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Lu J, Zhou C, Pu J, Tian J, Yin X, Lv D, Guan X, Guo T, Zhang M, Zhang B, Yan Y, Zhao G. Brain microstructural changes in essential tremor patients and correlations with clinical characteristics: a diffusion kurtosis imaging study. J Neurol 2023; 270:2106-2116. [PMID: 36609498 DOI: 10.1007/s00415-023-11557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Essential tremor (ET) is the second most common movement disorder; however, the pathophysiological mechanism of ET is unclear. We aimed to investigate the microstructural degeneration of gray matter (GM) and white matter (WM) and their correlations with cognition and tremor in patients with ET. METHODS The participants were 63 patients with ET and 63 matched healthy controls (HCs) who underwent 3D-T1 weighted and diffusion kurtosis images (DKI). Microstructural degeneration was measured using high-level diffusion parameters derived from DKI. A voxel-wise analysis of the means of the GM-based spatial statistics and tract-based spatial statistics were conducted to assess differences in diffusion parameters between the ET and HC groups. The volume differences between the two groups were also assessed, and tremor severity and multi-domain cognitive performance were evaluated. Finally, the relationship between microstructural degeneration and clinical characteristics were assessed. RESULTS The ET group had significantly lower mean kurtosis of the temporal, parietal, and occipital lobes and the cerebellum and lower radial kurtosis in several tracts. These microstructural changes in GM and WM were correlated with tremor and cognitive scores. However, no significant difference in volume was found between the groups. CONCLUSION Our findings suggest that ET entails extensive GM and WM microstructural alterations, which support the neurodegenerative hypothesis of ET. Our study contributes to a better understanding of the mechanisms underlying tremor and cognitive impairment in ET.
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Affiliation(s)
- Jinyu Lu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Jun Tian
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Xinzhen Yin
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Dayao Lv
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
| | - Yaping Yan
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
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2
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Hu Y, Wu Y, Su H, Tu J, Zeng L, Lei J, Xia L. Exploring the relationship between brain white matter change and higher degree of invisible hand tremor with computer technology. Technol Health Care 2022; 31:921-931. [PMID: 36442160 DOI: 10.3233/thc-220361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: At present, the clinical diagnosis of white matter change (WMC) patients depends on cranial magnetic resonance imaging (MRI) technology. This diagnostic method is costly and does not allow for large-scale screening, leading to delays in the patient’s condition due to inability to receive timely diagnosis. OBJECTIVE: To evaluate whether the burden of WMC is associated with the degree of invisible hand tremor in humans. METHODS: Previous studies have shown that tremor is associated with WMC, however, tremor does not always have imaging of WMC. Therefore, to confirm that the appearance of WMC causes tremor, which are sometimes invisible to the naked eye, we achieved an optical-based computer-aided diagnostic device by detecting the invisible hand tremor, and we proposed a calculation method of WMC volume by using the characteristics of MRI images. RESULTS: Statistical analysis results further clarified the relationship between WMC and tremor, and our devices are validated for the detection of tremors with WMC. CONCLUSIONS: The burden of WMC volume is positive factor for degree of invisible hand tremor in the participants without visible hand tremor. Detection technology provides a more convenient and low-cost evaluating method before MRI for tremor diseases.
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Affiliation(s)
- Yang Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Yanqing Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Hai Su
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Jianglong Tu
- Department of Nephrology Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Luchuan Zeng
- School of Software, Nanchang University, Nanchang, Jiangxi, China
| | - Jie Lei
- School of Software, Nanchang University, Nanchang, Jiangxi, China
| | - Linglin Xia
- School of Software, Nanchang University, Nanchang, Jiangxi, China
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3
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Pharmacological treatment of tremor in multiple sclerosis; a systematic review. Mult Scler Relat Disord 2022; 60:103722. [DOI: 10.1016/j.msard.2022.103722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/20/2022]
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4
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Pietracupa S, Bologna M, Tommasin S, Berardelli A, Pantano P. The Contribution of Neuroimaging to the Understanding of Essential Tremor Pathophysiology: a Systematic Review. THE CEREBELLUM 2021; 21:1029-1051. [PMID: 34657271 DOI: 10.1007/s12311-021-01335-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 12/14/2022]
Abstract
Essential tremor (ET) is one of the most common movement disorders. Over the last 10 years, magnetic resonance imaging (MRI) has shed light on the structural and functional abnormalities possibly involved in ET pathophysiology. In this systematic review, we aimed to identify the cortical and subcortical structures involved and the role that different brain areas play in the pathophysiology of motor and non-motor ET features. We found that structural (grey and white matter) cerebellar damage and connectivity alterations between the cerebellum and various cortical areas play a role in both motor and non-motor symptoms of ET. In particular, many studies found an association between MRI findings and non-motor symptoms.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS, Italy.,Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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5
