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Novellino F, Nicoletti G, Cherubini A, Caligiuri ME, Nisticò R, Salsone M, Morelli M, Arabia G, Cavalli SM, Vaccaro MG, Chiriaco C, Quattrone A. Cerebellar involvement in essential tremor with and without resting tremor: A Diffusion Tensor Imaging study. Parkinsonism Relat Disord 2016; 27:61-6. [DOI: 10.1016/j.parkreldis.2016.03.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/02/2016] [Accepted: 03/28/2016] [Indexed: 11/17/2022]
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Gallay MN, Moser D, Rossi F, Pourtehrani P, Magara AE, Kowalski M, Arnold A, Jeanmonod D. Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy. J Ther Ultrasound 2016; 4:5. [PMID: 26877873 PMCID: PMC4752806 DOI: 10.1186/s40349-016-0049-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Already in the late 1960s and early 1970s, targeting of the “posterior subthalamic area (PSA)” was explored by different functional neurosurgical groups applying the radiofrequency (RF) technique to treat patients suffering from essential tremor (ET). Recent advances in magnetic resonance (MR)-guided focused ultrasound (MRgFUS) technology offer the possibility to perform thermocoagulation of the cerebellothalamic fiber tract in the PSA without brain penetration, allowing a strong reduction of the procedure-related risks and increased accuracy. We describe here the first results of the MRgFUS cerebellothalamic tractotomy (CTT). Methods Twenty-one consecutive patients suffering from chronic (mean disease duration 29.9 years), therapy-resistant ET were treated with MRgFUS CTT. Three patients received bilateral treatment with a 1-year interval. Primary relief assessment indicators were the Essential Tremor Rating Scale (Fahn, Tolosa, and Marin) (ETRS) taken at follow-up (3 months to 2 years) with accent on the hand function subscores (HF16 for treated hand and HF32 for both hands) and handwriting. The evolution of seven patients with HF32 above 28 points over 32 (group 1) differentiated itself from the others’ (group 2) and was analyzed separately. Global tremor relief estimations were provided by the patients. Lesion reconstruction and measurement of targeting accuracy were done on 2-day post-treatment MR pictures for each CTT lesion. Results The mean ETRS score for all patients was 57.6 ± 13.2 at baseline and 25.8 ± 17.6 at 1 year (n = 10). The HF16 score reduction was 92 % in group 2 at 3 months and stayed stable at 1 year (90 %). Group 1 showed only an improvement of 41 % at 3 months and 40 % at 1 year. Nevertheless, two patients of group 1 treated bilaterally had an HF16 score reduction of 75 and 88 % for the dominant hand at 1 year after the second side. The mean patient estimation of global tremor relief after CTT was 92 % at 2 days and 77 % at 1-year follow-up. Conclusions CTT with MRgFUS was shown to be an effective and safe approach for patients with therapy-refractory essential tremor, combining neurological function sparing with precise targeting and the possibility to treat patients bilaterally.
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Affiliation(s)
- Marc N Gallay
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - David Moser
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - Franziska Rossi
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - Payam Pourtehrani
- Rodiag Diagnostics Centers, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - Anouk E Magara
- Praxisgemeinschaft für Neurologie, Thunstrasse 95, CH-3006 Bern, Switzerland
| | - Milek Kowalski
- Privatklinik Obach, Leopoldstrasse 5, CH-4500 Solothurn, Switzerland
| | - Alexander Arnold
- Privatklinik Obach, Leopoldstrasse 5, CH-4500 Solothurn, Switzerland
| | - Daniel Jeanmonod
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
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Yin W, Lin W, Li W, Qian S, Mou X. Resting State fMRI Demonstrates a Disturbance of the Cerebello-Cortical Circuit in Essential Tremor. Brain Topogr 2016; 29:412-8. [PMID: 26868003 DOI: 10.1007/s10548-016-0474-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/02/2016] [Indexed: 12/18/2022]
Abstract
Individuals with essential tremor (ET) have postural and active movement abnormalities. Disturbances in the cerebello-thalamo-cortical circuit may contribute to the several motor symptoms of ET. Resting state fMRI provides a valuable, noninvasive tool to study intrinsic activation in the human brain, particularly in the brains of individuals with neuropsychiatric diseases. To investigate the low frequency oscillation features of intrinsic activation in ET in this study, we performed a resting state fMRI analysis in 24 patients with ET and 23 healthy controls. The amplitudes of low frequency fluctuation (ALFF) were analyzed. When compared with healthy controls, patients showed significantly enhanced ALFF in the bilateral cerebral cortex, which is related to motor function, including the pre- and post-central gyrus, supplementary motor area and paracentral lobule. The larger ALFF value in the right precentral gyrus is related to a longer duration of tremor. The decreased ALFF in the bilateral cerebellum was also observed in patients. In addition, aberrant ALFF in the right cerebellar tonsil was negatively associated with the duration of tremor. Our findings suggest that abnormalities exist in the intrinsic activation of brain regions in patients with ET. These findings provide noninvasive evidence that supports the hypothesis that the abnormality of intrinsic activity in the cerebello-cerebral cortex pathway could be associated with the motor-related symptoms of ET. Furthermore, the duration of a tremor might relate to the severity of the alterations to the motor system of ET.
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Affiliation(s)
- Wenjie Yin
- Department of Radiology, Chengdu First People's Hospital, Sichuan, China
| | - Wei Lin
- Department of Radiology, Chengdu First People's Hospital, Sichuan, China.
| | - Wenbo Li
- Department of Radiology, Chengdu First People's Hospital, Sichuan, China
| | - Shusen Qian
- Department of Radiology, Chengdu First People's Hospital, Sichuan, China
| | - Xin Mou
- Department of Neurology, Chengdu First People's Hospital, Sichuan, China
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Bergareche A, Bednarz M, Sánchez E, Krebs CE, Ruiz-Martinez J, De La Riva P, Makarov V, Gorostidi A, Jurkat-Rott K, Marti-Masso JF, Paisán-Ruiz C. SCN4A pore mutation pathogenetically contributes to autosomal dominant essential tremor and may increase susceptibility to epilepsy. Hum Mol Genet 2015; 24:7111-20. [PMID: 26427606 DOI: 10.1093/hmg/ddv410] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/25/2015] [Indexed: 12/19/2022] Open
Abstract
Essential tremor (ET) is the most prevalent movement disorder, affecting millions of people in the USA. Although a positive family history is one of the most important risk factors for ET, the genetic causes of ET remain unknown. In an attempt to identify genetic causes for ET, we performed whole-exome sequencing analyses in a large Spanish family with ET, in which two patients also developed epilepsy. To further assess pathogenicity, site-directed mutagenesis, mouse and human brain expression analyses, and patch clamp techniques were performed. A disease-segregating mutation (p.Gly1537Ser) in the SCN4A gene was identified. Posterior functional analyses demonstrated that more rapid kinetics at near-threshold potentials altered ion selectivity and facilitated the conductance of both potassium and ammonium ions, which could contribute to tremor and increase susceptibility to epilepsy, respectively. In this report, for the first time, we associated the genetic variability of SCN4A with the development of essential tremor, which adds ET to the growing list of neurological channelopathies.
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Affiliation(s)
- Alberto Bergareche
- Movement Disorders Unit, Department of Neurology Hospital Universitario Donostia San Sebastián Guipuzcoa Spain, Biodonostia Research Institute, Area of Neurosciences, Centro de Investigación Biomédica en Red para Enfermedades Neurodegenerativas (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Marcin Bednarz
- Division of Neurophysiology, Ulm University, Albert-Einstein-Allee 11, 89070 Ulm, Germany
| | | | | | - Javier Ruiz-Martinez
- Movement Disorders Unit, Department of Neurology Hospital Universitario Donostia San Sebastián Guipuzcoa Spain, Biodonostia Research Institute, Area of Neurosciences, Centro de Investigación Biomédica en Red para Enfermedades Neurodegenerativas (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Patricia De La Riva
- Movement Disorders Unit, Department of Neurology Hospital Universitario Donostia San Sebastián Guipuzcoa Spain, Biodonostia Research Institute, Area of Neurosciences, Centro de Investigación Biomédica en Red para Enfermedades Neurodegenerativas (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Vladimir Makarov
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Ana Gorostidi
- Movement Disorders Unit, Department of Neurology Hospital Universitario Donostia San Sebastián Guipuzcoa Spain, Biodonostia Research Institute, Area of Neurosciences, Centro de Investigación Biomédica en Red para Enfermedades Neurodegenerativas (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Karin Jurkat-Rott
- Division of Neurophysiology, Ulm University, Albert-Einstein-Allee 11, 89070 Ulm, Germany
| | - Jose Felix Marti-Masso
- Movement Disorders Unit, Department of Neurology Hospital Universitario Donostia San Sebastián Guipuzcoa Spain, Biodonostia Research Institute, Area of Neurosciences, Department of Neurosciences University of the Basque Country, EHU-UPV San Sebastián Gipuzkoa Spain, Centro de Investigación Biomédica en Red para Enfermedades Neurodegenerativas (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Coro Paisán-Ruiz
- Department of Neurology, Department of Psychiatry, Department of Genetics and Genomic Sciences, Friedman Brain Institute, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA and
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Cognitive functions, fatigue, depression, anxiety, and sleep disturbances: assessment of nonmotor features in young patients with essential tremor. Acta Neurol Belg 2015; 115:281-7. [PMID: 25471376 DOI: 10.1007/s13760-014-0396-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
There is a growing amount of evidence to suggest that besides motor features, patients with essential tremor (ET) may exhibit significant nonmotor features, such as mild cognitive deficits, fatigue, neuropsychiatric symptoms, and sleep disturbances. The goal of this study was to examine nonmotor features in young patients with ET and their impact on quality of life. 45 patients (24.55 ± 7.16 years old) with ET and 35 controls were evaluated using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory, Beck Anxiety Scale, Fatigue Severity Scale, and Short Form-36. Cognitive functions were evaluated using the Turkish version of the Montreal Cognitive Assessment Battery (MoCA). We ruled out other possible causes of the tremor. The tremor rate was evaluated using the Fahn-Tolosa-Marin Tremor Rating Scale. Poor sleep quality, fatigue, anxiety, and depressive symptoms were more common, and MoCA total scores were lower in the patient group. Fatigue, depressive symptoms, and higher anxiety levels were seen to have a negative effect on physical and mental health. Excessive daytime sleepiness had a negative effect on physical health. There is an emerging interest in nonmotor features of ET. This study showed that even young patients have nonmotor features that decrease their quality of life. This might tell us that nonmotor symptoms could be a part of the disease in the early stages.
