We read with interest the recent article by Josephs et al.1 Like the experience at the Mayo Clinic, we have encountered patients with tremor-dominant Parkinson disease (PD), presenting with unilateral tremor, who have long and benign courses. Many of these patients have had minimal levodopa responsiveness except for modest improvement in segmental hypokinesia and perhaps tone. Several of these patients disabled by their tremor have now undergone subthalamic deep brain stimulation with near abolition of their tremor. We too believe that patients with tremor-dominant PD have long been ignored in the literature, often intermixed with those having rigid/akinetic disease in large series.
Van Horn G, Schiess MC. Benign Tremulous Parkinsonism?. Arch Neurol. 2006;63(10):1507. doi:10.1001/archneur.63.10.1507-a