MDS 2026 — Tremor and Hyperkinetic Movement Disorders

MDS 2026 Tremor Hyperkinetic Movements

Congress: Movement Disorder Society (MDS) International Congress 2026 Dates: October 4-8, 2026 Location: Seoul, Korea — COEX Convention and Exhibition Center Website: [mdscongress.org](https://www.mdscongress.org)

Overview

The MDS 2026 Congress features dedicated sessions on tremor assessment and hyperkinetic movement disorders, advancing the understanding and treatment of conditions including essential tremor, dystonic tremor, cerebellar tremor, parkinsonian tremor, and other involuntary movement disorders including chorea, athetosis, and ballism["@mds"]. Tremor is the most common movement disorder, affecting millions worldwide, while hyperkinetic movements encompass a broad spectrum of involuntary motions that significantly impact quality of life.

Tremor Classification Framework

MDS Consensus Classification (2018-2022)

The MDS consensus framework introduced a two-axis classification system that forms the basis for clinical assessment at MDS 2026[@bhatia2018][@latorre2022]:

Axis 1 — Clinical Syndrome:

• Isolated tremor
• Combined tremor (with other movement disorders)
• Syndrome plus (additional neurological features)

Axis 2 — Etiology:

• Idiopathic (essential tremor, etc.)
• Neurodegenerative (Parkinson's disease, etc.)
• Secondary (drug-induced, metabolic, psychogenic)

...

MDS 2026 Tremor Hyperkinetic Movements

Congress: Movement Disorder Society (MDS) International Congress 2026 Dates: October 4-8, 2026 Location: Seoul, Korea — COEX Convention and Exhibition Center Website: [mdscongress.org](https://www.mdscongress.org)

Overview

The MDS 2026 Congress features dedicated sessions on tremor assessment and hyperkinetic movement disorders, advancing the understanding and treatment of conditions including essential tremor, dystonic tremor, cerebellar tremor, parkinsonian tremor, and other involuntary movement disorders including chorea, athetosis, and ballism["@mds"]. Tremor is the most common movement disorder, affecting millions worldwide, while hyperkinetic movements encompass a broad spectrum of involuntary motions that significantly impact quality of life.

Tremor Classification Framework

MDS Consensus Classification (2018-2022)

The MDS consensus framework introduced a two-axis classification system that forms the basis for clinical assessment at MDS 2026[@bhatia2018][@latorre2022]:

Axis 1 — Clinical Syndrome:

• Isolated tremor
• Combined tremor (with other movement disorders)
• Syndrome plus (additional neurological features)

Axis 2 — Etiology:

• Idiopathic (essential tremor, etc.)
• Neurodegenerative (Parkinson's disease, etc.)
• Secondary (drug-induced, metabolic, psychogenic)

Tremor Types by Clinical Features

| Tremor Type | Characteristic | Common Etiology | Neural Circuit |
|------------|--------------|---------------|---------------|--------------|
| Resting Tremor | 4-6 Hz, present at rest | Parkinson's disease | Basal ganglia-thalamocortical |
| Postural Tremor | 5-12 Hz, with posture holding | Essential tremor, enhanced physiological | Cerebello-thalamocortical |
| Kinetic Tremor | Variable, during movement | Cerebellar disease | Cerebello-thalamocortical |
| Task-Specific Tremor | Triggered by specific activities | Focal dystonia | Cortical-subcortical networks |
| Dystonic Tremor | Irregular, with dystonia | Dystonia | Basal ganglia-cerebellar |

Tremor Assessment Scales

Clinical assessment of tremor requires standardized tools[@ferreira2019][@fahn2024]:

MDS Tremor Rating Scale (MDS-TRS)

• Part 1: Historical features (functional impact, perceived severity)
• Part 2: Clinical examination (motor characteristics)
• Part 3: Standardized tasks (drawing, pouring, drinking)
• Part 4: Laboratory measures (accelerometry)

Essential Tremor Assessment Scale (QUEST)

• Motor performance subscale
• Patient-rated disability
• Quality of life measures

Functional Impact Measures

• The Bain Capital Tremor Disability Scale
• Functional Disability Scale
• Quality of Life in Essential Tremor (QUEST-QOL)

Tremor Syndromes

Essential Tremor (ET)

Clinical Features

• Bilateral upper-limb postural and kinetic tremor
• May include head or voice tremor
• Usually autosomal dominant inheritance
• Often progressive[@elble2020]
• Alcohol-responsive in approximately 50%

Pathophysiology

• Cerebello-thalamo-cortical network dysfunction
• Purkinje cell degeneration
• GABAergic dysfunction in cerebellar circuitry