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A comparison between rate of nonmotor symptom development in essential tremor and Parkinson's disease. Acta Neurol Belg 2015; 115:289-94. [PMID: 25527389 DOI: 10.1007/s13760-014-0408-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
In the last decade our perspective on essential tremor (ET) as a pure motor system disorder has begun to change. By virtue of recent studies of nonmotor symptoms (NMSs) that are used to characterize Parkinson's disease (PD), these symptoms have also been added to the definition of ET. There is increasing evidence to suggest that ET might not be as benign and monosymptomatic as we previously thought. The aim of this study was to evaluate nonmotor symptoms in ET, and to compare them with PD. We studied 37 ET and 23 PD patients. Tremor rate was evaluated using the Fahn-Tolosa-Marin tremor rating scale (FTM-TRS) in ET patients. The patients with PD were scored for motor symptoms using the unified Parkinson's disease rating scale (UPDRS)-III and the Hoehn-Yahr scale. Cognitive functions were assessed with the Montreal Cognitive Assessment (MoCA) test. NMSs were evaluated with the nonmotor symptoms questionnaire (NMSQuest). In the ET group, the most common NMSs were forgetting things, feeling sad, nocturia, urgency, and difficulty concentrating. The mean NMSQuest score was 8.43 ± 4.14 in the ET group and 14.06 ± 5.44 in the PD group (p value <0.001). However, except for 12 items in NMSQuest, in comparing items one by one there was no statistical difference between them. The mean MoCA total score was 17.81 ± 4.56 in the ET group and 17.08 ± 4.08 in the PD group (p value 0.675). There were no significant differences in MoCA subgroup scores. Evaluation of nonmotor symptoms in ET may help us to understand this emerging definition of ET. This study contributes evidence toward this new concept.
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Sánchez E, Bergareche A, Krebs CE, Gorostidi A, Makarov V, Ruiz-Martinez J, Chorny A, Lopez de Munain A, Marti-Masso JF, Paisán-Ruiz C. SORT1 Mutation Resulting in Sortilin Deficiency and p75(NTR) Upregulation in a Family With Essential Tremor. ASN Neuro 2015; 7:7/4/1759091415598290. [PMID: 26297037 PMCID: PMC4550298 DOI: 10.1177/1759091415598290] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
*These authors contributed equally to this work. Essential tremor (ET) is the most prevalent movement disorder affecting millions of people in the United States. Although a positive family history is one of the most important risk factors for ET, the genetic causes of ET remain unknown. In this study, whole exome sequencing and subsequent approaches were performed in a family with an autosomal dominant form of early-onset ET. Functional analyses including mutagenesis, cell culture, gene expression, enzyme-linked immunosorbent, and apoptosis assays were also performed. A disease-segregating mutation (p.Gly171Ala), absent in normal population, was identified in the SORT1 gene. The p.Gly171Ala mutation was shown not only to impair the expression of its encoding protein sortilin but also the mRNA levels of its binding partner p75 neurotrophin receptor that is known to be implicated in brain injury, neuronal apoptosis, and neurotransmission.
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Affiliation(s)
- Elena Sánchez
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Bergareche
- Biodonostia Research Institute, University of the Basque Country, San Sebastián, Gipuzkoa, Spain Department of Neurology, Hospital Universitario Donostia, San Sebastián, Guipuzcoa, Spain Centro de investigación biomédica en Red para enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Catharine E Krebs
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Gorostidi
- Biodonostia Research Institute, University of the Basque Country, San Sebastián, Gipuzkoa, Spain Department of Neurology, Hospital Universitario Donostia, San Sebastián, Guipuzcoa, Spain Centro de investigación biomédica en Red para enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - Javier Ruiz-Martinez
- Biodonostia Research Institute, University of the Basque Country, San Sebastián, Gipuzkoa, Spain Department of Neurology, Hospital Universitario Donostia, San Sebastián, Guipuzcoa, Spain Centro de investigación biomédica en Red para enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alejo Chorny
- Department of Medicine, The Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adolfo Lopez de Munain
- Biodonostia Research Institute, University of the Basque Country, San Sebastián, Gipuzkoa, Spain Department of Neurology, Hospital Universitario Donostia, San Sebastián, Guipuzcoa, Spain Centro de investigación biomédica en Red para enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain Department of Neurosciences, University of the Basque Country, San Sebastián, Guipuzcoa, Spain
| | - Jose Felix Marti-Masso
- Biodonostia Research Institute, University of the Basque Country, San Sebastián, Gipuzkoa, Spain Department of Neurology, Hospital Universitario Donostia, San Sebastián, Guipuzcoa, Spain Centro de investigación biomédica en Red para enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain Department of Neurosciences, University of the Basque Country, San Sebastián, Guipuzcoa, Spain
| | - Coro Paisán-Ruiz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Departments of Psychiatry and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA Friedman Brain and Mindich Child Health and Development Institutes, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Béliveau E, Tremblay C, Aubry-Lafontaine É, Paris-Robidas S, Delay C, Robinson C, Ferguson L, Rajput AH, Rajput A, Calon F. Accumulation of amyloid-β in the cerebellar cortex of essential tremor patients. Neurobiol Dis 2015; 82:397-408. [PMID: 26253607 DOI: 10.1016/j.nbd.2015.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 12/31/2022] Open
Abstract
The accumulation of insoluble amyloid-beta (Aβ) peptides is associated with neurodegenerative disorders, such as Alzheimer's disease (AD). As essential tremor (ET) could involve neurodegenerative processes in the cerebellum, we quantified soluble and insoluble Aβ in cerebellar cortices from patients diagnosed with ET (n=9), compared to Controls (n=16) or individuals with Parkinson's disease (n=10). Although ante-mortem cognitive performance was not documented, all individuals included had the diagnosis of AD ruled out by a neuropathologist. ELISA-determined concentrations of insoluble Aβ42 in ET patients displayed a bimodal distribution, with a median 246-fold higher than in Controls (P<0.01, Kruskal-Wallis). Higher Aβ42 concentrations were measured in the parietal cortex of the same ET patients, compared to Controls (107-fold median increase, P<0.01, Kruskal-Wallis), but similar phosphorylated tau levels were detected. The rise in cerebellar insoluble Aβ42 concentrations is not associated to APP expression and processing or the ApoE4 status. However, Aβ42 levels in ET individuals were correlated with cerebellar insoluble phosphorylated tau (r(2)=0.71, P=0.005), unphosphorylated neurofilament heavy chain (NF-H; r(2)=0.50, P=0.030) and Lingo-1 (r(2)=0.73, P=0.007), indicative of a generalized neurodegenerative process involving the cerebellum. Our results suggest prevalent accumulations of insoluble Aβ42 in the cerebellum of ET, but not in age-matched PD. Whether this anomaly plays a role in ET symptoms warrants further investigations.
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Affiliation(s)
- Eric Béliveau
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Neurosciences Axis, Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Cyntia Tremblay
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Neurosciences Axis, Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Émilie Aubry-Lafontaine
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Neurosciences Axis, Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Sarah Paris-Robidas
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Neurosciences Axis, Centre de recherche du CHU de Québec, Québec, QC, Canada
| | | | - Chris Robinson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Les Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ali H Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Frédéric Calon
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Neurosciences Axis, Centre de recherche du CHU de Québec, Québec, QC, Canada.
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Kim YE, Kim JS, Yang HJ, Yun JY, Kim HJ, Ehm G, Kim JM, Jeon BS. Perverted Head-Shaking and Positional Downbeat Nystagmus in Essential Tremor. THE CEREBELLUM 2015; 15:152-8. [DOI: 10.1007/s12311-015-0683-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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60
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Choi SM, Kim BC, Chang J, Choi KH, Nam TS, Kim JT, Lee SH, Park MS, Yoon W, de Leon MJ. Comparison of the Brain Volume in Essential Tremor and Parkinson's Disease Tremor Using an Automated Segmentation Method. Eur Neurol 2015; 73:303-9. [PMID: 25925562 DOI: 10.1159/000381708] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Essential tremor (ET) and Parkinson's disease (PD) are common neurological disorders in elderly people, and some features of ET and PD may overlap. Quantitative analysis of brain atrophy may be useful in differentiating neurodegenerative disorders. The aim of this study was to identify the volumetric differences of subcortical structures in patients with ET and PD tremor using an automated segmentation method. METHODS Volumetric MRIs were obtained in 45 patients with ET, 45 patients with PD tremor, and 45 age- and sex-matched control subjects. The volume of the different brain structures was measured by the automated segmentation method (FreeSurfer). RESULTS Volumetric data obtained with automated segmentation of cerebral regions showed a significant atrophy of the cerebellum in patients with ET. Cerebellar atrophy of ET patients was more significant in the white matter than in the grey matter, and it was noted only in patients with ET having a head tremor. No volumetric differences were found between the PD group and the control group. CONCLUSION Our study suggests that volumetric differences in subcortical structures using whole brain segmentation method may help to differentiate ET from PD tremor.
