Thammongkolchai Thananan, Neilson Lee E, Termsarasab Pichet
Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.
Tremor Other Hyperkinet Mov (N Y). 2025 Aug 25;15:39. doi: 10.5334/tohm.1072. eCollection 2025.
To describe a unique form of task-specific tremor (TST) in billiards players.
Task-specific movement disorders occur during highly learned activities. While task-specific dystonia in billiards players has been reported, TST has not been previously characterized.
Case series with literature review.
Two right-handed billiards professionals developed tremor specifically during cueing. In Case 1, a 55-year-old experienced right arm tremor triggered by shoulder extension during cue positioning. Tremor resolved upon shooting, improved with alcohol, and was confirmed by electromyography showing a 6.3-Hz tremor. Botulinum toxin provided partial benefit, whereas medications were ineffective. Case 2, a 66-year-old player, had coarse tremor in the non-dominant (left) hand used to form the bridge during his shooting stance, contrasting with Case 1, where the dominant hand holding the cue was affected. Medications were ineffective, but thalamic deep brain stimulation resulted in approximately 70% improvement. Both had subtle bilateral postural and kinetic tremor, and neither showed features of dystonia.
Our cases expand the phenomenology of task-specific movement disorders in billiards players to include tremor. Alcohol responsiveness and electrophysiologic findings suggest a variant of essential tremor. Recognizing primary cueing tremor may have implications for treatment, natural history, and pathophysiology, which likely differ from those of billiards-related dystonia.
描述台球运动员中一种独特形式的任务特异性震颤（TST）。
任务特异性运动障碍发生在高度熟练的活动中。虽然已有报道台球运动员存在任务特异性肌张力障碍，但此前尚未对TST进行过特征描述。
病例系列研究并进行文献综述。
两名右利手台球职业选手在击球时出现了特定的震颤。病例1，一名55岁的选手，在球杆定位时肩部伸展引发右臂震颤，击球时震颤消失，饮酒后改善，肌电图证实为6.3赫兹的震颤。肉毒杆菌毒素有部分疗效，而药物治疗无效。病例2，一名66岁的选手，在击球姿势中用于架桥的非优势手（左手）出现粗大震颤，与病例1中持杆的优势手受影响形成对比。药物治疗无效，但丘脑深部脑刺激使震颤改善了约70%。两人均有轻微的双侧姿势性和动作性震颤，且均未表现出肌张力障碍的特征。
我们的病例扩展了台球运动员任务特异性运动障碍的现象学，使其包括震颤。对酒精的反应性和电生理检查结果提示为特发性震颤的一种变异型。认识原发性击球震颤可能对治疗、自然病程和病理生理学有影响，其可能与台球相关肌张力障碍不同。
