Tremor and Other Hyperkinetic Movements Feed

Family History of Dementia in an Essential Tremor Cohort

Thu, 22 Oct 2026 00:00:00 GMT

Feelings of Helplessness in ET: A Preliminary Analysis of Prevalence and Clinical Correlates

Thu, 22 Oct 2026 00:00:00 GMT

Revisiting Parakinesia Brachialis Oscitans: You Yawn, I Move! A Scoping Review

Wed, 21 Oct 2026 00:00:00 GMT

Background: Parakinesia brachialis oscitans (PBO) is a rarely reported phenomenon in which a paretic limb moves involuntarily during yawning. The literature consists predominantly of case reports and small series, with limited comparative evidence. Methods: We conducted a PRISMA-ScR-guided scoping review of PubMed, Embase, and Web of Science from inception to 28 August 2026, with backward citation searching. Eligible reports described one or more patients with an involuntary, stereotyped, yawn-locked movement of a paretic limb after a focal central nervous system lesion, with the lesion site reported on neuroimaging. Data included demographics, movement description, latency, lesion site, etiology, and outcome. Results: Twenty-two reports describing 31 patients met the inclusion criteria. Most patients were men (67.7%), with a mean age of 56.1 years. PBO involved the upper limb alone in 29 patients (93.5%). Acute ischemic stroke was the most common etiology (83.9%). Lesions were often seen in the internal capsule (44.4%) and the corona radiata or subcortical white matter (40.7%). Onset ranged from immediate to four months after the lesion. Complete resolution was documented in 10 patients (32.3%), PBO persisted for up to three years in five, and outcome was not reported in 15 (48.4%). Discussion: PBO is associated with focal lesions affecting distributed voluntary motor-control networks, frequently involving subcortical motor pathways. Although no mechanism has been established, the observations suggest a release of preserved brainstem and extrapyramidal circuits. Outcome was unreported in almost half the cases; prospective, standardized reporting is needed to clarify its course and prognostic significance. Highlights This scoping review gathered 22 reports describing 31 patients with PBO after a focal brain injury. PBO involved the upper limb alone in 29 patients and lesions were most commonly subcortical, involving the internal capsule. Onset ranged from presentation to four months and PBO persisted for up to three years. However, the outcome was not reported in half of the included cases.

Clinical and Genetic Spectrum of VPS13A Disease Across India: A Retrospective Multicentre Genetically Confirmed Cohort

Mon, 12 Oct 2026 00:00:00 GMT

Objectives: To characterize the geographic and molecular spectrum of genetically confirmed VPS13A disease across India and examine patterns of delay to tertiary evaluation. Methods: We conducted a multicentre retrospective study across eight tertiary movement disorder centres in India. Clinical, investigational, genetic, treatment, and follow-up data were collected. Results: Eighteen unrelated patients from eight tertiary centres were included. Chorea was the most common initial manifestation (10/18), and 8/18 patients were evaluated more than five years after symptom onset. Longer intervals to tertiary evaluation were descriptively more frequent among patients with non-choreic presentations, particularly seizures. Twenty-three distinct VPS13A variants were identified, predominantly loss-of-function variants, including apparently novel variants and two variants recurring in unrelated patients. Conclusion: VPS13A disease in this multicentre Indian cohort demonstrated substantial molecular heterogeneity, including apparently novel and recurrent variants. Longer intervals to tertiary evaluation were descriptively more frequent among patients with non-choreic presentations, particularly those with seizures, highlighting that clinicians need to maintain a high degree of suspicion for VPS13A even in such presentations.

Clinical and Electrophysiological Heterogeneity of Orthostatic Tremor: An Individual Patient Data Analysis