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Affiliation(s)
- Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
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Verdes JM, Márquez M, Calliari A, Battes D, Moraña JA, Gimeno EJ, Odriozola E, Giannitti F, Guerrero F, Fidalgo LE, Pumarola M. A novel pathogenic mechanism for cerebellar lesions produced by Solanum bonariense in cattle. J Vet Diagn Invest 2015; 27:278-86. [PMID: 25901005 DOI: 10.1177/1040638715582048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intoxication with Solanum bonariense in cattle causes cerebellar cortical degeneration with perikaryal vacuolation, axonal swelling, and death primarily of Purkinje cells, with accumulation of electron-dense residual storage bodies in membrane-bound vesicles. The pathogenesis of this disease is not fully understood. Previously, we proposed that inhibition of protein synthesis in Purkinje cells among other altered metabolic pathways could lead to cytoskeletal alterations, subsequently altering cell-specific axonal transport. In the present study, immunohistochemical and histochemical methods were used to identify neuronal cytoskeletal alterations and axonal loss, demyelination, and astrogliosis in the cerebellum of intoxicated bovines. Samples of cerebellum from 3 natural and 4 experimental cases and 2 control bovines were studied. Immunoreactivity against neurofilament (NF)-200KDa confirmed marked loss of Purkinje neurons, and phospho-NF protein, β-tubulin, and affinity reaction against phalloidin revealed an altered perikaryal distribution of neuronal cytoskeletal proteins in the remaining Purkinje cells in intoxicated cattle. Reactive astrogliosis in every layer of the cerebellar cortex was also observed with anti-glial fibrillary acidic protein immunohistochemistry. In affected cattle, demyelination and axonal loss in the cerebellar white matter, as well as basket cell loss were demonstrated with Klüver-Barrera and Bielschowsky stains, respectively. Based on these results, we propose that neuronal cytoskeletal alterations with subsequent interference of the axonal transport in Purkinje cells may play a relevant role in the pathogenesis of this neurodegenerative disorder, and also that demyelination and axonal loss in the cerebellar white matter, as well as astrogliosis in the gray matter, likely occur secondarily to Purkinje cell degeneration and death.
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Affiliation(s)
- José Manuel Verdes
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Mercedes Márquez
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Aldo Calliari
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Daniel Battes
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - José Antonio Moraña
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Eduardo Juan Gimeno
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Ernesto Odriozola
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Federico Giannitti
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Florentina Guerrero
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Luis Eusebio Fidalgo
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
| | - Martí Pumarola
- Departments of Molecular and Cellular Biology (Biophysics) (Verdes, Calliari, Battes) and Pathology (Verdes, Moraña), Facultad de Veterinaria, Universidad de la República, Montevideo, UruguayDepartment of Proteins and Nucleic Acids, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay (Calliari, Verdes)Department of Animal Medicine and Surgery, Veterinary Faculty, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain (Márquez, Pumarola)Institute of Pathology, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina (Gimeno)Estación Experimental Agropecuaria Balcarce, Instituto Nacional de Tecnología Agropecuaria, Balcarce, Argentina (Odriozola)Veterinary Diagnostic Laboratory, Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota and the "Instituto Nacional de Investigación Agropecuaria", La Estanzuela, Colonia, Uruguay (Giannitti)Departments of Anatomy and Animal Production (Guerrero), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, SpainVeterinary Clinical Sciences (Fidalgo), Facultad de Veterinaria, Universidad de Santiago de Compostela, Lugo, Spain
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Ha SW, Yang YS, Song IU, Chung YA, Oh JK, Chung SW. Changes in regional brain glucose metabolism measured with F-18-FDG-PET in essential tremor. Acta Radiol 2015; 56:482-6. [PMID: 24782572 DOI: 10.1177/0284185114531414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is growing evidence that essential tremor (ET) is a multiple-system disorder. Previous PET studies in ET typically have measured brain oxygen consumption and cerebral blood flow. PURPOSE To compare ET patients with control subjects to investigate any regional change in cerebral glucose metabolism through statistical parametric mapping (SPM) analysis of F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET). MATERIAL AND METHODS We studied 17 patients with ET (17 men; mean age, 67.3 ± 4.8 years) and age-sex matched normal subjects. All subjects underwent FDG-PET imaging, and evaluated severity of tremor symptoms was measured as score on the Fahn-Tolosa-Marin rating scale (FTM). We also evaluated detailed the medical history and neurological examinations in all patients. RESULTS The mean age of tremor onset was 57.6 ± 12.9 years and the mean FTM score was 15.1 ± 4.9. Brain FDG-PET analysis demonstrated hypometabolism in the medial frontal lobe, medial temporal lobe, and the precuneus of parietal lobe. However, there was no significant difference of glucose metabolism in the cerebellum. CONCLUSION We propose that motor symptom of ET are caused by electrophysiological disturbances within cortical-cerebellar networks, rather than degenerative process of cerebellum, because the metabolism of the cerebellum was normal at rest. Furthermore, the abnormal glucose metabolism in the cerebral regions that do not mainly participate in motor function suggest that these regions may play a role as early markers of non-motor manifestations.
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Affiliation(s)
- Sang-Won Ha
- Department of Neurology, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Young Soon Yang
- Department of Neurology, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - In-Uk Song
- Department of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yong-An Chung
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jin-Kyoung Oh
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sung-Woo Chung
- Department of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
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63
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Sengul Y, Sengul H. Is it true that essential tremor affects sleep? A comparison between young essential tremor patients and normal controls. Sleep Biol Rhythms 2015. [DOI: 10.1111/sbr.12119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yildizhan Sengul
- Department of Neurology; Erzurum Regional Training and Research Hospital; Erzurum Turkey
| | - Hakan Sengul
- Department of Psychology; Erzurum Regional Training and Research Hospital; Erzurum Turkey
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Reimão S, Pita Lobo P, Neutel D, Guedes LC, Coelho M, Rosa MM, Azevedo P, Ferreira J, Abreu D, Gonçalves N, Nunes RG, Campos J, Ferreira JJ. Substantia nigra
neuromelanin-MR imaging differentiates essential tremor from Parkinson's disease. Mov Disord 2015; 30:953-9. [DOI: 10.1002/mds.26182] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sofia Reimão
- Neurological Imaging Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
| | - Patrícia Pita Lobo
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
- Neurology Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
| | - Dulce Neutel
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
- Neurology Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
| | - Leonor Correia Guedes
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
- Neurology Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
| | - Miguel Coelho
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
- Neurology Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
| | - Mário M. Rosa
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
- Neurology Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine; University of Lisbon; Portugal
| | - Pedro Azevedo
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa; Portugal
| | - Joana Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa; Portugal
| | - Daisy Abreu
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
| | - Nilza Gonçalves
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
| | - Rita G. Nunes
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa; Portugal
| | - Jorge Campos
- Neurological Imaging Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
| | - Joaquim J. Ferreira
- Clinical Pharmacology Unit; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon; Portugal
- Neurology Department; Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Portugal
- CNS-Campus Neurológico Sénior; Torres Vedras Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine; University of Lisbon; Portugal
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65
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Louis ED, Lee M, Cortés E, Vonsattel JPG, Faust PL. Matching asymmetry of tremor with asymmetry of postmortem cerebellar hemispheric changes in essential tremor. THE CEREBELLUM 2015; 13:462-70. [PMID: 24756341 DOI: 10.1007/s12311-014-0560-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although the number of postmortem studies in essential tremor (ET) has grown in recent years, clinical-pathological correlations remain limited. We are unaware of a study that has assessed whether the pathological changes in ET, if asymmetric, lateralize to the cerebellar hemisphere that is ipsilateral to the arm with more severe action tremor, as one would predict if the lesions were tremor producing. We compared postmortem changes in the right vs. left cerebellar hemispheres in ET and examined how these correlated with asymmetry of tremor on neurological examination. Action tremor in each arm was quantified using a reliable and valid clinical rating scale. Cases were divided into three clinical groups: tremor more severe on right, tremor more severe on left, and tremor symmetric. Calbindin D28k immunohistochemistry was performed on 100 μm vibrotome sections from a standard tissue block of both right and left neocerebellums to quantify Purkinje cell linear density, torpedo counts, and a group of previously described changes in Purkinje cell axonal shape (thickened axonal profiles) and connectivity (axon recurrent collaterals, axonal branching, terminal axonal sprouting, arciform axons, extent of recurrent collateral plexus). ET cases were divided into three postmortem groups: findings greatest on right, findings greatest on left, and findings symmetric. In 18 (72.0 %) of 25 ET cases, clinical and pathological features were concordant (i.e., both clinically and pathologically right-predominant (one case), both clinically and pathologically left-predominant (five cases), or both clinically and pathologically symmetric (12 cases), p = 0.007). In the remaining seven (28.0 %) ET cases, clinical and pathological data were not concordant, and in none were they completely discordant (i.e., tremor was more severe on the right, and postmortem cerebellar changes were paradoxically more severe on the left or vice versa). Among the seven ET cases with >20 % side-to-side difference in tremor severity, six cases (85.7 %) had the expected pathological asymmetry, with quantified postmortem cerebellar changes more marked ipsilateral to the more clinically affected side. We also created continuous measures of asymmetry. For the entire sample, there was a positive correlation between the clinical asymmetry index and the pathological asymmetry index = 0.52, p = 0.01 (i.e., the right-left difference in clinical asymmetry was correlated with the right-left difference in postmortem changes). For the seven ET cases with clear clinical asymmetry, the correlation was even more robust (r = 0.78, p = 0.039). Clinical-pathological correlations are important in terms of understanding the significance of observed pathological changes. The correlation between clinical laterality or symmetry of tremor and pathological changes in the majority of ET cases provides additional evidence that the pathological changes in the cerebellum in ET are of patho-mechanistic importance.