Three cases of isolated resting tremor of the lower limbs

Resting tremor is considered to be a phenotype of Parkinson’s disease. Isolated resting tremor of the lower limbs however is uncommon in Parkinson’s disease. In this case series we report on three patients with isolated resting tremor of the lower limbs. One patient was diagnosed with Parkinson’s disease, one with drug induced parkinsonism and in one a descriptive diagnosis of “benign tremulous parkinsonism” with a “Scan Without Evidence of Dopaminergic Deficit” was made. Deep brain stimulation of the ventral intermediate nucleus of the thalamus led to almost complete suppression of tremor in the Parkinson’s disease patient. Our case series emphasizes the need to rethink the diagnosis of Parkinson’s disease in patients with isolated resting tremor of the lower limbs and provides evidence for the ventral intermediate nucleus of the thalamus to be an effective target for Deep brain stimulation electrode placement in Parkinson’s disease patients with isolated lower limb tremor.