Thu, 08 Oct 2026 00:00:00 GMT

Background: Orthostatic tremor (OT) is traditionally classified using tremor frequency and the presence of associated neurological signs. However, increasing reports of overlapping frequencies, fluctuating electrophysiological profiles, and diverse clinical associations indicate that current classification systems may not fully capture the clinical heterogeneity of OT. Methods: A systematic review of PubMed/MEDLINE from inception to February 2026 identified case reports, case series, and original studies reporting electromyography-confirmed OT with individual patient data. Demographic, clinical, electrophysiological, and data on associated conditions were extracted. Cases were classified according to the 2018 Movement Disorder Society criteria and separately grouped as isolated or non-isolated OT. Associations between tremor frequency and clinical phenotype were assessed using receiver operating characteristic analysis and multivariable logistic regression. Results: One hundred studies comprising 244 patients were included. Mean tremor frequency was 13.32 ± 4.15 Hz (range 3–20 Hz). Seventeen patients (6.97%) could not be classified using current criteria because of frequencies exceeding 18 Hz or fluctuations across the 13-Hz threshold. Non-isolated OT had significantly lower tremor frequencies than isolated OT (11.03 Hz vs 14.80 Hz, p < 0.001). Tremor frequency independently predicted non-isolated phenotype (OR 0.78) (AUC 0.72). Parkinsonian disorders were the most common associated condition, but substantial frequency overlap was observed across neurological and systemic disorders associated with OT. Discussion: Most cases were classifiable using the current OT criteria. However, a small subset demonstrated boundary-spanning or out-of-range frequencies. These findings suggest that tremor frequency remains an important electrophysiological feature of OT but should be interpreted alongside the clinical context. Highlights: Electromyography-confirmed orthostatic tremor exhibited marked clinical and electrophysiological heterogeneity across neurological and non-neurological conditions. Most cases were classifiable using the current OT criteria. However, a small subset demonstrated boundary-spanning or out-of-range frequencies. These findings suggest that tremor frequency remains an important electrophysiological feature of OT but should be interpreted alongside the clinical context.

Bobble-Head Doll Syndrome Caused by Aqueductal Web–Associated Obstructive Hydrocephalus in an Adult: A Case Report with Video

Thu, 08 Oct 2026 00:00:00 GMT

Background: Bobble-head doll syndrome (BHDS) is a rare movement disorder usually observed in children and associated with third ventricular lesions or hydrocephalus. Case report: A 24-year-old man presented with progressive memory impairment, gait instability, urinary incontinence, and irregular no-no head tremor with a sensory trick. MRI revealed severe obstructive hydrocephalus due to an aqueductal web. Ventriculoperitoneal shunting was performed, and the tremor resolved within one week. Neurological symptoms improved, and he remained independent 18 months after surgery. Discussion: Adult BHDS is extremely rare. Early recognition and appropriate CSF diversion can provide favorable outcomes.

Orthostatic Hyperkinetic Disorders in Subacute Sclerosing Panencephalitis – A Novel Observation

Fri, 18 Sep 2026 00:00:00 GMT

Background: Subacute sclerosing panencephalitis (SSPE) is a progressive, often fatal inflammatory encephalitis caused by persistent measles virus infection of the central nervous system. The neurological manifestations of SSPE are well characterised, encompassing cognitive decline, periodic myoclonic jerks, and often relentless progression. Case Report: We report a case of a 14-year-old male with SSPE who developed bilateral lower limb shaking and knee buckling, with associated loss of quadriceps tone on standing. These features resulted in recurrent falls and necessitated supported ambulation. Discussion: To our knowledge, this combination of orthostatic limb shaking and loss of tone in the context of SSPE has not been previously described in the literature. This case expands the recognised phenotypic spectrum of SSPE.

Progressive Axonal Neuropathy and Cerebellar Ataxia Associated with Homozygous Pathogenic POLG Mutation in a Patient of African Descent from Northern Minas Gerais/Jequitinhonha Valley, Brazil: A Case Report and Epidemiological Implications

Fri, 04 Sep 2026 00:00:00 GMT

We report a 41-year-old man of African descent from the Northern Minas Gerais/Jequitinhonha Valley region of Brazil — historically characterized by geographic isolation, predominantly Afro-Indigenous ancestry, and structural consanguinity — born to first-degree cousin parents, who presented with progressive axonal sensorimotor neuropathy, cerebellar ataxia, dysarthria, and oculomotor abnormalities. His sister had died with a similar untreated neurological syndrome. Three serial electroneuromyographic studies demonstrated stable chronic axonal polyneuropathy with complete bilateral absence of sural, fibular, and plantar sensory potentials, and active distal denervation. Brain MRI, unchanged over a two-year interval, showed T2/FLAIR hyperintense foci in both cerebellar hemispheres and the right middle cerebellar peduncle with cerebellar atrophy, without diffusion restriction or contrast enhancement. Next-generation sequencing (NGS; Mendelics®; 101-gene hereditary neuropathy panel) identified a homozygous pathogenic variant in the POLG gene (c.2243G>C; p.Trp748Ser — ClinVar ID 13507), confirming the diagnosis of mitochondrial DNA depletion syndrome type 4B (OMIM #613662). The patient’s paternal great-grandfather was from the state of Ceará, a region with documented European colonization, providing a plausible route for the introduction of this classically European founder allele into his Afro-Brazilian lineage, with homozygosity emerging through consanguinity. To our knowledge, this is the first report of p.Trp748Ser in a patient of African descent, directly challenging its presumed ethnic exclusivity. Clinical and electrophysiological stability over 2.5 years is consistent with the favorable course reported in p.W748S homozygotes. This case underscores the importance of POLG-related ataxia as a diagnostic consideration in patients of non-European ancestry presenting with axonal neuropathy and cerebellar signs, and highlights the consequences of underrepresentation of populations of African descent in genetic disease research.