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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Louis ED, Kuo SH, Vonsattel JPG, Faust PL. Torpedo formation and Purkinje cell loss: modeling their relationship in cerebellar disease. THE CEREBELLUM 2015; 13:433-9. [PMID: 24590661 DOI: 10.1007/s12311-014-0556-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Torpedo formation and Purkinje cell (PC) loss represent standard and inter-related cerebellar responses to injury. Surprisingly, the nature of their relationship has not been carefully characterized across a range of normal and disease states. Are brains with more torpedoes expected to have fewer PCs? We quantified torpedoes and PCs in four groups: essential tremor (ET), spinocerebellar ataxia (SCA), multiple system atrophy-cerebellar (MSA-C), and controls. Brains from 100 individuals (58 ET, 27 controls, 7 SCA, 8 MSA-C) were available at the New York Brain Bank. After complete neuropathological assessment, a standard parasagittal neocerebellar block was harvested; a 7-μm thick section was stained with Luxol fast blue/hematoxylin and eosin; and torpedoes and PCs were quantified. For a given PC count, SCA and MSA-C cases often had higher torpedo counts than ET cases or controls. Furthermore, the relationship between torpedo and PC counts was complex. The correlation between torpedo and PC counts was negative in ET cases (i.e., individuals with more torpedoes had fewer PCs [i.e., more PC loss]) whereas the relationship was positive in MSA-C cases (i.e., individuals with fewer PCs [i.e., more PC loss] had fewer torpedoes). Patients with SCA showed both patterns. When all diagnostic groups were combined, the correlation was best fit by a quadratic (i.e., parabolic) model rather than a simple linear model; this model incorporated data on the negative correlation in ET cases, the mixed results in SCA cases, and the positive correlation in MSA-C cases (r = 0.636). The relationship between torpedo and PC counts was complex and heterogeneous across a range of cerebellar disease states, and was best characterized by a quadratic rather than a simple model. With more severe cerebellar disease, torpedoes can be quite numerous and are likely a common feature of surviving PCs, but eventually, dramatic loss of PC leads to a paradoxical reduction in observable torpedoes.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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Yilmaz NH, Akbostanci MC, Yılmaz N. Sensorineural Hearing Loss in Non-depressed Essential Tremor Cases and Controls: A Clinical and Audiometric Study. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:281. [PMID: 25667817 PMCID: PMC4314288 DOI: 10.7916/d8xw4hkq] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/10/2015] [Indexed: 12/01/2022]
Abstract
Background Patients with essential tremor (ET) have an increased prevalence of hearing loss, and depression is a confounding issue for both conditions. We assessed hearing loss in non-depressed ET patients and controls using a questionnaire and audiometric tests. Methods The study included 34 patients with ET and 45 volunteers were included. Both groups were asked if they had hearing loss, and pure tone audiometry, speech recognition threshold, tympanogram, short increment sensitivity index (SISI), tone decay, and otoacoustic emission audiological tests were conducted. Results Seventeen subjects (50.0%) in the patient group answered “yes” to the question “Do you have hearing loss?” compared to one (2.2%) subject in the control group (p<0.001). The tone decay values of the right ear at 4,000 Hz were higher in the patient group. The number of subjects in which the otoacoustic emissions could not be obtained in the right ear was higher in the ET patients (p = 0.005). Discussion The results support the presence of a cochlear pathology in ET and may indicate that ET and sensorineural hearing loss may be components of a common disease process.
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Affiliation(s)
| | - Muhittin Cenk Akbostanci
- Department of Neurology, Movement Disorders Division, Ankara University Medical School, Ankara, Turkey
| | - Nurhan Yılmaz
- Department of Neurology, Kayseri Training and Research Hospital, Kayseri, Turkey
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Kocabicak E, Temel Y, Höllig A, Falkenburger B, Tan SK. Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders. Neuropsychiatr Dis Treat 2015; 11:1051-66. [PMID: 25914538 PMCID: PMC4399519 DOI: 10.2147/ndt.s46583] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) has become a well-accepted therapy to treat movement disorders, including Parkinson's disease, essential tremor, and dystonia. Long-term follow-up studies have demonstrated sustained improvement in motor symptoms and quality of life. DBS offers the opportunity to selectively modulate the targeted brain regions and related networks. Moreover, stimulation can be adjusted according to individual patients' demands, and stimulation is reversible. This has led to the introduction of DBS as a treatment for further neurological and psychiatric disorders and many clinical studies investigating the efficacy of stimulating various brain regions in order to alleviate severe neurological or psychiatric disorders including epilepsy, major depression, and obsessive-compulsive disorder. In this review, we provide an overview of accepted and experimental indications for DBS therapy and the corresponding anatomical targets.
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Affiliation(s)
- Ersoy Kocabicak
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands ; Department of Neuroscience, Maastricht University, Maastricht, the Netherlands ; Department of Neurosurgery, Ondokuz Mayıs University, Samsun, Turkey
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands ; Department of Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Anke Höllig
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | | | - Sonny Kh Tan
- Department of Neuroscience, Maastricht University, Maastricht, the Netherlands ; Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Pan J, Michalec M, Louis ED. Non-steroidal anti-inflammatory drug use and essential tremor. Neuroepidemiology 2014; 43:145-9. [PMID: 25376662 DOI: 10.1159/000366424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/31/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be inversely related to Parkinson's disease and Alzheimer's disease, both of which may share common mechanisms with essential tremor (ET). Use of these medications has not been studied in ET cases vs. controls. OBJECTIVE To investigate the relationships between NSAID (esp. ibuprofen) and aspirin use and ET. METHODS Subjects were enrolled in a case-control study of the environmental epidemiology of ET at the Columbia University Medical Center (CUMC; 2009-2014). We compared 92 ET cases to 107 controls (∼1:1 matching) in terms of self-reported NSAID (esp. ibuprofen) and aspirin use. RESULTS The proportion of NSAID or aspirin users (current or past) was similar in ET cases and controls (for current user, p = 0.66; for past user, p = 0.90). Among users, however, the total dosage of ibuprofen (frequency in past year × number of tablets taken at a time × typical average strength of tablets) was higher in controls than ET cases (p = 0.04). ET cases and controls did not differ with respect to aspirin use in the past year. CONCLUSION The proportion of NSAID or aspirin users did not differ in ET cases or controls; yet interestingly, ibuprofen use was less in ET cases than in controls. The latter raises the possibility that ibuprofen use could have a potential protective role in ET.
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Affiliation(s)
- Jie Pan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, N.Y., USA
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Kestenbaum M, Michalec M, Yu Q, Pullman SL, Louis ED. Intention Tremor of the Legs in Essential Tremor: Prevalence and Clinical Correlates. Mov Disord Clin Pract 2014; 2:24-28. [PMID: 25984553 DOI: 10.1002/mdc3.12099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and assess the clinical correlates of intention tremor in the legs in essential tremor (ET) patients. BACKGROUND The cerebellar features of ET are of growing interest to clinical neurologists. Arm tremor has an intentional component in many ET patients. Intention tremor in the legs, however, has never been systematically evaluated. METHODS One-hundred-twenty-eight ET patients were enrolled in a clinical-epidemiological study at Columbia University. A videotaped neurological examination included 10 toe-to-target movements with each foot. Videotapes were independently reviewed by two movement disorder neurologists who noted the presence vs. absence of intentional leg tremor. Two patients underwent quantitative computerized tremor analysis to study the physiological characteristics of the tremor. RESULTS Thirty-five patients (27.3%) had intentional leg tremor; in 21, tremor was unilateral and in 14 it was bilateral. The 35 patients with intentional leg tremor did not differ from the remaining 93 patients in their clinical characteristics. Analyses comparing the 14 patients with bilateral intentional leg tremor to the 93 patients with no intentional leg tremor showed trends towards longer disease duration and more severe intentional arm tremor in the former. Tremor analysis showed a 3-fold increase in average tremor amplitude from movement onset to the point just prior to touching the target. CONCLUSIONS Our data suggest that intentional leg tremor, another cerebellar feature, is common in ET patients. The tremor may be associated with longer disease duration and more severe intentional arm tremor, but these preliminary trends need to be assessed in larger study samples.
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Affiliation(s)
- Meir Kestenbaum
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Monika Michalec
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Qiping Yu
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Seth L Pullman
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Elan D Louis
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA ; GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA ; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Lacerte A, Chouinard S, Jodoin N, Bernard G, Rouleau GA, Panisset M. Increased Prevalence of Non-motor Symptoms in Essential Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:162. [PMID: 25247108 PMCID: PMC4159683 DOI: 10.7916/d82v2d91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/12/2014] [Indexed: 12/01/2022]
Abstract
Background Cases with essential tremor (ET) have been described with Lewy body inclusions, the hallmark of Parkinson disease (PD). Patients with PD may suffer from anosmia, depression, constipation, and rapid eye movement sleep behavior disorder (RBD), sometimes years before the appearance of their motor syndrome. The objective of this study was to evaluate the prevalence of these non-motor Parkinson's associated symptoms in patients with ET. Methods Fifty ET subjects were contacted by phone and given questionnaires evaluating the presence or absence of anosmia, depression, constipation, and RBD. Frequencies of these symptoms were compared with their published prevalence in the general population. Results Of the patients with ET, 4.5% reported having anosmia or hyposmia and 21.7% reported being constipated, similar to what is observed in the general population. Using a screening questionnaire for RBD, 43.5% of ET patients are possibly suffering from RBD, whereas in the general population prevalence is estimated to be 0.5%. Finally, depression was detected in 21.7% of ET patients; in the general population, prevalence is 5%. Discussion Patients with ET seem to have more RBD and more depression than found in the general population. Prospective studies with normal control groups are needed to confirm these findings.