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Holtbernd F, Shah NJ. Imaging the Pathophysiology of Essential Tremor-A Systematic Review. Front Neurol 2021; 12:680254. [PMID: 34220687 PMCID: PMC8244929 DOI: 10.3389/fneur.2021.680254] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The pathophysiology underlying essential tremor (ET) still is poorly understood. Recent research suggests a pivotal role of the cerebellum in tremor genesis, and an ongoing controversy remains as to whether ET constitutes a neurodegenerative disorder. In addition, mounting evidence indicates that alterations in the gamma-aminobutyric acid neurotransmitter system are involved in ET pathophysiology. Here, we systematically review structural, functional, and metabolic neuroimaging studies and discuss current concepts of ET pathophysiology from an imaging perspective. Methods: We conducted a PubMed and Scopus search from 1966 up to December 2020, entering essential tremor in combination with any of the following search terms and their corresponding abbreviations: positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and gamma-aminobutyric acid (GABA). Results: Altered functional connectivity in the cerebellum and cerebello-thalamico-cortical circuitry is a prevalent finding in functional imaging studies. Reports from structural imaging studies are less consistent, and there is no clear evidence for cerebellar neurodegeneration. However, diffusion tensor imaging robustly points toward microstructural cerebellar changes. Radiotracer imaging suggests that the dopaminergic axis is largely preserved in ET. Similarly, measurements of nigral iron content and neuromelanin are unremarkable in most studies; this is in contrast to Parkinson's disease (PD). PET and MRS studies provide limited evidence for cerebellar and thalamic GABAergic dysfunction. Conclusions: There is robust evidence indicating that the cerebellum plays a key role within a multiple oscillator tremor network which underlies tremor genesis. However, whether cerebellar dysfunction relies on a neurodegenerative process remains unclear. Dopaminergic and iron imaging do not suggest a substantial overlap of ET with PD pathophysiology. There is limited evidence for alterations of the GABAergic neurotransmitter system in ET. The clinical, demographical, and genetic heterogeneity of ET translates into neuroimaging and likely explains the various inconsistencies reported.
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Affiliation(s)
- Florian Holtbernd
- Institute of Neuroscience and Medicine (INM-4/INM-11), Forschungszentrum Juelich GmbH, Juelich, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Juelich GmbH, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
- Department of Neurology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
| | - N. Jon Shah
- Institute of Neuroscience and Medicine (INM-4/INM-11), Forschungszentrum Juelich GmbH, Juelich, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Juelich GmbH, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
- Department of Neurology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Aachen, Germany
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6
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Sleep disturbances in essential tremor: an investigation of associated brain microstructural changes using diffusion tensor imaging. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Tantik Pak A, Şengül Y, Otcu Temur H, Alkan A. Impaired integrity of commissural and association fibers in essential tremor patients: Evidence from a diffusion tensor imaging study. Turk J Med Sci 2021; 51:328-334. [PMID: 33021759 PMCID: PMC7991855 DOI: 10.3906/sag-2004-305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background/aim The evolving understanding of essential tremors (ET) has led to a new definition of neurodegenerative disease, pointing to diffuse brain network involvement with a wide spectrum of associated motor and nonmotor symptoms. Considering the fact that white matter should also be affected by the nature of the disease, our study aimed to evaluate the integrity of white matter and its clinical correlations in ET patients. Materials and methods Approximately 40 patients diagnosed with ET and 40 age-and sex-matched control subjects (ranging between 18–80 years old) were included in the study. The sociodemographic characteristics and clinical features of the patients were recorded. Tremors were assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Diffusion Tensor Imaging (DTI) was performed to evaluate the integrity of white matter. The selected white matter regions used for DTI assessment were the corpus callosum (CC) (i.e., the largest commissural tract in the human brain), the superior longitudinal fasciculus (SLF), and the inferior longitudinal fasciculus (ILF) (i.e., the largest association fiber bundles). Results The mean age of the ET patients and control subjects was 44.23 ± 18.91 and 37.45 ± 10.95 years old (P = 0.542). The fractional anisotropy (FA) values of the CC body (P = 0.003), ILF (p = 0.016), average diffusion coefficient (ADC) values of the CC body (p = 0.001), genu (P = 0.049), SLF (V < 0.001), and ILF (P < 0.001) differed between groups. After controlling for age and sex, there was no correlation between tremor severity and DTI parameters, but impaired integrity in the genu of CC FA (P = 0.035, r = 0.442) and the splenium of CC ADC (P = 0.007, r = 0.543) were related with a longer duration of tremor. Finally, positive family history was correlated with the splenium of CC FA and ADC (P = 0.008, r = 0.536; P = 0.027, r = 0.461) and ILF ADC (P = 0.011, r = –0.519). Conclusion In our study, major white matter structure changes were found in the ET patients. The results suggest that possible neurodegeneration also affects white matter structures in ET patients and that the duration of the tremor and family history are related with impaired integrity of white matter.