Sleep Disturbances and Their Correlates in Essential Tremor and Essential Tremor Plus: A Questionnaire-Based Case–Control Study

Thu, 03 Sep 2026 00:00:00 GMT

Background: Essential tremor (ET) has been increasingly recognized to involve non-motor symptoms, including sleep disturbances. Essential Tremor Plus (ET-plus), is characterized by additional neurological “soft signs” and may display greater non-motor symptom burden. Despite emerging evidence from polysomnographic studies, large-scale subjective evaluations of sleep across the ET spectrum remain limited. Objectives: To assess the prevalence and severity of sleep disturbances in ET and ET-plus using validated sleep questionnaires, and to compare with healthy controls. Methods: This study was conducted at NIMHANS, Bengaluru, and included 100 patients (60 ET and 40 ET-plus) and 100 healthy controls. Tremor severity was assessed using TETRAS and FTMRS, and sleep symptoms with ESS, PSQI, Mayo Sleep Questionnaire, RLS-Q, BQ, GAD-7 and PHQ-9. Non-parametric tests and effect size estimations were used for group comparisons. Results: ET-plus patients were older and exhibited greater tremor severity than ET. Global PSQI scores differed significantly among ET and ET Plus vs controls (p < 0.001), with ET-plus reporting the poorest sleep quality. ET and ET-plus demonstrated significantly higher ESS (p < 0.001) and greater prevalence of probable RBD, RLS, and sleep apnea risk compared with controls. Tremor disability scores correlated with PSQI scores in ET-plus, suggesting an interaction between motor and non-motor burden. Conclusions: Both ET and ET plus have significant sleep dysfunction with ET-plus patients showing markedly poorer sleep quality, higher daytime somnolence, and greater parasomnia prevalence than ET and controls. These findings highlight the clinical relevance of routine sleep assessment in ET and may impact quality of life and management.

Expanding the TBL1XR1 Disease Spectrum: Generalized Dystonia Associated with a New Genetic Variant

Thu, 03 Sep 2026 00:00:00 GMT

Background: A growing number of identified genes increasingly reveal genetic overlaps between neurodevelopmental disorders and combined dystonia syndromes. Case report: We report a 61-year-old man with a neurodevelopmental disorder, mild ataxic signs and generalized dystonia who had been misdiagnosed with cerebral palsy for 40 years. Whole-exome sequencing identified a novel heterozygous pathogenic frameshift variant in TBL1XR1. Discussion: TBL1XR1 variants are classically associated with Pierpont syndrome and autism spectrum disorder. Although movement disorders have been reported, this case suggests generalized dystonia as a possible additional manifestation. It highlights the value of retrospective genetic phenotyping and next-generation sequencing in adults with long-standing neurodevelopmental diagnoses.

Prevalence of Probable REM Sleep Behavior Disorder in Essential Tremor

Tue, 25 Aug 2026 00:00:00 GMT

Background: Essential Tremor (ET) has traditionally been regarded as a pure motor disorder. However, emerging evidence suggests associations with non-motor symptoms, including cognitive impairment, psychiatric disturbances, and sleep abnormalities. REM Sleep Behavior Disorder (RBD) is a known prodromal feature of alpha-synucleinopathies such as Parkinson’s disease (PD). The relationship between ET and RBD remains unclear, with previous studies reporting variable prevalence rates. Objective: This study aimed to determine the prevalence of probable RBD (pRBD) among patients with ET using the REM Sleep Behavior Disorder Single-Question Screen (RBD1Q). Methods: In this single-center, cross-sectional study, we identified ET patients from the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor College of Medicine. Eligible patients were contacted and screened for pRBD using the RBD1Q. A small cohort of healthy controls, including spouses, was also screened. Demographic and clinical characteristics were compared between ET patients with and without pRBD. Results: Among 245 ET patients, 21.2% screened positive for pRBD. There were no significant differences in age, age at tremor onset, or tremor duration between patients with and without pRBD. There was a significantly higher percentage of males among ET patients with pRBD (63.5% vs. 48.7%, p = 0.045). Discussion: In this study, pRBD screen positivity was relatively more common in ET patients than historical controls. These findings suggest that sleep-related symptoms may be relevant in ET and support further study with polysomnographic confirmation of RBD and longitudinal follow-up of these symptoms in ET patients.

