphine improved TST, which was refractory to oral levodopa and other tremor therapies, in 6/8 subjects.

Discussion: These results offer a treatment option for TST, which is usually refractory to other pharmacologic treatments, in patients with other parkinsonian features, and infers a dopaminergic pathophysiology of TST.

Keywords: DaTscan; Parkinson’s disease; Task specific tremor; apomorphine; writing tremor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apomorphine / pharmacology
  • Apomorphine / therapeutic use
  • Dopamine / therapeutic use
  • Humans
  • Levodopa / therapeutic use
  • Parkinson Disease* / complications
  • Parkinson Disease* / drug therapy
  • Tremor / drug therapy
  • Tremor / etiology

Substances

  • Apomorphine
  • Dopamine
  • Levodopa

Grants and funding

William Ondo, MD has received research grants from Biogen, Sun, Restless Legs Syndrome Foundation, Parkinson’s Study Group, Dystonia Coalition (NIH), Biogen, Cerevel, SCION, and Harmony.