A 77 year old female smoker with history of Polymyalgia Rheumatica and Sarcoidosis presented to hospital with a two day history of fever, nausea, gait ataxia, and new bilateral intention tremor. After admission, she was noted to become rigid with features of parkinsonism and subsequently developed worsening weakness with inability to follow appendicular commands. MRI brain showed midbrain and thalamic infiltration, with CSF findings of markedly elevated WBC, elevated protein, and West Nile IgM. Her condition worsened over the following eleven days to include fulminant flaccid paralysis and neurogenic shock requiring ICU transfer despite empiric treatment with standard of care therapies. Worsening shock refractory to vasopressors, persisting GCS of 3, and rising lactate with acute renal failure prompted family and clinicians to pursue palliative measures. She died with family at bedside 13 days after admission.

Isolated cranial tremors (face tremor, jaw tremor, vocal tremor, and embouchure tremor) are unusual examples of focal tremor disorders. The etiology and treatment of these troublesome and occasionally disabling conditions deserve more attention. In this review, we summarize current knowledge about these disorders and consider their etiologies and treatment approaches. We suggest changes to the current classification system of isolated cranial tremors based on shared phenomenology and treatment response.

The cerebellum is widely recognized for its contributions to motor, cognitive, and affective processes through dynamic cerebello-cortical networks. Recent studies using cerebellar-cortical electroencephalography (EEG), a technique that enables noninvasive, millisecond-resolution recordings of cerebellar and cortical activity, have revealed disease-specific spectral and network alterations in patients with movement and neurodegenerative disorders, including ataxia, essential tremor (ET), Parkinson's disease (PD), dystonia, as well as in healthy individuals. Synchronous cerebellar-cortical EEG reliably detects these signals and captures network dynamics, providing mechanistic insights into cerebellar-specific functions and interactions that may inform the development of brain-computer interfaces, targeted neuromodulation, and future applications in neurological disorders.

The thalamus is a critical relay center in motor circuit and plays a key role in the pathophysiology of Parkinson's disease (PD). Hierarchical organization is a fundamental principle underlying human brain networks. However, how thalamic functional gradient relates to PD motor symptoms and their genetic modulation remains unclear. Here, we employed dimensional reduction techniques on thalamocortical functional connectome in two independent cohorts and derived lateral-medial and anterior-posterior thalamic functional axes. Dataset 1 included 46 healthy controls (HC), 72 postural instability and gait difficulty (PIGD) patients, and 71 tremor-dominant (TD) patients. Dataset 2 comprised 118 HC, 99 PIGD patients, and 101 TD patients. We observed expansions in TD subtype and contractions in PIGD subtype along lateral/medial principal axis, as well as contractions along anterior/posterior secondary axis in both two subtypes, reflecting potentially altered thalamocortical interactions across unimodal and transmodal networks. Thalamic network gradient analysis revealed widespread network-level gradient alterations in both PIGD and TD subtypes. Notably, ventral attention network gradients within the first two gradients were negatively correlated with motor impairment in both subtypes. Transcription-neuroimaging association analyses using Allen Human Brain Atlas data identified subtype-specific genes associated with thalamic gradient alterations, which were enriched in distinct biological processes and overexpressed in developmental periods as early as "early fetal" stage. These findings characterize alterations in thalamocortical functional organization in PD motor subtypes and provide a multiscale description linking thalamic functional gradients with gene expression patterns.

Functional movement disorders (FMDs) are common but often misdiagnosed among functional neurological disorders. Key findings from this study include frequent diagnostic delays, a predominance of women (70% of cases), and frequent comorbidity with anxiety and mood disorders. Tremor and dystonia were the most common FMD phenotypes. Delayed recognition, high psychiatric comorbidity, and fragmented care emerged as major challenges. Lack of structured psychiatric assessment and low adherence to psychiatric follow-up, especially among those with lower education and in certain occupations, were noted, highlighting important gaps in care. These findings are based on data from a tertiary clinic in the Philippines, an underrepresented setting in the literature. We conducted a cross-sectional review of individual patient data from a Movement Disorders Clinic, including 37 patients diagnosed with FMDs according to established diagnostic criteria. Women accounted for 70% of cases (female-to-male ratio 2.3:1), with a mean age at symptom onset in the late twenties. Tremor (35%) and dystonia (32%) were the most frequent phenotypes, often coexisting. The mean delay from symptom onset to first consultation exceeded three years. There was a significant positive correlation between delay to consultation and total symptom duration (r = 0.497, p < 0.002), suggesting that later presentation is associated with longer symptom duration. Anxiety and mood disorders were the most common psychiatric comorbidities, yet many patients lack formal, structured psychiatric evaluation, indicating gaps in mental health assessment. Only 46% of those referred to psychiatry attended follow-up, with poorer adherence observed among patients with lower educational attainment and in specific occupational groups. These results underscore the major clinical and systemic burdens associated with FMDs in resource-limited healthcare settings. The study emphasizes three key findings: persistent diagnostic delays, the frequent co-occurrence of psychiatric issues, and substantial gaps in integrated care, especially relating to psychiatrically informed follow-up. Early identification of FMDs, integration of neurological and psychiatric services, and efforts to reduce stigma and bolster access, particularly for underserved groups, are essential steps to improve patient outcomes.