Spectrum of Dystonia in Progressive Supranuclear Palsy: A Prospective Observational Study and Review of Literature

Wed, 19 Aug 2026 00:00:00 GMT

Background: Dystonia is an under-recognized yet clinically significant feature of Progressive supranuclear palsy (PSP), contributing to disability and impaired motor function. Method: In this prospective study, we examined the clinical and neuroimaging details of eighty-eight consecutive PSP patients who visited our movement disorder clinic [2024–2025]. Patients fulfilling the 2017 Movement Disorder Society-PSP criteria for possible or probable PSP were enrolled after ethics approval and informed consent. We aimed to evaluate the prevalence, phenomenology, subtype associations, clinical and neuroimaging correlates of dystonia. Additionally, a literature search was performed and 29 articles were included for detailed review. Result: The literature review identified predominantly retrospective studies, reporting dystonia in approximately 30–60% of the patients, with variable patterns of cranio-cervical and limb involvement. In our prospective cohort, dystonia was present in 64.8% (n = 57) cases. PSP-RS was the most frequent subtype (39.8%), followed by PSP-P (26.1%) and PSP-CBS (23.8%). Dystonia was more common in PSP-RS and PSP-CBS, with predominant limb dystonia in PSP-CBS, and cranio-cervical dystonia in PSP-RS. A trend toward earlier dystonia was observed in PSP-CBS. Patients with dystonia demonstrated lower Midbrain to pons ratios and higher Magnetic resonance parkinsonism index, suggesting greater brainstem involvement. Botulinum toxin therapy resulted in clinical improvement in selected dystonia patients. Conclusion: Dystonia is a frequent and clinically meaningful feature in PSP. Our prospective study expands upon the existing literature by demonstrating distinct subtype-specific patterns and neuroimaging correlates, supporting the concept of a “dystonia spectrum” in PSP and highlighting its relevance for clinical recognition and management.

Lansoprazole-Induced Myoclonus

Fri, 14 Aug 2026 00:00:00 GMT

Although Lansoprazole, a proton pump inhibitor, is quite safe, there have been occasional reports of associated neurological dysfunction. We present a middle-aged man who developed bilateral asterixis within few hours of the first dose of lansoprazole. Interestingly, the jerks disappeared rapidly after discontinuation of lansoprazole.

Botulinum Neurotoxin Treatment of Camptocormia- A Critical Review and Update

Wed, 05 Aug 2026 00:00:00 GMT

Camptocormia is a disabling postural disorder characterized by involuntary forward flexion of the thoracolumbar spine that resolves in the supine position. It is mostly associated with Parkinson’s disease and parkinsonian syndromes, but may also occur in dystonia, paraspinal myopathies, and after exposure to some drugs. Available treatments, including postural aids, medication adjustment, and deep brain stimulation, are often only partly effective and may carry risk. Because overactivity of trunk flexor muscles is thought to contribute to camptocormia, botulinum neurotoxin (BoNT) has emerged as a potential treatment. This review critically evaluates the published literature on BoNT treatment of camptocormia. We searched Medline, Google Scholar, and Scopus for English-language publications published through April 1, 2026, identifying nine reports including three case series and six single case reports. No randomized placebo-controlled trials were found. Most studies used onabotulinumtoxinA, but injection targets, dosing, and outcome measures varied. Improvement in posture, reduced pain and functional benefits were described. The most consistent benefit was with bilateral injection of the rectus abdominis and external oblique muscles, whereas isolated psoas or iliopsoas injections were less effective. Overall, BoNT appears promising for the treatment of camptocormia; however, randomized, placebo-controlled trials are needed to confirm efficacy and establish optimal treatment protocols. The studies should be conducted with caution because long-term outcome data are limited and reported efficacy has been modest.