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Affiliation(s)
- Aygül Tantik Pak
- Department of Neurology, University of Health Sciences, Gaziosmanpaşa Research and Training Hospital, İstanbul, Turkey
| | - Yildizhan Şengül
- Department of Neurology, Bezmiâlem Foundation University Hospital, İstanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmiâlem Foundation University Hospital, İstanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmiâlem Foundation University Hospital, İstanbul, Turkey
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8
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de Lima Xavier L, Simonyan K. Neural Representations of the Voice Tremor Spectrum. Mov Disord 2020; 35:2290-2300. [PMID: 32976662 DOI: 10.1002/mds.28259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Voice tremor is a common movement disorder that manifests as involuntary oscillations of laryngeal muscles, leading to rhythmic alterations in voice pitch and loudness. Differential diagnosis of essential tremor of voice (ETv) is often challenging and includes dystonic tremor of voice (DTv), which is characterized by irregular, isometric contractions of laryngeal muscles during dystonic activity. Although clinical characteristics of voice tremor are well described, the pathophysiology underlying its heterogeneous phenomenology remains limited. METHODS We used a multimodal approach of functional magnetic resonance imaging for assessment of brain activity during symptomatic speech production, high-resolution magnetic resonance imaging for the examination of cortical thickness and gray matter volume, and diffusion-weighted imaging for evaluation of white matter integrity to identify disorder-specific neural alterations and their relationships with the symptomatology of ETv and DTv. RESULTS We found a broad overlap between cortical alterations in ETv and DTv, involving sensorimotor regions responsible for the integration of multisensory information during speech production, such as primary sensorimotor, inferior/superior parietal, and inferior temporal cortices. In addition, ETv and DTv showed unique patterns of abnormalities in regions controlling speech motor preparation, which were localized in the cerebellum in ETv and the premotor cortex, insula, and superior temporal gyrus in DTv. Neural alterations in superior parietal and inferior temporal cortices were correlated with ETv severity, whereas changes in the left premotor cortex were associated with DTv severity. CONCLUSIONS Our findings point to the pathophysiological spectrum underlying ETv and DTv and favor a more heterogeneous rather than dichotomous diagnostic classification of these voice tremor disorders. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Laura de Lima Xavier
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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Sengul Y, Temur HO, Corakcı Z, Sengul HS, Dowd H, Ustun I, Alkan A, Louis ED. Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study. Int J Neurosci 2020; 132:154-164. [PMID: 32730718 DOI: 10.1080/00207454.2020.1803859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Essential tremor (ET) is disease with both motor and non-motor features. Notable among the non-motor features is cognitive impairment. While this impairment has been attributed to cortico-thalamo-cerebellar pathway pathology, it is likely that a more complicated involvement of brain structures underlies cognitive function in ET. OBJECTIVE To evaluate the brain microstructural changes of both white matter and grey matter in ET using region of interest based diffusion tensor imaging (DTI), and to correlate these changes with cognitive function assessed during detailed neuropsychological testing. METHOD Thirty-five non-demented ET patients with a range of cognitive function (Clinical Dementia Rating = 0-0.5, mean age = 57.5 ± 16.7 years, age range = 23-76 years) underwent a comprehensive neuropsychological evaluation and brain magnetic resonance imaging, including DTI. DTI findings were reported as fractional anisotropy, average diffusion coefficient, these values were evaluated for 32 ROIs. Cognitive domains included attention, visuospatial functions, executive function, verbal memory, visual memory, and language. Domain Z-scores were calculated each cognitive domain and compared for each brain region. RESULTS Microstructural changes in prefrontal cortical areas (dorsolateral, ventrolateral), paralimbic and limbic structures (posterior cingulate cortex, precuneus, hippocampus), basal ganglia (substantia nigra, putamen, caudate nucleus) and white matter bundles (corpus callosum, anterior thalamic radiation, longitudinal fasciculus, frontooccipital fasciculus, etc.) correlated with specific domains of cognitive function in ET patients. CONCLUSION These data suggest that not only the cerebello thalamocortical pathway, but numerous other brain structures are related to level of cognitive performance and possibly underlie cognitive dysfunction in ET.
