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Lookup NU author(s): Dr Jacopo Pasquini, Professor Nicola PaveseORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. Background: Parkinsonian tremor usually starts asymmetrically. The mid-term prognosis of this lateralized tremor is unknown, as is the development of tremor in the contralateral arm. Objective: To investigate the occurrence of contralateral tremor in the Parkinson's Progression Marker Initiative database, with data available for 7 years. Methods: Tremor requiring treatment (TRT) was defined as any rest, postural or kinetic tremor with amplitude >1 cm (MDS-UPDRS score ≥2) as this criterion is commonly accepted as an insufficiently treated tremor. Tremor was analyzed by side mainly in the off-medication state. Results: At baseline, 348 (87.7%) of the 397 patients with Parkinson's disease had tremor at least on one side of the body. 183 (46%) had only mild tremors but 165 (41.6%) had TRT. 159 patients (40.1%) had lateralized TRT and six (1.6%) had bilateral TRT. Among patients with asymmetrical TRT, 40 patients (25.2%) developed contralateral TRT at 3 years, 49 patients (30.8%) at 5 years, and 61 patients (38.4%) at 7 years. The side more affected by tremor was also more affected by other cardinal signs. In 159 patients with initially asymmetrical TRT, tremor severity did not increase on the more tremulous side over the 7-year period. However, there was an increase in tremor on the contralateral side. This was associated with a clear increase in bradykinesia and rigidity on both sides. Conclusion: The study findings may prove beneficial in counseling patients with TRT, and may also provide an explanation as to why the worsening of tremor is not correlated with overall disease progression.
Author(s): Pasquini J, Pavese N, Ceravolo R, Helmich RC, Deuschl G
Publication type: Article
Publication status: Published
Journal: Movement Disorders Clinical Practice
Year: 2025
Pages: Epub ahead of print
Online publication date: 16/09/2025
Acceptance date: 26/08/2025
Date deposited: 30/09/2025
ISSN (print): 2330-1619
ISSN (electronic): 2330-1619
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1002/mdc3.70353
DOI: 10.1002/mdc3.70353
Data Access Statement: Data used in the preparation of this article was obtained on 2024-04-12 from the Parkinson's Progressive Markers Initiative (PPMI) database (https://www.ppmi-info.org), RRID:SCR_006431. For up-to-date information on the study, visit https://www.ppmi-info.org. This analysis used data openly available from PPMI (Tier 1 Data). Codes generated to perform the analyses in this article are shared on Zenodo at the following DOI: https://doi.org/10.5281/zenodo.14892610.
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