Task Specific Tremor in Parkinson’s Disease Responds to Apomorphine

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.