Parkinson’s disease (PD) tremor has been found to be a variable clinical feature of the disease both across patients and within individual patients over the disease course. Clinical ratings of tremor severity have been found to have limited utility as objective measures of this poorly understood disease manifestation. Recent advances in functional neuroimaging methods have, however, provided new insights into the pathophysiology of PD tremor. This chapter reviews concepts of tremor pathogenesis in PD in light of recent imaging studies and discuss the use of imaging methods to differentiate tremor due to PD from essential tremor (ET). The chapter also provides an in depth discussion of the potential utility of image-based tremor biomarkers in delineating the natural history of PD tremor and in the objective assessment of its response to specific therapeutic interventions such as deep brain stimulation (DBS).
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