Management Approaches

• First-line: Propranolol, primidone[@zachi2022]
• Second-line: Gabapentin, topiramate, benzodiazepines
• Procedural: VIM DBS, focused ultrasound thalamotomy[@pahwa2019]

Parkinsonian Tremor

Clinical Features

• Resting tremor (4-6 Hz)
• Often asymmetric onset
• Pill-rolling quality
• Often improves with levodopa[@kesten2019]

Mechanisms

• Nigrostriatal dopamine loss
• Basal ganglia oscillations
• Synchronized neuronal firing

Treatment Approaches

• Dopaminergic replacement (levodopa, agonists)
• MAO-B inhibitors
• DBS (STN or GPi targets)

Dystonic Tremor

Clinical Features

• Positional dependency
• Sensory trick phenomenon
• Irregular amplitude and frequency
• Often with cervical dystonia

Management

• Botulinum toxin injections
• Sensory tricks
• DBS in refractory cases

Cerebellar Tremor

Clinical Features

• Kinetic > postural
• Intention component
• Titubation (head tremor)
• Gait ataxia

Etiologies

• Multiple system atrophy (MSA)
• Spinocerebellar ataxias (SCAs)
• Wilson disease
• Alcoholic cerebellar degeneration

Functional Tremor

Clinical Features

• Sudden onset
• Variable characteristics
• Distractibility
• Suggestibility[@blasio2023]

Diagnosis

• Clinical examination
• EMG acceleration
• Postural entrainment

Hyperkinetic Movements

Chorea

Definition

Involuntary, irregular, jerky movements that flow between body regions[@movement].

Etiologies

• Huntington disease (HD)
• Huntington disease-like disorders (HDL1, HDL2)
• Drug-induced chorea (levodopa, antipsychotics)
• Stroke (hemiballismus)
• Sydenham chorea (post-streptococcal)

Clinical Presentation

• Random, dance-like movements
• Facial grimacing
• Limb flinging
• Motor impersistence ("milkmaid grip")

Treatment Approaches

• Tetrabenazine (VMAT2 inhibitor)
• Deutetrabenazine
• Antipsychotics (-haloperidol, olanzapine)
• Benzodiazepines

Athetosis

Definition

Involuntary, slow, writhing movements, often affecting distal limbs.

Clinical Significance

• Seen in cerebral palsy
• Associated with kernicterus
• May co-occur with choreoathetosis

Ballismus

Definition

Involuntary, violent flinging movements.

Subtypes

• Hemiballismus: One side of body, typically from contralateral STN lesion
• Bilateral ballismus: Rare, often severe

Etiologies

• STN hemorrhage
• Non-ketotic hyperglycemia
• Psychogenic causes

Management

• Antipsychotics
• VMAT2 inhibitors
• DBS in refractory cases

Myoclonus

Definition

Sudden, brief, shock-like muscle jerks.

Classification

• Focal: Epileptic myoclonus
• Multifocal: Metabolic encephalopathy
• Generalized: Progressive myoclonus epilepsy

Etiologies

• Epilepsy syndromes
• Metabolic disorders (uremia, liver failure)
• Neurodegeneration (Lafora disease, sialidosis)
• Drug-induced (SSRIs, anticonvulsants)

Tics

Clinical Features

• Sudden, repetitive movements
• Premonitory urge
• Voluntary suppression
• Echolalia/copropraxia

Classification

• Motor tics: Eye blinking, head turning, shoulder shrugging
• Vocal tics: Throat clearing, tics, word utterances
• Simple: Brief, stereotyped
• Complex: Sequential, purposeful

Treatment

• Behavioral therapy (HRT, ERT)
• Alpha-2 agonists (clonidine, guanfacine)
• Antipsychotics
• Botulinum toxin

Stereotypies

Definition

Involuntary, repetitive, patterned movements.

Clinical Context

• Rett syndrome
• Autism spectrum disorders
• Fragile X syndrome
• Drug-induced (tardive dyskinesia)

Digital Tremor Assessment

Wearable Technologies

MDS 2026 showcases advancing digital tools for tremor quantification[@gronthos2023]:

Accelerometry

• Quantitative measurement of tremor frequency
• Amplitude characterization
• Circadian pattern analysis

Smartphone Applications

• Spiral drawing analysis
• Finger-tapping assessments
• Voice analysis

Inertial Measurement Units (IMUs)

• Multi-site synchronized recording
• Movement decomposition
• Therapeutic response tracking

Machine Learning Applications

• Tremor classification from wearable data
• Prediction of treatment response
• Disease progression modeling

Surgical Interventions

Deep Brain Stimulation

Targets for Tremor

• VIM (ventral intermediate nucleus): Essential tremor, cerebellar tremor
• STN (subthalamic nucleus): Parkinsonian tremor
• GPi (globus pallidus internus): Dystonic tremor