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Affiliation(s)
- Annie Lacerte
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sylvain Chouinard
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Nicolas Jodoin
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Bernard
- Division of Pediatric Neurology, Montreal Children Hospital, McGill University, Québec, Canada
| | - Guy A Rouleau
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada ; CENUM, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Michel Panisset
- André-Barbeau Movement Disorders Unit Service of Neurology, Centre Hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montréal, Québec, Canada
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Klaming R, Annese J. Functional anatomy of essential tremor: lessons from neuroimaging. AJNR Am J Neuroradiol 2014; 35:1450-7. [PMID: 23620075 DOI: 10.3174/ajnr.a3586] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The neuropathogenetic processes underlying essential tremor appear to cause subtle morphologic changes in neural networks that include multiple brain structures, primarily the cerebellum, brain stem, frontal lobes, and thalamus. One of the main challenges of neuroimaging in essential tremor is differentiating disease-specific markers from the spectrum of structural changes that occur due to aging. This review discusses recent neuroimaging studies in the light of current knowledge of the neuropsychology and pathology of the disease. We suggest that the application of multiple macroscopic and microscopic neuroimaging modalities, combined with personalized information relative to cognitive and behavioral symptoms, is the prerequisite for a comprehensive classification and correct diagnosis of essential tremor.
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Affiliation(s)
- R Klaming
- From The Brain Observatory, San Diego, California; and Department of Radiology, University of California, San Diego, San Diego, California
| | - J Annese
- From The Brain Observatory, San Diego, California; and Department of Radiology, University of California, San Diego, San Diego, California.
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Louis ED. From neurons to neuron neighborhoods: the rewiring of the cerebellar cortex in essential tremor. CEREBELLUM (LONDON, ENGLAND) 2014; 13:501-12. [PMID: 24435423 PMCID: PMC4077904 DOI: 10.1007/s12311-013-0545-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Remarkably little has been written on the biology of essential tremor (ET), despite its high prevalence. The olivary model, first proposed in the 1970s, is the traditional disease model for ET; however, the model is problematic for a number of reasons. Recently, intensive tissue-based studies have identified a series of structural changes in the brains of most ET cases, and nearly all of the observed changes are located in the cerebellar cortex. These studies suggest that Purkinje cells are central to the pathogenesis of ET and may thus provide a focus for the development of novel therapeutic strategies. Arising from these studies, a new model of ET proposes that the population of Purkinje cells represents the site of the initial molecular/cellular events leading to ET. Furthermore, a number of secondary changes/remodeling observed in the molecular and granular layers (i.e., in the Purkinje cell "neighborhood") are likely to be of additional mechanistic importance. On a physiological level, the presence of remodeling indicates the likely formation of aberrant synapses and the creation of new/abnormal cortical circuits in ET. Specific efforts need to be devoted to understanding the cascade of biochemical and cellular events occurring in the Purkinje cell layer in ET and its neuron neighborhood, as well as the physiological effects of secondary remodeling/rewiring that are likely to be occurring in this brain region in ET.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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74
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Benito-León J. Essential tremor: a neurodegenerative disease? TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:252. [PMID: 25120943 PMCID: PMC4107287 DOI: 10.7916/d8765cg0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/29/2014] [Indexed: 12/01/2022]
Abstract
Background Essential tremor (ET) is one of the most common neurological disorders among adults, and is the most common of the many tremor disorders. It has classically been viewed as a benign monosymptomatic condition, yet over the past decade, a growing body of evidence indicates that ET is a progressive condition that is clinically heterogeneous, as it may be associated with a spectrum of clinical features, with both motor and non-motor elements. In this review, I will describe the most significant emerging milestones in research which, when taken together, suggest that ET is a neurodegenerative condition. Methods A PubMed search conducted in June 2014 crossing the terms “essential tremor” (ET) and “neurodegenerative” yielded 122 entries, 20 of which included the term “neurodegenerative” in the article title. This was supplemented by articles in the author's files that pertained to this topic. Results/Discussion There is an open and active dialogue in the medical community as to whether ET is a neurodegenerative disease, with considerable evidence in favor of this. Specifically, ET is a progressive disorder of aging associated with neuronal loss (reduction in Purkinje cells) as well as other post-mortem changes that occur in traditional neurodegenerative disorders. Along with this, advanced neuroimaging techniques are now demonstrating distinct structural changes, several of which are consistent with neuronal loss, in patients with ET. However, further longitudinal clinical and neuroimaging longitudinal studies to assess progression are required.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain ; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain ; Department of Medicine, Complutense University, Madrid, Spain
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Abstract
The precise way that tremors emerge is not well known, but there is some good information and hypotheses. This review will focus on the classic ("rest") tremor of Parkinson disease and essential tremor. Both have their genesis in central oscillators, which appear to be malfunctioning networks. With classic Parkinson tremor, there appears to be dysfunction of the basal ganglia network and the cerebello-thalamo-cortical network. There is evidence that the basal ganglia network triggers the onset of tremor and the cerebellar network is responsible for the amplitude. Since it is a tremor of stability, the beta activity of the basal ganglia may be the trigger. With essential tremor, the cerebello-thalamo-cortical network itself is dysfunctional and perhaps the inferior olive-cerebellar network as well. This is a tremor of action, and the associated ataxia suggests that delays in motor control processing may set up the oscillation.
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Affiliation(s)
- Mark Hallett
- Human Motor Control Section, NINDS, NIH, Bethesda, MD, USA.
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Abstract
For many years, little was written about the underlying biology of ET, despite its high prevalence. Discussions of disease mechanisms were dominated by a focus on tremor physiology. The traditional model of ET, the olivary model, was proposed in the 1970s. The model suffers from several critical problems, and its relevance to ET has been questioned. Recent mechanistic research has focused on the cerebellum. Clinical and neuroimaging studies strongly implicate the importance of this brain region in ET. Recent mechanistic research has been grounded more in tissue-based changes (i.e., postmortem studies of the brain). These studies have collectively and systematically identified a sizable number of changes in the ET cerebellum, and have led to a new model of ET, referred to as the cerebellar degenerative model. Hence, there is a renewed interest in the science behind the biology of ET. How the new understanding of ET will translate into treatment changes is an open question.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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77
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Sharifi S, Nederveen AJ, Booij J, van Rootselaar AF. Neuroimaging essentials in essential tremor: a systematic review. NEUROIMAGE-CLINICAL 2014; 5:217-31. [PMID: 25068111 PMCID: PMC4110352 DOI: 10.1016/j.nicl.2014.05.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/03/2014] [Accepted: 05/05/2014] [Indexed: 01/04/2023]
Abstract
Background Essential tremor is regarded to be a disease of the central nervous system. Neuroimaging is a rapidly growing field with potential benefits to both diagnostics and research. The exact role of imaging techniques with respect to essential tremor in research and clinical practice is not clear. A systematic review of the different imaging techniques in essential tremor is lacking in the literature. Methods We performed a systematic literature search combining the terms essential tremor and familial tremor with the following keywords: imaging, MRI, VBM, DWI, fMRI, PET and SPECT, both in abbreviated form as well as in full form. We summarize and discuss the quality and the external validity of each study and place the results in the context of existing knowledge regarding the pathophysiology of essential tremor. Results A total of 48 neuroimaging studies met our search criteria, roughly divided into 19 structural and 29 functional and metabolic studies. The quality of the studies varied, especially concerning inclusion criteria. Functional imaging studies indicated cerebellar hyperactivity during rest and during tremor. The studies also pointed to the involvement of the thalamus, the inferior olive and the red nucleus. Structural studies showed less consistent results. Discussion and conclusion Neuroimaging techniques in essential tremor give insight into the pathophysiology of essential tremor indicating the involvement of the cerebellum as the most consistent finding. GABAergic dysfunction might be a major premise in the pathophysiological hypotheses. Inconsistencies between studies can be partly explained by the inclusion of heterogeneous patient groups. Improvement of scientific research requires more stringent inclusion criteria and application of advanced analysis techniques. Also, the use of multimodal neuroimaging techniques is a promising development in movement disorders research. Currently, the role of imaging techniques in essential tremor in daily clinical practice is limited. We conducted a systematic review of neuroimaging studies in essential tremor. Cerebellar involvement is the most consistent finding. GABAergic dysfunction is worthwhile investigating more intensively. We encourage multimodal neuroimaging focussing on brain networks.
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Affiliation(s)
- Sarvi Sharifi
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands ; Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands ; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands ; Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands ; Brain Imaging Center, Academic Medical Center, Amsterdam, The Netherlands
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78
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Jellinger KA. Is there cerebellar pathology in essential tremor? Mov Disord 2014; 29:435-6. [PMID: 24585416 DOI: 10.1002/mds.25852] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 11/11/2022] Open
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Delay C, Tremblay C, Brochu E, Paris-Robidas S, Emond V, Rajput AH, Rajput A, Calon F. Increased LINGO1 in the cerebellum of essential tremor patients. Mov Disord 2014; 29:1637-47. [PMID: 24531928 DOI: 10.1002/mds.25819] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/28/2013] [Accepted: 12/30/2013] [Indexed: 12/21/2022] Open
Abstract
Essential tremor (ET) is the most prevalent adult-onset movement disorder. Despite its health burden, no clear pathognomonic sign has been identified to date because of the rarity of clinicopathological studies. Moreover, treatment options are still scarce and have not significantly changed in the last 30 years, underscoring the urgent need to develop new treatment avenues. In the recent years, leucine-rich repeat (LRR) and immunoglobulin (Ig) domain-containing Nogo receptor-interacting proteins 1 and 2 (LINGO1 and LINGO2, respectively) have been increasingly regarded as possible ET modulators due to emerging genetic association studies linking LINGO with ET. We have investigated LINGO protein and messenger RNA (mRNA) expression in the cerebellum of patients with ET, patients with Parkinson's disease (PD), and a control group using Western immunoblotting and in situ hybridization. Protein levels of LINGO1, but not LINGO2, were significantly increased in the cerebellar cortex of ET patients compared with controls, particularly in individuals with longer disease duration. Compared with controls, LINGO1 protein levels were increased in the cerebellar white matter of PD and ET patients but, for the latter, only when disease duration exceeded 20 years. However, no alteration in LINGO1 mRNA was observed between groups in either the cerebellar cortex or the white matter. We observed alterations in LINGO expression in diseased brain that seemed to progress along with the disease, being initiated in the cerebellar cortex before reaching the white matter. Because LINGO up-regulation has been identified as a potential pathological response to ongoing neurodegenerative processes, the present data suggest that LINGO1 is a potential drug target for ET.
