Talk:Holmes tremor

Goal
There are only a few secondary sources about Holmes tremor, and we covered all of the aspects of Holmes tremor that we could find information about. Some of the sections are a little brief because the limited sources available did not go into detail about these parts of Holmes tremors.AGBiology (talk) 04:24, 9 April 2015 (UTC)

Review
I think you guys did a good job! The intro paragraph could be more general. I felt like there were a bunch of technical words in there that could be left out. Also, do you know how many cases of the disease there have been? I know you said that there are not very many resources and it's mainly on cases. But I think that would be a good fact to have in there. - Mmich25

Primary Review 1
This article was very well written and formatted, and was able to excellently portray the information about Holmes tremor without being overly technical. This is an absolutely integral aspect of good Wikipedia articles, as it allows the average lay reader to understand the content of your article. Your article was also neutral and sufficiently broad given the limited resources available to your group. However, you should consider added more illustrations to your article, even if they are just diagrams of where the cerebellum and brainstem are located. Also, at points, it seemed that your group was citing things from the second source that were not actually present in the source, putting the verifiability of the article into question. With this being said, below are my suggestions for this article:

1. In the lead section, you should bold the first use of “Holmes tremor;” currently, the second use is bolded.

2. I think that you might have too much information in the lead section. It might be beneficial to just provide an overview of your article in this section, and then discuss the topics more in depth later in the article.

3. In the lead section, signs and symptoms section, and mechanisms section, your group discusses the frequency of the tremors. I think that the article would seem more unified if you only stated this fact once in an appropriate section.

4. Consider further explaining what is meant by hyper-excitability and rhythmic oscillation of neuronal loops in simple language. Your group first mentions this in the lead section.

5. In the triggers section, you attribute the tremors to lesion damage, but in the lead section, the tremors are attributed to hyper-excitability and rhythmic oscillation of neuronal loops and neurodegeneration. This seems to be contradictory.

6. The genetics section does not have any citations or sources; you always need to backup what you say with a citation.

7. In the mechanisms section, you should consider adding a sentence that, in simple terms, explains how the bulk of the paragraph relates to hyper-excitability and rhythmic oscillation of neuronal loops and neurodegeneration.

8. Proof-read the article for small grammatical mistakes.

9. Consider adding illustrations, possibly of the previously suggested topics.

Your second source is correctly cited, and is definitely a secondary source, as it is reviewing other scientific literature. I think that you used the article when it was applicable. However, there seemed to be some points in the article where your group would cite something that was not mentioned in the source. For example, the second source does not discuss anything about the onset of the tremors, the dopaminergic pathways involved with the tremors, or the use of levodopa for treatment; however, there are sentences in your group’s article that discuss these topics and attribute the information to the second source. Your group needs to find a source that contains this information, so that it can be correctly cited.

Overall, I think that your group did a great job with this article. Your group is well on its way to fulfilling all of the criteria for a good article, but there is still some work to be done. I enjoyed reading your article and learning more about Holmes tremor. Nice job!

Semaj311 (talk) 20:40, 12 April 2015 (UTC)

Response

First of all, thank you for your feedback. We did make the changes you suggested for the lead section. We did remove some information from this section so it now gives a general overview of Holmes tremors. The frequency of the tremor is now only talked about in the lead and signs and symptoms sections. We added a link that defines hyper-excitability, but we thought that the definition rhythmic oscillation is fairly straight forward so we did not provide more information on this topic. In the lead section we mention that a cause of Holmes tremors are permanent structural changes and this includes lesions so we don't believe this is contradictory. We did add a citation to the genetics section to support our information. The mechanisms section describes the changes the changes that result because of the hyper-excitability and neurodegeneration. We did proofread the article, and we did not add any images because we could not find any images related to Holmes tremors. Finally, we realized that a couple of our citations were mixed up and made the appropriate changes so now everything is properly cited. AGBiology (talk) 02:09, 24 April 2015 (UTC)

Primary Review 2
This article was very interesting to read and expanded a lot especially given the limited amount of sources on the topic. The article is very well written and the language and tone was very professional. There were no spelling errors as far as I saw and the article was very understandable in terms of flow and grammar. The layout was also easy to follow and the sections and subsections were helpful in looking for specific details on the subject. The introduction was a little long and while having a summary of each of the things that are going to be discusses is helpful, there still seemed to be a bit too much information to begin the article. There information that was reported was verifiable with the list of references present at the bottom of the page and even including a couple sources for further reading which I think is helpful for other points of view. There possibly could be a couple more links on some of the more scientific words like the corticostriatothalamocortical hap was one that I probably would have tried to link. I also think that maybe just giving the basic definition or link to tremor might be helpful for those that want to double check the meaning.

