Scoping Review of Treatment Strategies for Holmes Tremor: Pharmacological and Surgical Interventions.

Background: Holmes tremor is a rare neurological condition, first described in 1904, characterized by a low-frequency tremor that manifests at rest, posture, and action. Despite its recognition for over a century, effective treatment strategies for Holmes tremor remain elusive due to its rarity and challenges in conducting robust studies. Methods: Given that the existent medical literature on Holmes tremor is based on reports and case series, we conducted a survey using the keywords "Holmes tremor" and "Rubral tremor" to analyze the therapeutic approaches utilized, as well as their success rate. Results: We have found 121 Holmes tremor patients across 97 publications. Levodopa and anticholinergics emerged as the most common employed pharmacological treatments, demonstrating significant response rates. Dopaminergic agonists are also promising therapeutic approaches, albeit with fewer reported cases. From the surgical perspective, functional neurosurgery offers substantial benefits to the symptomatic control of patients, with deep brain stimulation electrodes being a promising strategy. Discussion: Pharmacological treatment, specifically levodopa, anticholinergics and dopaminergic agonists exhibit the highest success rate in managing Holmes tremor. Additionally, surgical strategies may help tremor control as supported by previous reviews with quantitative analysis. However, the heterogeneity in the reporting of these cases underscores the need for standardized case descriptions to permit conclusions. Highlights: This study brings a new perspective to the treatment of HT, as it estimates which medications and interventions may be more consistent for the treatment for Holmes Tremor.