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The objectives of this study were to investigate re\u2010emergent tremor pathophysiology by studying the role of the primary motor cortex in this tremor and making a comparison with rest tremor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled 10 Parkinson's disease patients with both re\u2010emergent and rest tremor. Tremor was assessed by spectral analysis, corticomuscular coherence and tremor\u2010resetting produced by transcranial magnetic stimulation over the primary motor cortex. We also recorded transcranial magnetic stimulation\u2010evoked potentials generated by motor cortex stimulation during rest tremor, tremor suppression during wrist extension, and re\u2010emergent tremor. Spectral analysis, corticomuscular coherence, and tremor resetting were compared between re\u2010emergent tremor and rest tremor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Re\u2010emergent tremor showed significant corticomuscular coherence, causal relation between motor cortex activity and tremor muscle and tremor resetting. The P60 component of transcranial magnetic stimulation\u2010evoked potentials reduced in amplitude during tremor suppression, recovered before re\u2010emergent tremor, was facilitated at re\u2010emergent tremor onset, and returned to values similar to those of rest tremor during re\u2010emergent tremor. Compared with rest tremor, re\u2010emergent tremor showed similar corticomuscular coherence and tremor resetting, but slightly higher frequency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Re\u2010emergent tremor is causally related with the activity of the primary motor cortex, which is likely a convergence node in the network that generates re\u2010emergent tremor. Re\u2010emergent tremor and rest tremor share common pathophysiological mechanisms in which the motor cortex plays a crucial role. \u00a9 2020 International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.28022","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T06:32:04Z","timestamp":1584340324000},"page":"1002-1011","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Re\u2010emergent Tremor in Parkinson's Disease: The Role of the Motor Cortex"],"prefix":"10.1002","volume":"35","author":[{"given":"Giorgio","family":"Leodori","sequence":"first","affiliation":[{"name":"IRCCS NEUROMED  Pozzilli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Belvisi","sequence":"additional","affiliation":[{"name":"IRCCS NEUROMED  Pozzilli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria 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