The topic was as broad as it could be with the limited amount of sources on the topic to be able to expand on the subject. It was helpful that the many aspects of signs and symptoms, causes, diagnosis, treatment and even the mechanism were included because those are more of the things that people would search for immediately. The article is also neutral in the point of view that it is being written and there are no biases which gives all the points of view that were researched. There are no illustrations, which is understandable because of the lack in sources but maybe an image or video of the symptoms of the tremor could be included in the signs and symptoms. Or another image of what is going on in the brain could be included in the mechanisms portion.

The first source “Diagnosis and Treatment of Common Forms of Tremor” by Puschmann included lot of information about different tremors, however, the authors did a good job or incorporating the most important and most relevant points from the article. The information was properly incorporated into the article and cited from the source. This made the topic clear and distinct from the many different tremors that were included in source. Overall this was a well written and very organized article which made it look pretty close to any other Wikipedia article. I enjoyed learning about the Holmes Tremor and the different aspects to it. Lokazaki0326 (talk) 20:02, 12 April 2015 (UTC)

Response

Thanks for your feedback. We did agree that our lead paragraph contained too much information, and we cut out some information that we felt was too detailed for the lead. We tried to link corticostriatothalamocortical hap, but could not find any websites that simply described what it is. However, we did link the general category of neuronal networks. Also, we could not find any pictures that depicted a Holmes tremor or the changes that occur in the brain. Therefore, we just did our best to describe the Holmes tremor and changes in the brain. AGBiology (talk) 02:16, 24 April 2015 (UTC)

Primary Review 3
I found your article to be very educational and fairly easy to understand. There were a couple of terms that I would go back and link for further definition and clarification (namely "Corticostriatothalamocortical Hap" and "cerebellar"). There were also a few terms like "stroke" and "flexion-extension" that a layperson may not completely understand and would therefore benefit from a definition or explanation. However, it was apparent that there would be some medical terminology used in this article and I think that you did a great job simplifying the bulk of it. I reviewed the first source because it seemed to be most relevant to the majority of this article. It was very informative and helpful in furthering my understanding of the underlying mechanisms and assessments of a tremor. It did not focus on Holmes tremor specifically, but it was very helpful for understanding what is at the root of Holmes tremor. The first article, written by Puschmann and Wszolek, was also very interesting as it brought in a few different types of tremors and how the assessments and treatments for each were related, and therefore, were related to Holmes tremors. The other two article sources were somewhat beneficial, but not nearly as helpful as the first. However, citations were all done well and it was easy to see that the sources used were credible. I also only found a couple of grammatical errors, which can be cleared up by proofreading each section. The article flowed very well and was neatly organized, much like other Wikipedia articles. Authors appeared to take a neutral stance on the subject which allotted a more scientific, factual approach. Adding in an image would be beneficial, even one as simple as an MRI of a typical brain vs a brain with Holmes tremor. It would illustrate some of the regions that are mentioned, giving readers a nice visual aid. Adding in a couple of sources to further explain the medical terminology might also be beneficial to readers. There are some concepts that may always be a bit confusing, but a majority of the terms here can be simplified a bit more with further reading and sources. However, despite there being limited sources for information on Holmes tremor, I think that this article was very informative and well written. BMRmed1392 (talk) 18:45, 13 April 2015 (UTC)

Response: Thank you for your feedback, we really appreciate the time and effort you put into reading our article. With regards to the scientific words and phrases that may be difficult for people with out a science background to understand, we went through and changed what we could. We tried to wiki link as many words as possible but many of the words you mentioned were unable to be linked. We changed what we could, but there were some specifiic locations and circuits that we felt we needed to leave to keep the information accurate from the research we did. In regards to a picture, we talked about it, and decided that our article is not detailed enough about the areas of the brain Holmes tremor affect, so we thought a picture might end up being more distracting and confusing to the understanding of out article, rather than enhancing the understanding of it. We also went through multiple times to check grammar and spelling mistakes so hopefully those are now all taken care of. Once again we appreciate the help! (Spidey1994 (talk) 03:41, 24 April 2015 (UTC))

Secondary Review 1
On the whole, I found the article well written and effective in conveying information about Holmes tremor. However, there were a few grammatical/writing errors that could improve the article. In the risk factor subheading, the article states that, “Researchers found that raising the dose of antidepressants or neuroleptics elevate the risk for developing Holmes tremor.” This sentence may be improved by replacing “elevate” with “elevated” or “elevates.” In the “Treatment” section the article states that “Treatment of a Holmes tremor can fail or is delayed because…” Replacement of “is” with “be” could improve this sentence. Another suggestion for the article as a whole would be the addition of pictures or animations. As of right now, the article has no visuals - maybe you could add a picture diagram of some of the anatomy discussed in the article. For example, the Guillain-Mollaret Triangle, or the dentate nucleus.

