Cerebellar rTMS attenuates essential tremor by modulating visuomotor network connectivity

• Cerebellar repetitive transcranial magnetic stimulation (rTMS) attenuates essential tremor.¹
• The effect is associated with modulation of visuomotor network connectivity; the work involves direct neurophysiology and methods (Clinical Neurophysiology, Volume 183).^{1 1}

Weekly enrichment (2026-07-20)

• The primary Clinical Neurophysiology (2025) study used source-level EEG in 20 essential tremor (ET) patients scanned before and after a 4-week course of bilateral cerebellar rTMS, compared against 20 healthy controls, with brain sources reconstructed via standardized low-resolution brain electromagnetic tomography (LORETA) and connectivity assessed by alpha-band (8–13 Hz) phase-locking value.²
• At baseline, ET patients showed lower nodal efficiency in visual areas and reduced inter-regional occipital connectivity relative to controls.²
• Local network metrics in the left superior occipital gyrus, left cuneus, and right fusiform gyrus correlated negatively with tremor severity and improved significantly after rTMS.²
• Connectivity changes between the left inferior occipital gyrus and superior parietal gyrus, and between the right superior parietal gyrus and midcingulate cortex, correlated strongly with improvements in activities of daily living.²
• The authors present these as preliminary mechanistic insights and candidate biomarkers, explicitly pending validation in future sham-controlled studies.²
• Context: a randomized sham-controlled trial (45 patients; 12 sessions of 900 pulses of 1-Hz rTMS at 90% resting motor threshold per hemisphere over 4 weeks) reported significant reductions in Fahn-Tolosa-Marin (FTM) total score and subscores A and B that persisted to 3 months.³
• Context: a randomized pilot (38 patients) compared 1-Hz cerebellar rTMS (1200 pulses/day for 10 days) with oral propranolol; both improved FTM totals with no significant difference between arms.⁴
• The evidence base is mixed: a double-blind sham-controlled crossover trial (23 patients) found no significant FTM improvement versus sham, and an add-on pilot (22 patients) likewise found no significant effect, underscoring unresolved efficacy.^{5 6}
• Mechanistically, low-frequency (1-Hz) cerebellar rTMS at ~90% resting motor threshold is hypothesized to act through the cerebello-thalamo-cortical pathway implicated in tremor-related oscillations.⁴

Footnotes

1. https://www.sciencedirect.com/science/article/pii/S1388245725013240?dgcid=rss_sd_all ↩ ↩² ↩³

2. https://doi.org/10.1016/j.clinph.2025.2111472 ↩ ↩² ↩³ ↩⁴ ↩⁵

3. https://doi.org/10.3988/jcn.2023.0348 ↩

4. https://doi.org/10.1002/brb3.2926 ↩ ↩²

5. https://escholarship.org/uc/item/2sv5j5qq ↩

6. https://pubmed.ncbi.nlm.nih.gov/30928207/ ↩