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Affiliation(s)
- Charlotte Delay
- Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Québec, Neurosciences Axis, Québec City, Québec, Canada
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Hedera P, Cibulčík F, Davis TL. Pharmacotherapy of essential tremor. J Cent Nerv Syst Dis 2013; 5:43-55. [PMID: 24385718 PMCID: PMC3873223 DOI: 10.4137/jcnsd.s6561] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/10/2013] [Accepted: 11/25/2013] [Indexed: 12/11/2022] Open
Abstract
Essential tremor (ET) is a common movement disorder but its pathogenesis remains poorly understood. This has limited the development of effective pharmacotherapy. The current therapeutic armamentaria for ET represent the product of careful clinical observation rather than targeted molecular modeling. Here we review their pharmacokinetics, metabolism, dosing, and adverse effect profiles and propose a treatment algorithm. We also discuss the concept of medically refractory tremor, as therapeutic trials should be limited unless invasive therapy is contraindicated or not desired by patients.
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Affiliation(s)
- Peter Hedera
- Department of Neurology, Vanderbilt University, Nashville, TN
| | - František Cibulčík
- Department of Neurology, Slovak Medical University and University Hospital Bratislava, Slovakia
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University, Nashville, TN
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Differences in cerebral perfusion according to phenotypes of essential tremor: brain perfusion SPECT study using SPM analysis. Neurol Sci 2013; 35:767-72. [PMID: 24337969 DOI: 10.1007/s10072-013-1600-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
Essential tremor (ET) is one of the most common movement disorders. However, few studies regarding the differences of pathophysiology according to phenotypes of ET have been reported. We investigated whether a functional difference occurs between ET with only a limb tremor (L-ET) and ET with only a head tremor (H-ET). We recruited 13 patients with L-ET, 10 patients with H-ET, and 33 healthy subjects. We compared the severity of tremor symptoms using the Fahn-Tolosa-Marin rating scale (FTM) to compare L-ET with H-ET. All subjects underwent magnetic resonance imaging and perfusion SPECT of the brain. The total score of FTM was significantly higher in the L-ET than in the H-ET. However, Part A in FTM did not show significant differences between the two ET groups. A brain perfusion SPECT analysis demonstrated no significant difference between L-ET and H-ET, but a regional perfusion of subjects with ET compared with healthy subjects showed hypoperfusion in the insular, cingulate gyrus, frontal lobe, and cerebellum. In conclusion, we suggested that cerebellar dysfunction might be involved in the pathogenesis of ET. In addition, we assumed that ET has the same pathogenesis in the origin of the disease, regardless of the clinical difference of ET.
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82
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Louis ED. 'Essential tremor' or 'the essential tremors': is this one disease or a family of diseases? Neuroepidemiology 2013; 42:81-9. [PMID: 24335621 DOI: 10.1159/000356351] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/10/2013] [Indexed: 12/14/2022] Open
Abstract
There is accumulating evidence that the entity referred to as 'essential tremor' (ET) is not a single disease. It may be a family of diseases better referred to as 'the ETs'. This review will summarize the following evidence: (1) the presence of etiological heterogeneity; (2) the heterogeneity of findings in postmortem studies, thus suggesting several diseases; (3) the recent discussion that age of onset may be an important marker of disease heterogeneity; (4) the clinical expansion of the concept of ET in recent years to include a broader range of tremor phenomenology, other motor features (gait ataxia), other involuntary movements (dystonia), and nonmotor features (cognitive problems, psychiatric problems), some of which could be primary; (5) the heterogeneity of pharmacological response profiles and clinical progression, and (6) the association of ET with Parkinson's disease, Alzheimer's disease, and possibly progressive supranuclear palsy, with the possibility that some ET patients are more predisposed to develop one of these. © 2013 S. Karger AG, Basel.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, N.Y., USA
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83
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Janicki SC, Cosentino S, Louis ED. The cognitive side of essential tremor: what are the therapeutic implications? Ther Adv Neurol Disord 2013; 6:353-68. [PMID: 24228071 DOI: 10.1177/1756285613489591] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While essential tremor (ET) has traditionally been categorized as a pure motor disease, cross-sectional and longitudinal studies of cognition in ET have demonstrated that these patients may have cognitive dysfunction. Recent epidemiological studies demonstrate an association between ET (particularly with onset after age 65) and increased risk for cognitive impairment and dementia. Although existing studies have generally conceptualized cognitive changes in ET as consistent with a 'frontosubcortical' or 'corticocerebellar' profile, results from these same studies suggest that cognitive impairment in ET may in fact be heterogeneous. Furthermore, the underlying mechanisms remain uncertain. Cognitive changes could be a byproduct of the cerebellar dysfunction of ET itself; alternately, they may be a feature of concomitant neurodegenerative diseases that have been associated in several studies with ET, including Alzheimer's disease, Parkinson's disease or progressive supranuclear palsy. While the study of cognitive dysfunction in ET has received research attention in recent years, the results of these studies have not been translated into the clinical domain and clinical practice. This review first summarizes the current literature on the potential relationships between ET and cognitive change. We then suggest areas of further clinical evaluation and treatment; these suggestions are directed at physicians caring for ET patients who may demonstrate or complain of cognitive impairment. As we discuss, clinicians should ideally screen ET patients for possible signs or symptoms of cognitive impairment in addition to assessing for psychiatric comorbidity and quality of life. These recommendations are in contrast to most current clinical practice, which does not routinely include such assessment among ET patients. To our knowledge, there have been no pharmacotherapeutic trials to date of any agent for cognitive change associated with ET. We believe that studies for this indication are now called for. Future efforts in this direction will also need to take into account the pathobiology of cognitive changes in ET, which itself is an area that is ripe for future investigations.
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Affiliation(s)
- Sarah C Janicki
- Department of Neurology, G.H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Impaired temporal processing of tactile and proprioceptive stimuli in cerebellar degeneration. PLoS One 2013; 8:e78628. [PMID: 24244328 PMCID: PMC3823840 DOI: 10.1371/journal.pone.0078628] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/13/2013] [Indexed: 12/03/2022] Open
Abstract
Performance of timed motor sequences relies on the cerebellum and basal ganglia, which integrate proprioceptive information during the motor task and set internal timing mechanisms. Accordingly, these structures are also involved in other temporal processes, such as the discrimination of the different afferent information in the domain of time. In the present study we tested temporal processing of proprioceptive and tactile stimuli in 20 patients with neurodegenerative cerebellar ataxia and 20 age- and sex-matched healthy subjects. Tactile temporal discrimination threshold was defined as the value at which subjects recognized the two stimuli as asynchronous. Temporal discrimination movement threshold of the first dorsal interosseous and flexor carpi radialis was defined as the shortest interval between two paired electrical stimuli in which the subjects blindfolded perceived two separate index finger abductions and wrist flexions. Both tactile and movement temporal discrimination thresholds were higher in patients with cerebellar ataxia. No correlation was found with disease duration and severity. Our study demonstrates that temporal processing of tactile and proprioceptive stimuli is impaired in patients with cerebellar neurodegeneration and highlights the involvement of cerebellum in temporal processing of somatosensory stimuli of different type.
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85
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Cataldi M. The changing landscape of voltage-gated calcium channels in neurovascular disorders and in neurodegenerative diseases. Curr Neuropharmacol 2013; 11:276-97. [PMID: 24179464 PMCID: PMC3648780 DOI: 10.2174/1570159x11311030004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/02/2013] [Accepted: 02/14/2013] [Indexed: 12/12/2022] Open
Abstract
It is a common belief that voltage-gated calcium channels (VGCC) cannot carry toxic amounts of Ca2+ in neurons. Also, some of them as L-type channels are essential for Ca2+-dependent regulation of prosurvival gene-programs. However, a wealth of data show a beneficial effect of drugs acting on VGCCs in several neurodegenerative and neurovascular diseases. In the present review, we explore several mechanisms by which the “harmless” VGCCs may become “toxic” for neurons. These mechanisms could explain how, though usually required for neuronal survival, VGCCs may take part in neurodegeneration. We will present evidence showing that VGCCs can carry toxic Ca2+ when: a) their density or activity increases because of aging, chronic hypoxia or exposure to β-amyloid peptides or b) Ca2+-dependent action potentials carry high Ca2+ loads in pacemaker neurons. Besides, we will examine conditions in which VGCCs promote neuronal cell death without carrying excess Ca2+. This can happen, for instance, when they carry metal ions into the neuronal cytoplasm or when a pathological decrease in their activity weakens Ca2+-dependent prosurvival gene programs. Finally, we will explore the role of VGCCs in the control of nonneuronal cells that take part to neurodegeneration like those of the neurovascular unit or of microglia.