Prevalence of Diagnosed Essential Tremor Using Electronic Healthcare Records: A Population-Based Study in Northeast-Central Pennsylvania

Thu, 16 Jul 2026 00:00:00 GMT

Background: Essential tremor (ET) is one of the most common movement disorders, yet reported prevalence estimates vary widely, likely because of differences in ascertainment strategies, which can influence data validity and comparability. Electronic healthcare records (EHRs) offer an opportunity to estimate prevalence at the population level. However, the impact of these strategies remains incompletely understood, raising questions about the accuracy and generalizability of the resulting estimates. Methods: We conducted a retrospective, population-based cross-sectional study using EHR data from the Geisinger Health System (GHS) to identify cases of ET. Cases were mapped to a census-defined population of 1,081,934 individuals aged ≥10 years in Northeast–Central Pennsylvania on April 1, 2020. ET prevalence was assessed using two ascertainment strategies: (1) the neurology cohort and (2) the all-specialties cohort. Age-threshold, age-specific, and sex-stratified prevalence estimates were calculated, along with age-standardized rates based on the 2020 U.S. population. Results: Crude prevalence of ET was 0.261% (95% CI, 0.252–0.271) in the neurology cohort and 0.653% (95% CI, 0.638–0.668) in the all-specialties cohort. Age-standardized prevalence was 0.40% (95% CI, 0.39–0.41) and 1.01% (95% CI, 1.00–1.02), respectively. Prevalence increased progressively with age across both ascertainment strategies, and sex-stratified analyses demonstrated similar age-related patterns with a modest female predominance, particularly in the all-specialties cohort. Discussion: ET prevalence estimates vary substantially depending on ascertainment strategy, with broader EHR-based definitions identifying more than twice as many cases as neurologist-restricted approaches. These findings highlight the importance of standardization in improving comparability across studies.

Correction: A Case of Cala Trio-Induced Glossopharyngeal Neuralgia in a Patient with Essential Tremor and Idiopathic Parkinson’s Disease

Thu, 09 Jul 2026 00:00:00 GMT

This article details a correction to Arnold, M.R. and Hiller, A.L. (2026) ‘A Case of Cala Trio-Induced Glossopharyngeal Neuralgia in a Patient with Essential Tremor and Idiopathic Parkinson’s Disease’, Tremor and Other Hyperkinetic Movements, 16(1), p. 41. Available at: https://doi.org/10.5334/tohm.1224.

Post-Hypoxic Myoclonus and Deep Brain Stimulation. Experience from a Small Patient Cohort and Literature Review Highlighting Variable Outcomes

Tue, 07 Jul 2026 00:00:00 GMT

Lance Adams Syndrome (LAS), or chronic post-hypoxic myoclonus (PHM), is a rare and disabling condition which occurs in the aftermath of a diffuse hypoxic brain injury, usually when patient regains consciousness. Due to its refractoriness to antiepileptics, deep brain stimulation (DBS) has been attempted over the past fifteen years. We describe three patients who underwent Globus Pallidus interna (GPi)-DBS at the NYU Langone Department of Neurosurgery. Despite varying stimulation parameters and contact combinations, none achieved substantial improvement of action and negative myoclonus or regained the ability to ambulate unassisted. We compared our results with previous reports. Our literature review identified ten cases of LAS treated with DBS since 2010. The target was GPi in 8/10 patients, the ventralis intermedius (VIM) nucleus in one, and the subtalamic nucleus (STN) in one. Varying degrees of improvement were reported, with some evidence suggesting that long pulse width and lower frequency might be more effective. However, most reports provided only partial Unified Myoclonus Rating Scale (UMRS) scores, with missing information on rest and reflex myoclonus as well as negative myoclonus. Due to the paucity of prior reports and the limited generalizability of existing evidence, the efficacy of DBS in LAS has yet to be demonstrated. Further case reports, both positive and negative, supported by neurophysiological measures, may help bridge this knowledge gap.

Pallidal Deep Brain Stimulation in Dystonia: Investigating Differential Response by Dystonia Distribution