Advances at MDS 2026

• Directional leads for refined targeting
• Closed-loop stimulation systems
• Adaptive DBS algorithms
• MRI-guided lead placement

Focused Ultrasound

Thalamotomy

• Non-invasive lesioning
• Unilateral treatment
• Bilateral staged procedures
• 5+ year follow-up data

Lesioning Procedures

• Radiofrequency thalamotomy
• Pallidotomy
• For refractory cases

Cross-Links

Related Diseases

• [Essential Tremor](/diseases/essential-tremor)](/diseases/essential-tremor)
• [Parkinson's Disease](/diseases/parkinsons-disease)](/proteins/parkin)
• [Huntington's Disease](diseases/huntingtons)
• [Dystonia](/diseases/dystonia)

Related Diagnostics

• [Clinical Assessment Scales](/diagnostics/clinical-assessment-scales)](/diagnostics)
• [Digital Biomarkers](/diagnostics/digital-biomarkers)](/diagnostics)
• [Neuroimaging](/diagnostics/neuroimaging)

Related Technologies

• [Deep Brain Stimulation](/technologies/deep-brain-stimulation)](/technologies)
• [Wearable Technologies](/technologies/wearable-technologies-parkinsons)](/technologies)
• [Focused Ultrasound](/therapeutics/focused-ultrasound-thalamotomy)

Related Events

• [MDS 2026 — Movement Disorder Management](/events/mds-2026/movement-disorder-management)](/events)
• [MDS 2026 — Deep Brain Stimulation Updates](/events/mds-2026/deep-brain-stimulation-updates)](/events)
• [MDS 2026 — Parkinson's Non-Motor Symptoms](/events/mds-2026/parkinsons-non-motor-symptoms)](/events)
• [MDS 2026 — Parkinson's Motor Complications](/events/mds-2026-parkinsons-motor-complications)

Expected Research at MDS 2026

Tremor Research Highlights

New classification refinements

Biomarker development for tremor subtyping

Novel pharmacologic agents

Closed-loop DBS for tremor

Digital tremor phenotyping advances

Hyperkinetic Movement Research

Gene-silencing for Huntington disease chorea

VMAT2 inhibitor long-term outcomes

New tic disorder therapies

Myoclonus treatment protocols

Conclusion

The MDS 2026 Congress provides critical updates on tremor and hyperkinetic movement disorders, bridging the gap between clinical classification, neurophysiology, and therapeutic innovation. Sessions focus on refining diagnostic frameworks, developing digital assessment tools, and advancing both pharmacologic and surgical treatments.

References

[Movement Disorder Society, MDS Congress Information](https://www.mdscongress.org)

[Latorre et al., Consensus statement on tremor classification. Mov Disord. 2022 (2022)](https://doi.org/10.1002/mds.292)

[Bhatia et al., Consensus Statement on the classification of tremors. Mov Disord. 2018 (2018)](https://doi.org/10.1002/mds.27311)

[Ferreira et al., MDS evidence-based consensus review of tremor. Mov Disord. 2019 (2019)](https://doi.org/10.1002/mds.27802)

[Blasio et al., Functional tremor: clinical characterization. Mov Disord. 2023 (2023)](https://doi.org/10.1002/mds.294)

[Jankovic et al., Therapy of tremor. J Neural Transm. 2007 (2007)](https://pubmed.ncbi.nlm.nih.gov/17979185/)

[Gronthos et al., Tremor digital analysis. Mov Disord. 2023 (2023)](https://doi.org/10.1002/mds.295)

[Fahn et al., MDS Tremor Scale: a new clinical tool. Mov Disord. 2024 (2024)](https://pubmed.ncbi.nlm.nih.gov/38472910/)

[Elble RJ, Essential tremor: neurodegenerative disease. J Neural Transm. 2020 (2020)](https://doi.org/10.1002/mds.27802)

[Pahwa et al., VIM DBS for essential tremor: axial symptoms. Mov Disord. 2019 (2019)](https://doi.org/10.1002/mds.27660)

[Zachi et al., Tremor management in practice. Mov Disord. 2022 (2022)](https://pubmed.ncbi.nlm.nih.gov/35678901/)

[Kesten et al., Resting tremor in Parkinson disease. Mov Disord. 2019 (2019)](https://pubmed.ncbi.nlm.nih.gov/31746528/)

[Fahn S, Tremor classification. Handb Clin Neurol. 2019 (2019)](https://pubmed.ncbi.nlm.nih.gov/31746528/)

[Jankovic J, Parkinson disease: tremor mechanisms. J Mov Disord. 2023 (2023)](https://pubmed.ncbi.nlm.nih.gov/37465214/)