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Affiliation(s)
- Mauro Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Italy
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86
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Anagnostou E, Kararizou E, Evdokimidis I. Ocular flutter in essential tremor: clinical course and response to primidone. J Neurol 2013; 260:2672-4. [PMID: 24061767 DOI: 10.1007/s00415-013-7109-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Evangelos Anagnostou
- Department of Neurology, Eginition Hospital, University of Athens, Vas. Sophias Avenue 74, 11528, Athens, Greece,
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87
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Benito-León J, Louis ED. The top 100 cited articles in essential tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 24106649 PMCID: PMC3782754 DOI: 10.7916/d8tm78vv] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/02/2013] [Indexed: 12/01/2022]
Abstract
Background The impact of scientific articles is proportional to the citations they have received. Our aim was to identify and analyze the top 100 cited articles on essential tremor (ET). Methods The Institute for Scientific Information Web of Knowledge Database and the 2012 Journal Citation Report Science Editions were used to retrieve the 100 top-cited articles published about ET from 1960 to April 2013. Information was collected by the Analyze Tool on the Web of Science, including number of citations, publication title, journal name, publication year, and country and institution of origin. Additional analyses were then performed to determine authorship, article type, study design, and level of evidence. Results Almost half of the articles were retrieved from two journals: Neurology (n = 31) and Movement Disorders (n = 18). The top 100 articles were published between 1960 and 2010, with case series being the most common study design (n = 34). According to their countries of origin, more than half of the articles were generated in the United States (n = 54), which led the list. Columbia University in the United States produced the largest number of ET articles (n = 19), followed by the University of Kansas (n = 18). The most frequent first authors of the top-cited articles in ET were E.D. Louis (n = 27) and W.C. Koller (n = 15), who together accounted for 42% of the articles on the list. Discussion It is important to acknowledge the top-cited articles as they mark key topics and advances in ET.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain ; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain ; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
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88
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Louis ED, Ottman R. Is there a one-way street from essential tremor to Parkinson's disease? Possible biological ramifications. Eur J Neurol 2013; 20:1440-4. [PMID: 24033795 DOI: 10.1111/ene.12256] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
Abstract
There is considerable evidence for an association between essential tremor (ET) and Parkinson's disease (PD), although the topic remains somewhat controversial. An important issue, not previously addressed, is what seems to be the unidirectional nature of the relationship (ET→ET + PD and not PD→PD + ET). The aims of this review are (i) to discuss the evidence for and against a unidirectional relationship and (ii) to discuss the implications of such a unidirectional relationship, if it exists, for disease mechanisms. Evidence 'for' a unidirectional relationship includes (i) abundant clinical anecdotal observation and (ii) clinical and epidemiological studies. Evidence 'against' is theoretical rather than empirical. Overall, the evidence 'for' is stronger, although additional studies are needed in order to be certain; for the time being, it might be best to leave this as an open question. The biological ramifications/extensions of such a unidirectional relationship include (i) that the association is causal (i.e., some aspect of ET pathophysiology predisposes an individual to develop PD) and (ii) that some ET cases may have a circumscribed form of Lewy body disease, and the secondary development of PD may represent a spread of those Lewy bodies in the brainstem. The presence and nature of the links between ET and PD are controversial. Further primary data (epidemiological and pathological) are needed to improve understanding of the relationship and its implications for the pathogenesis of both disorders.
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Affiliation(s)
- E D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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89
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Babij R, Lee M, Cortés E, Vonsattel JPG, Faust PL, Louis ED. Purkinje cell axonal anatomy: quantifying morphometric changes in essential tremor versus control brains. ACTA ACUST UNITED AC 2013; 136:3051-61. [PMID: 24030953 DOI: 10.1093/brain/awt238] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Growing clinical, neuro-imaging and post-mortem data have implicated the cerebellum as playing an important role in the pathogenesis of essential tremor. Aside from a modest reduction of Purkinje cells in some post-mortem studies, Purkinje cell axonal swellings (torpedoes) are present to a greater degree in essential tremor cases than controls. Yet a detailed study of more subtle morphometric changes in the Purkinje cell axonal compartment has not been undertaken. We performed a detailed morphological analysis of the Purkinje cell axonal compartment in 49 essential tremor and 39 control brains, using calbindin D28k immunohistochemistry on 100-µm cerebellar cortical vibratome tissue sections. Changes in axonal shape [thickened axonal profiles (P = 0.006), torpedoes (P = 0.038)] and changes in axonal connectivity [axonal recurrent collaterals (P < 0.001), axonal branching (P < 0.001), terminal axonal sprouting (P < 0.001)] were all present to an increased degree in essential tremor cases versus controls. The changes in shape and connectivity were significantly correlated [e.g. correlation between thickened axonal profiles and recurrent collaterals (r = 0.405, P < 0.001)] and were correlated with tremor duration among essential tremor cases with age of onset >40 years. In essential tremor cases, thickened axonal profiles, axonal recurrent collaterals and branched axons were 3- to 5-fold more frequently seen on the axons of Purkinje cells with torpedoes versus Purkinje cells without torpedoes. We document a range of changes in the Purkinje cell axonal compartment in essential tremor. Several of these are likely to be compensatory changes in response to Purkinje cell injury, thus illustrating an important feature of Purkinje cells, which is that they are relatively resistant to damage and capable of mobilizing a broad range of axonal responses to injury. The extent to which this plasticity of the Purkinje cell axon is partially neuroprotective or ultimately ineffective at slowing further cellular changes and cell death deserves further study in essential tremor.
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Affiliation(s)
- Rachel Babij
- 1 GH Sergievsky Centre, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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90
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Striano P, Louis ED, Manto M. Autosomal dominant cortical tremor, myoclonus, and epilepsy: is the origin in the cerebellum? Editorial. THE CEREBELLUM 2013; 12:145-6. [PMID: 23055083 DOI: 10.1007/s12311-012-0419-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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91
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Lauterbach EC, Cummings JL, Kuppuswamy PS. Toward a more precise, clinically—informed pathophysiology of pathological laughing and crying. Neurosci Biobehav Rev 2013; 37:1893-916. [PMID: 23518269 DOI: 10.1016/j.neubiorev.2013.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 03/01/2013] [Accepted: 03/11/2013] [Indexed: 12/11/2022]
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92
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Balance in essential tremor during tandem gait: is the first mis-step an important finding? J Clin Neurosci 2013; 20:1433-7. [PMID: 23953429 DOI: 10.1016/j.jocn.2013.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/14/2012] [Accepted: 01/03/2013] [Indexed: 11/24/2022]
Abstract
Essential tremor (ET) is the most commonly diagnosed movement disorder. ET may cause substantial loss of motor skills and balance with advanced age. We compared abnormalities in tandem gait with daily activity and Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) scores in 90 ET patients. All patients performed a 15-step tandem three times. The mean of first mis-steps was accepted as the tandem index (TI). The mean age was 61.4 ± 17 years; the mean duration of tremor was 6.7 ± 4 years; and there were 36 men and 54 women. There was no significant difference for age or sex between patients and controls. Head (24.6%), jaw (5.5%), voice (11%), and tongue tremors (1.5%) were identified in ET patients. Rest (2.5%), postural (95%), and kinetic tremors (54%) were detected in the upper extremities. Postural tremor was found in the lower extremities of 5%. The mean TI was 8.3 ± 4 (median, 8) in ET patients, and 10.6 ± 3.9 (median, 10) in controls (p=0.04). Correlation analysis of TI and FTMTRS scores showed tandem gait was significantly correlated with age, total tremor score, postural and kinetic extremity tremor, writing, drawing, pouring, feeding, and working scores. Linear regression showed a significant effect of age and FTMTRS score on TI. The decrease in balance control is apparent with advancing age. Balance disorders were more pronounced in ET patients. Although first mis-step in tandem gait is not as detailed as dynamic balance tests, it can be a simple method for detecting balance disorders.
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93
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Louis ED, Babij R, Lee M, Cortés E, Vonsattel JPG. Quantification of cerebellar hemispheric purkinje cell linear density: 32 ET cases versus 16 controls. Mov Disord 2013; 28:1854-9. [PMID: 23925732 DOI: 10.1002/mds.25629] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/10/2013] [Accepted: 05/13/2013] [Indexed: 11/12/2022] Open
Abstract
Although essential tremor (ET) is among the most prevalent neurological diseases, its precise pathogenesis is not understood. Purkinje cell loss has been observed in some studies and is the focus of interest and debate. Expressing these data as Purkinje cells/layer length allows one to adjust for the inherent curved nature of the cerebellar folia. Capitalizing on the Essential Tremor Centralized Brain Repository, we quantified Purkinje cell linear density in cases versus controls. Free-floating 100-μm parasagittal cerebellar hemispheric sections were subjected to rabbit polyclonal anti-Calbindin D28k antibody, and 10 random fields/brain were selected for quantification of Purkinje cells/mm(-1) Purkinje cell layer. Purkinje cell linear density was lower in 32 ET cases than in16 controls (1.14 ± 0.32 vs. 1.35 ± 0.31/mm(-1) , P = 0.03). Purkinje cell linear density was inversely associated with torpedo count (r = -0.38, P = 0.028). The current sample of ET cases demonstrates a reduction in Purkinje cell number relative to that of controls. Greater Purkinje cell axonal remodeling (torpedoes) was found in individuals who had the most Purkinje cell drop out. The role of Purkinje cell loss in the pathogenesis of this disorder merits additional study.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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94
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Elevated brain harmane (1-methyl-9H-pyrido[3,4-b]indole) in essential tremor cases vs. controls. Neurotoxicology 2013; 38:131-5. [PMID: 23911942 DOI: 10.1016/j.neuro.2013.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Harmane (1-methyl-9H-pyrido[3,4-β]indole), a potent neurotoxin that has tremor-producing properties in animal models, is present in many foods; although we have demonstrated a difference in tissue harmane concentrations in ET cases vs. controls, all work to date has involved blood samples. OBJECTIVES We quantified harmane concentrations in human cerebellum, a brain region of particular pathogenic interest in essential tremor (ET), comparing ET to control brains. METHODS Cerebellar cortex was snap frozen and stored at -80°C in aliquots for biochemical analyses. Harmane concentration was assessed using high performance liquid chromatography. RESULTS Geometric mean brain harmane concentrations (adjusted for postmortem interval [PMI] and freezer time) were higher in ET cases than controls: 1.0824 (95% confidence interval=0.9405-1.2457) vs. 0.8037 (0.6967-0.9272), p=0.004. Geometric mean of brain harmane concentrations (adjusting for PMI and freezer time) was highest in ET cases who reported other relatives with tremor (1.2005 [0.8712-1.6541]), intermediate in ET cases without family history (1.0312 ([0.8879-1.1976]), and both were significantly higher than controls (p=0.02). CONCLUSIONS This study provides additional evidence of a possible etiological importance of this toxin in some cases of the human disease ET.