ShieldsMU (talk) 22:55, 12 April 2015 (UTC)

Secondary Review
As stated by other reviewers, the content of the article is good, but the writing style could be improved. In many cases the verb tenses do not match with the subject or time frame. Changing these will allow the reader to read with ease. Also, adding figures or depictions of the tremor would aid in the overall presentation and understanding. The triggers section wouldd be an easy place to put in a diagram of a spinal lesion. For the genetics genome section, where did this information come from? There is no source. Also, it may be a good idea to mention where the tumors useually occur. Overall a good read, just make sure to proof it for grammar and make sure all of the ideas are flushed out. It was written well so the average audience will have an easy time understanding the content. Thank you! Sfiore315 (talk) 23:40, 12 April 2015 (UTC)

Secondary Review
Overall, this article gives a nice, informative overview of Holmes Tremor. The content was really good, especially given how few secondary sources were available on the topic. I think the treatment section could use some clarification though. I was a bit confused, is tumor removal the only treatment available or are there other methods for tremors caused by stroke? Also, the layout of the article and the writing itself could be improved. Adding an image, making the introduction less dense, and improving the grammar and style of some of the sentences could really improve the way the article reads and would better convey the great information you guys have. Good job overall! Lambchop22 (talk) 03:33, 14 April 2015 (UTC)

The introduction is very informative, though some of the information seems to be very in depth to be included so early in the article. In the symptoms section of the article, more specific details would be helpful in conveying the nature of the disease, it seems to be a repetition of information from the introduction. Overall, Te article is very informative and provides a solid foundation from which more in depth research to the topic could be based. Enjoyed thoroughly!Bscheidt (talk) 19:33, 12 April 2015 (UTC)

Secondary review
As was mentioned by other reviewers, visuals would be of great benefit to the article. Also, make sure the paragraphs and sections flow as well as possible. The article could also be improved by using additional resources. The more sources confirming the information you found, the better. I like that you added in additional reading material. Since there is not a ton of information on the subject, this is good to give readers another outlet of information if they are looking for something the page does not offer, or information to confirm what you have written. You could even use some of those further readings as a source to beef up your own article, since you have minimal references. Overall, great work! I look forward to rereading after you make changes/edits if you decide to do so!

Secondary Review
This article is well organized and written. There are a few technical words that could be explained more like “hyper-excitability” and “rhythmic oscillations,” and maybe some pictures would improve the article. Other than that the article is clear and easy to read. I was surprised that symptoms are delayed one to twenty-four months after the lesion; that was an interesting detail. Overall, the article provides a good summary of Holmes tremor given the few sources available.BiologyGF (talk) 14:22, 13 April 2015 (UTC)

Secondary Review
The article was well done and was very interesting. However, I felt that more pictures would be beneficial, as well as more links to other topics, such as "dopaminergic and cerebellothalamic systems" and the "cortico... hap" topic. I understand if these are not topics discusses by wikipedia, but more links in general would be beneficial. I also agree with previous commenters that some of your introduction could be cut down and incorporated into the body of the article. It was very well done, though, and I enjoyed the article. Mychm52 (talk) 21:07, 13 April 2015 (UTC)

