Intentionstremor

Intention tremor, also known as cerebellar or kinetic tremor, is a low-frequency tremor that occurs during voluntary, goal-directed movement and tends to worsen as the limb approaches a target. It is typically absent at rest and is most noticeable during tasks such as reaching for an object or performing finger-to-nose testing. It is distinct from the rest tremor seen in conditions like Parkinson’s disease.

Causes and pathophysiology are related to dysfunction of the cerebellum or its connections. Lesions or degeneration in the cerebellar hemispheres, dentate nucleus, or superior cerebellar peduncles can disrupt motor timing and error correction, producing tremor that intensifies with movement accuracy demands. Common etiologies include stroke, brain tumors, demyelinating diseases such as multiple sclerosis, traumatic brain injury, chronic alcohol-related cerebellar degeneration, and progressive or hereditary ataxias. The tremor is often described as abrupt or progressive following injury or disease affecting cerebellar circuits.

Clinical features and evaluation focus on movement-related signs. In addition to the tremor, patients may exhibit dysmetria (overshooting or undershooting), dysdiadochokinesia (impaired rapid alternating movements), gait ataxia, and scanning speech. The finger-to-nose and heel-to-shine tests help elicit cerebellar signs. Diagnosis is clinical, supported by neuroimaging such as MRI to identify underlying cerebellar pathology.

Treatment and prognosis are dependent on the underlying cause. Addressing the primary condition is primary, with physical and occupational therapy to improve coordination. Pharmacologic options for cerebellar tremor are limited and often provide only partial relief. In selected cases, deep brain stimulation of the thalamic ventral intermediate nucleus or other targeted approaches, as well as botulinum toxin injections to specific muscles, may be considered. The course varies with etiology, ranging from stable to progressively disabling.