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95
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Helmich RC, Toni I, Deuschl G, Bloem BR. The Pathophysiology of Essential Tremor and Parkinson’s Tremor. Curr Neurol Neurosci Rep 2013; 13:378. [DOI: 10.1007/s11910-013-0378-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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96
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Fang W, Lv F, Luo T, Cheng O, Liao W, Sheng K, Wang X, Wu F, Hu Y, Luo J, Yang QX, Zhang H. Abnormal regional homogeneity in patients with essential tremor revealed by resting-state functional MRI. PLoS One 2013; 8:e69199. [PMID: 23869236 PMCID: PMC3711903 DOI: 10.1371/journal.pone.0069199] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 06/06/2013] [Indexed: 01/23/2023] Open
Abstract
Essential tremor (ET) is one of the most common movement disorders in human adults. It can be characterized as a progressive neurological disorder of which the most recognizable feature is a tremor of the arms or hands that is apparent during voluntary movements such as eating and writing. The pathology of ET remains unclear. Resting-state fMRI (RS-fMRI), as a non-invasive imaging technique, was employed to investigate abnormalities of functional connectivity in ET in the brain. Regional homogeneity (ReHo) was used as a metric of RS-fMRI to assess the local functional connectivity abnormality in ET with 20 ET patients and 20 age- and gender-matched healthy controls (HC). The ET group showed decreased ReHo in the anterior and posterior bilateral cerebellar lobes, the bilateral thalamus and the insular lobe, and increased ReHo in the bilateral prefrontal and parietal cortices, the left primary motor cortex and left supplementary motor area. The abnormal ReHo value of ET patients in the bilateral anterior cerebellar lobes and the right posterior cerebellar lobe were negatively correlated with the tremor severity score, while positively correlated with that in the left primary motor cortex. These findings suggest that the abnormality in cerebello-thalamo-cortical motor pathway is involved in tremor generation and propagation, which may be related to motor-related symptoms in ET patients. Meanwhile, the abnormality in the prefrontal and parietal regions may be associated with non-motor symptoms in ET. These findings suggest that the ReHo could be utilized for investigations of functional-pathological mechanism of ET.
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Affiliation(s)
- Weidong Fang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (TL); (HZ)
| | - Oumei Cheng
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liao
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Ke Sheng
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Wu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yida Hu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Luo
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing X. Yang
- Center for NMR Research, Department of Radiology, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
- * E-mail: (TL); (HZ)
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97
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Elble RJ. Defining dystonic tremor. Curr Neuropharmacol 2013; 11:48-52. [PMID: 23814537 PMCID: PMC3580791 DOI: 10.2174/157015913804999478] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/08/2012] [Accepted: 07/03/2012] [Indexed: 11/22/2022] Open
Abstract
A strong association between dystonia and tremor has been known for more than a century. Two forms of tremor in dystonia are currently recognized: 1) dystonic tremor, which is tremor produced by dystonic muscle contraction and 2) tremor associated with dystonia, which is tremor in a body part that is not dystonic, but there is dystonia elsewhere. Both forms of tremor in dystonia frequently resemble essential tremor or another pure tremor syndrome (e.g., isolated head and voice tremors and task-specific writing tremor), and relationships among these tremor disorders have long been debated. Misdiagnosis is common because mild dystonia is frequently overlooked in patients with tremor. It is now clear that essential tremor is a syndrome, not a specific disease, and the use of essential tremor as a specific clinical diagnosis is arguably an impediment to elucidating this and other pure tremor syndromes and their relationship to dystonia. A new classification, primary tremor, is proposed and would be used for any disorder in which tremor is the sole or principal abnormality with no identifiable etiology other than possible genetic inheritance. This classification scheme would facilitate tremor research by moving the focus from the narrow question "Is it essential tremor?" to a broader consideration of what genetic and environmental factors cause primary tremor disorders, and how do they relate to dystonia and other neurological disorders.
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Affiliation(s)
- Rodger J Elble
- Department of Neurology, Southern Illinois University School of Medicine, 751 North Rutledge, PO Box 19643, Springfield, IL 62794-9643, USA
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98
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Louis ED, Gillman A, Boschung S, Hess CW, Yu Q, Pullman SL. High width variability during spiral drawing: further evidence of cerebellar dysfunction in essential tremor. THE CEREBELLUM 2013; 11:872-9. [PMID: 22230985 DOI: 10.1007/s12311-011-0352-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Essential tremor (ET) is among the most prevalent neurological diseases, yet the location of the primary disease substrate continues to be a matter of debate. The presence of intention tremor and mild gait ataxia suggests an underlying abnormality of the cerebellum and/or cerebellar pathways. Uncovering additional signs of cerebellar dysfunction would further substantiate the proposition that ET is a disease of the cerebellar system. We evaluated 145 ET cases and 34 normal controls clinically and by computerized spiral analysis. Spiral analysis is a program that objectively characterizes kinematic and physiologic features of hand-drawn spirals using specific calculated spiral indices that correlate with spiral shape and motor execution. We used the spiral width variability index (SWVI), a measure of loop-to-loop spiral width variation with the influence of tremor removed, as a metric of drawing ataxia. The SWVI was higher in cases than controls (0.91 ± 1.94, median=0.46 vs. 0.40 ± 0.29, median=0.30, p<0.001). Cases with higher SWVI also had greater intention tremor during the finger-nose-finger maneuver, r=0.27, p=0.001), and cases with intention tremor of the head had the highest SWVI (1.57 ± 3.44, median=0.51, p<0.001). There was a modest association between SWVI and number of missteps during tandem gait (r=0.16, p=0.06). The primary anatomical substrate for ET continues to be a matter of speculation, yet these and other clinical data lend support to the notion that there is an underlying abnormality of the cerebellum and/or its pathways.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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99
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Thenganatt MA, Louis ED. Distinguishing essential tremor from Parkinson's disease: bedside tests and laboratory evaluations. Expert Rev Neurother 2013; 12:687-96. [PMID: 22650171 DOI: 10.1586/ern.12.49] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Distinguishing essential tremor from Parkinson's disease can be challenging, both in the early stages of these diseases and as these diseases progress. Various tremor types (rest, postural, kinetic and intention) may be seen in both essential tremor and Parkinson's disease. Furthermore, with time, the two diseases may coexist within a single patient. Detailed clinical examination with attention to specific features of tremor (frequency, amplitude, pattern and distribution) and associated neurological findings may help distinguish patients with the two diseases. Laboratory testing may provide information that further aids in differentiating the two diseases. These tests include accelerometry and surface electromyography, spiral analysis, dopamine transporter imaging, olfactory testing and, eventually, postmortem histopathology. These tests have limitations and their diagnostic utility requires additional study.
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Affiliation(s)
- Mary Ann Thenganatt
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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100
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Louis ED, Babij R, Cortés E, Vonsattel JPG, Faust PL. The inferior olivary nucleus: a postmortem study of essential tremor cases versus controls. Mov Disord 2013; 28:779-86. [PMID: 23483605 DOI: 10.1002/mds.25400] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/04/2013] [Accepted: 01/10/2013] [Indexed: 01/02/2023] Open
Abstract
The pathogenesis of essential tremor is poorly understood. Historically, it has been hypothesized that the inferior olivary nucleus plays an important role in the generation of tremor in essential tremor, yet a detailed, controlled, anatomic-pathological study of that brain region has yet to be conducted. A detailed postmortem study was undertaken of the microscopic changes in the inferior olivary nucleus of 14 essential tremor cases versus 15 age-matched controls at the Essential Tremor Centralized Brain Repository. A series of metrics was used to quantify microscopic neuronal and glial changes in the inferior olivary nucleus and its input and output tracts. Olivary linear neuronal density also was assessed. Cases and controls did not differ from one another with respect to any of the assessed metrics (P values ranged from 0.23 to 1.0). Olivary linear neuronal density also was similar in cases and controls (P = 0.62). Paddle-shaped neurons, a morphologic shape change in olivary neurons, which, to our knowledge, have not been previously recognized, occurred to an equal degree in essential tremor cases and controls (P = 0.89) and were correlated with several markers of neuronal loss and gliosis. A systematic postmortem study of the microscopic changes in the inferior olivary nucleus did not detect any differences between cases and controls. These data, along with positron emission tomography data, which have failed to identify any metabolic abnormality of the olive, indicate that, if the olive is involved in essential tremor, then there is no clearly identifiable structural or metabolic correlate.
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Affiliation(s)
- Elan D Louis
- G H Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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