Primary Review
Overall I thought this was a really well written article along with being informative. I thought links were well used to help readers that may not have a strong scientific/medical background understand some key parts. The article and its subcategories are organized well which help the information flow in a logical manner. I did not see any grammatical errors either. A neutral viewpoint was also taken on this topic which makes it more reliable. Some of the sections were pretty brief, but that's understandable considering the limited amount of resources available to work with. I highly suggest adding one or two illustrations that relate to Holmes Tremor and a few sentences are missing citations. Here are a few more suggestions specific to the subcategories: I verified the third source and it does qualify as a secondary source in medicine. This source covers tremors more in a general fashion and not specifically Holmes Tremor. Because of this I think you pulled as much as you could from this source while making sure it still pertained to Holmes Tremor. This source was cited after a sentence in you lead section regarding drugs as a form of treatment- I was not able to find anything in the third source about drugs being less effective on Holmes Tremor. Was this citation accidentally mixed up with a different source? Above I made a comment asking what the thyroid has to do with tremors. There is a lot of information in this source about the thyroid in relation to tremors that I think you would be able to use to make that more clear. NeuroKJ (talk) 03:37, 14 April 2015 (UTC)
 * 1)  Lead section: 1. Do the two major neuronal networks cause the development of the tremors themselves? Or do malformations within the networks cause the development of the tremors? 2.  What are the short and long term effects? These weren't mentioned anywhere in the article. 3. It says that DBS is the most effective treatment strategy, but then a few sentences later it says that the removal of the tumor is the preferred method of treating the tremor. This seems a little contradictory.
 * 2)  Signs and Symptoms: 1.Can you maybe give an example of what a 4.5 Hz tremor is like? It's hard to picture what the tremor is like in terms of frequency- Does the tremor have really intense rapid movements or slower movements?
 * 3)  Causes: 1.How do the risk factors relate to the triggers? Is it the exposure of drugs and heavy metals that cause/lead to the strokes, tumors and lesions?
 * 4)  Mechanism: 1.Neurodegeneration is mentioned as the second principle to cause the tremor, but nothing else about neurodegeneration is said. Maybe expand on this? 2.The sentence starting with “Holmes tremor specifically is generated…” seems out of place. I would possibly move that to the top of the mechanism section or possibly delete it because that information was stated above in the Triggers part of Causes. 3.The last three sentences in this section about the frequency of the tremors seem out of place because they aren’t really a mechanism. I think that those sentences should be moved to signs and symptoms.
 * 5)  Diagnosis: 1.What does the thyroid functioning properly have to do with tremors? 2.What information from the patient’s history help lead to diagnosis?
 * 6)  Treatment: 1.The second and third sentences make it sound like tumors are the only factor that cause the tremors. I would maybe reword that part, because above you said that lesions and strokes can also lead to the tremor. 2.What about levodopa and DBS that were mentioned in the lead section?

Response: Thank you for your feedback, we really appreciate the work you put into your review in order to better our article. In our lead section, we rephrased the neuronal network part so there is less confusion about the causes of Holmes Tremor. We also fixed the DBS area, looking at our research and finding that removal of tumors is the most effective strategy. There was no additional research to further the short and long term effects. In the Signs and Symptoms, we added that a 4.5 Hz tremor is a slower type of tremor. We did not make major changes to our causes page because of limited research. We changed our mechanism page in line with your suggestions as well our diagnosis and treatment page. Thanks again for all of your feedback, we are very grateful! — Preceding unsigned comment added by Rayschneider0 (talk • contribs) 14:09, 24 April 2015 (UTC)

Primary Review
There are numerous inconsistencies in the article, and in my opinion there should be a major revision of it, preferably by a movement disorders specialist. I will point out only some :

1. LevoDopa is administered therapeutically in Holmes tremor, but it does not act on the cerebellothalamic pathway. The most likely target is either the nigrostriatal (presynaptic) or basal ganglia (post-synaptic) dopaminergic neurons (in a similar fashion to parkinson's disease).

2. Holmes tremor underlying mechanism does not appear to have as a major player the inferior olivary nucleus (the ION is hypothetically of significant importance in Essential tremor and Palatal tremor). Instead, the pathophysiology of Holmes tremor lies in a combined inerruption of nigrostriatal and dentato-thalamic pathways. The first one is the pathway involved in Parkinsons (hence the similarities in the rest component of tremor, sometimes the accompanying hemiparkinsonism, and response to L-Dopa)and the second one (which is the most important and most disabling) causes all the so-called "cerebellar outflow tremors" that have an intentional component.

3. I am not aware of any risk factors for Holmes tremor. Citation [1] does not make any reference to heavy metals, hypoglycemia, antidepressants etc as being risk factors for it (they are well known causes for other forms of tremor and not Holmes), and is completely misleading. I would recommend removing the whole "risk factors" paragraph.

4. It should be clearly stated in the article that the location of the lesion causing Holmes lies around the Red Nucleus in the midbrain (hence the alternative name "rubral tremor"or adjacent areas (i.e. thalamus). Most common causes are strokes (I would suggest adding Benedikt syndrome), trauma (when it involves the midbrain) and Multiple Sclerosis

5. I do not mean to be critical to the authors and I thank them for all their effort. However, I think that Wikipedia should include a warning about possible inconsistencies in this article and alert the reader who is not knowledgeable in order to prevent misinformation.

Personal statement : I am a Neurologist and movement disorders specialist

Grouper13 (talk) 14:26, 15 May 2015 (UTC)grouper13

Wilson's disease
Wing-beating tremor is also characteristic of Wilson's disease. See: http://www.nejm.org/doi/full/10.1056/NEJMicm1312190 Wikiation (talk) 14:22, 17 May 2015 (UTC)