Fri, 26 Jun 2026 00:00:00 GMT

Background: Dystonia is characterized by involuntary intermittent or sustained abnormal movements or postures. Deep brain stimulation (DBS) is an effective treatment, and response has been shown to vary across body regions but literature depicting this pattern is conflicting. Our study analyzes dystonia response to DBS by body distribution using the Burke-Fahn-Marsden Rating Scale motor (BFMRS-M) score and the Global Dystonia Rating Scale (GDRS). Methods: We reviewed standardized videos of patients with isolated non-acquired dystonia obtained at baseline and post-DBS of unilateral or bilateral globus pallidus interna between 2008 and 2020. BFMRS-M and GDRS were scored using blinded assessment by two movement disorders neurologists. Mean baseline and post-DBS scores were compared using a paired t-test. Results: Ten male and 10 female patients were included, with average age at surgery 49 years. Post-DBS total BFMRS-M scores demonstrated improvement (20.5 ± 3.6 vs 11.9 ± 2.6) and there was significant improvement in neck sub-scores (4.9 ± 0.6 vs 2.5 ± 0.4). All patients demonstrated an improved total GDRS score post-DBS (21.6 ± 3.7 vs 11.1 ± 2.1), with significant improvements in GDRS sub-scores of the neck (5.9 ± 0.6 vs 2.6 ± 0.4) and shoulder & proximal arms (4.7 ± 1.1 vs 1.6 ± 0.5). Discussion: Efficacy of DBS varies by distribution of dystonia and should be considered in treatment planning discussions. GDRS is a more sensitive outcome measurement for dystonia compared to BFMRS-M and should be more routinely integrated into studying treatment response. Highlights This study shows that pallidal deep brain stimulation yields differential improvement across dystonia body regions, with greatest benefit in the neck and proximal arms. These results highlight that the Global Dystonia Rating Scale is more sensitive to regional outcomes compared to the commonly utilized Burke-Fahn-Marsden Rating Scale.

A Case of Cala Trio-Induced Glossopharyngeal Neuralgia in a Patient with Essential Tremor and Idiopathic Parkinson’s Disease

Mon, 15 Jun 2026 00:00:00 GMT

Background: Cala Trio is a wrist-worn transcutaneous afferent patterned stimulation (TAPS) device for essential tremor (ET), delivering high-frequency stimulation to the median and radial nerves. Case Report: We report the first case of glossopharyngeal neuralgia (GPN) associated with Cala Trio initiation in a 69-year-old male with ET and Parkinson’s disease, with prior GPN. Throat spasms triggered by swallowing and coughing began after initiation on two trials and resolved with discontinuation; evaluation was unrevealing. Discussion: We review TAPS mechanisms, GPN neuroanatomy, and circuit-level links between peripheral nerve stimulation and brainstem cranial nerve hyperexcitability, highlighting a novel adverse event and need for caution in patients with prior GPN. Highlights We report the first case of glossopharyngeal neuralgia associated with Cala Trio TAPS therapy in a patient with essential tremor and Parkinson’s disease. Symptoms were temporally linked to device use and resolved upon discontinuation, suggesting a reversible neuromodulation-related effect and expanding the safety profile of peripheral tremor therapies. Publisher’s Note: A correction article relating to this paper has been published and can be found at https://tremorjournal.org/articles/10.5334/tohm.1258.

A Distributed Oscillatory Network Model of Parkinsonian Tremor: Integrating Basal Ganglia and Cerebello-Thalamic Circuits

Mon, 15 Jun 2026 00:00:00 GMT

Background: Parkinsonian tremor remains one of the least understood motor manifestations of Parkinson’s disease. Unlike bradykinesia and rigidity, tremor often shows weak correlation with dopaminergic degeneration and variable responses to pharmacological and surgical treatments, suggesting mechanisms beyond classical basal ganglia dysfunction. Increasing evidence indicates that tremor may arise from interactions between multiple motor circuits rather than from a single oscillatory generator. Methods: This mechanistic review integrates evidence from electrophysiological recordings, neuroimaging studies, lesion observations, and computational modeling studies investigating the neural mechanisms of parkinsonian tremor. Relevant literature addressing basal ganglia circuits, cerebello–thalamo–cortical pathways, and tremor-related neural oscillations was analyzed to develop a conceptual network framework. Results: Available evidence supports the involvement of a distributed oscillatory network in tremor generation. Within this framework, basal ganglia circuits, particularly the subthalamic nucleus–globus pallidus externa loop, act as primary oscillatory generators. Cerebello–thalamo–cortical pathways and brainstem nuclei modulate synchronization and amplitude of tremor-related activity, while thalamic nuclei function as resonance hubs integrating network oscillations and translating them into rhythmic motor output. Discussion: Conceptualizing parkinsonian tremor as a distributed network disorder helps explain several clinical observations, including the dissociation between tremor and other motor symptoms, variability in levodopa responsiveness, and heterogeneous tremor phenotypes. This framework also highlights the potential relevance of oscillatory biomarkers and network-based neuromodulation strategies, including adaptive deep brain stimulation, for future therapeutic approaches.