[1] It may arise from various underlying structural disorders including stroke, tumors, trauma, and other cerebellar lesions.
The formation of tremors is due to two main factors: the over-excited rhythmic movement of neuronal loops and permanent structural changes from neurodegeneration.
Two major neuronal networks, the corticostriatothalamocortical hap and the inferior olivary nucleus (ION) specifically target the development of the tremors.
[1] Risk factors for Holmes tremor include excess exposure to heavy metals, such as mercury and lead, as well as an increased intake of various drugs and toxins.
[1] Researchers found that raising the dose of antidepressants or neuroleptics elevate the risk for developing Holmes tremor.
Tremors depend on dosage and amount of exposure to these factors and will typically decrease dramatically if the intake is reduced.
Holmes tremor specifically occurs as a delayed reaction to lesion damage of the dopaminergic and cerebellothalamic systems.
[1] Because brainstem stroke and lesions are typically the causes of Holmes tremor, there is little research supporting a genetic factor to the disease.
However, one could be more susceptible to developing Holmes tremor if there is a familial history of stroke, substance abuse, or other disorders that increase risk.
An MRI can also be performed to look for structural lesions in areas such as the thalamus, midbrain tegmentum, and substantia nigra.
[2] Other treatment options involve coping strategies such as avoiding movements or actions that worsen tremors.