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Affiliation(s)
- Y Sengul
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey.,Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - H O Temur
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Z Corakcı
- Department of Occupational Therapy, Bezmialem Foundation University School of Medical Sciences, Istanbul, Turkey
| | - H S Sengul
- Laboratory of Neuropsychology, Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey
| | - H Dowd
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - I Ustun
- Department of Neurology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - A Alkan
- Department of Radiology, Bezmialem Foundation University School of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - E D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
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10
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Xi C, Li S, Liu Y, Mei B. Disappearance of long-term right-sided essential tremor after stroke in the left corona radiata. Neurol Clin Pract 2020; 9:487-489. [PMID: 32042486 DOI: 10.1212/cpj.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Chunhua Xi
- Department of Neurology (CX), The Third Affiliated Hospital of Anhui Medical University, HeFei; Department of Radiology (SL); and Department of Neurology (CX, YL, BM), Zhongnan Hospital of Wuhan University, HuBei Province, China
| | - Sirui Li
- Department of Neurology (CX), The Third Affiliated Hospital of Anhui Medical University, HeFei; Department of Radiology (SL); and Department of Neurology (CX, YL, BM), Zhongnan Hospital of Wuhan University, HuBei Province, China
| | - Yumin Liu
- Department of Neurology (CX), The Third Affiliated Hospital of Anhui Medical University, HeFei; Department of Radiology (SL); and Department of Neurology (CX, YL, BM), Zhongnan Hospital of Wuhan University, HuBei Province, China
| | - Bin Mei
- Department of Neurology (CX), The Third Affiliated Hospital of Anhui Medical University, HeFei; Department of Radiology (SL); and Department of Neurology (CX, YL, BM), Zhongnan Hospital of Wuhan University, HuBei Province, China
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11
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Pietracupa S, Bologna M, Bharti K, Pasqua G, Tommasin S, Elifani F, Paparella G, Petsas N, Grillea G, Berardelli A, Pantano P. White matter rather than gray matter damage characterizes essential tremor. Eur Radiol 2019; 29:6634-6642. [PMID: 31139970 DOI: 10.1007/s00330-019-06267-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated changes in gray matter (GM) and white matter (WM) in the whole brain, including both cortical and subcortical structures, and their relationship with tremor severity, psychiatric symptoms, and cognitive impairment in patients affected by essential tremor (ET). METHODS We studied 19 ET patients and 15 healthy subjects (HS). All the subjects underwent a 3-T MRI study based on 3D-T1 and diffusion tensor images. For the GM analysis, cortical thickness was assessed by using the Computational Anatomy Tool, basal ganglia and thalamus volumes by using the FMRIB software library, and cerebellum lobular volumes by using the spatial unbiased atlas template. For the WM assessment, we performed a voxel-wise analysis by means of tract-based spatial statistics. Patients' tremor severity and psychiatric and cognitive disorders were evaluated by means of standard clinical scales. Neuroimaging data were correlated with clinical scores. RESULTS We found significantly smaller right and left thalamic volumes in ET patients than in HS, which correlated with cognitive scores. We did not observe any significant differences either in cortical thickness or in cerebellar lobular volumes between patients and HS. WM abnormalities were detected in most hemisphere bundles, particularly in the corticospinal tract, cerebellar peduncles, and corpus callosum. The WM abnormalities significantly correlated with tremor severity, cognitive profile, and depression. CONCLUSION Our study indicates that ET is characterized by several GM and WM changes of both infra- and supratentorial brain structures. The results may help to better understand mechanisms underlying tremor severity and psychiatric and cognitive impairment in ET. KEY POINTS • We performed a comprehensive evaluation of gray and white matter in the same sample of patients with essential tremor using recently developed data analysis methods. • Essential tremor is characterized by widespread gray and white matter changes in both infra- and supratentorial brain structures. The results may help to better understand motor and non-motor symptoms in patients with essential tremor.
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Affiliation(s)
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Komal Bharti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Gabriele Pasqua
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | | | | | | | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli (IS), Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Patrizia Pantano
- IRCCS Neuromed, Pozzilli (IS), Italy. .,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
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12
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Nestrasil I, Svatkova A, Rudser KD, Chityala R, Wakumoto A, Mueller BA, Bednařík P, Tuite P, Wu X, Bushara K. White matter measures correlate with essential tremor severity-A pilot diffusion tensor imaging study. Brain Behav 2018; 8:e01039. [PMID: 29964316 PMCID: PMC6085909 DOI: 10.1002/brb3.1039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An evolving pathophysiological concept of essential tremor (ET) points to diffuse brain network involvement, which emphasizes the need to investigate white matter (WM) changes associated with motor symptoms of ET. OBJECTIVES To investigate ET-related WM changes and WM correlates of tremor severity using tremor clinical rating scales and accelerometry. METHODS Tract-based spatial statistics (TBSS) approach was utilized to compare 3 Tesla diffusion tensor imaging (DTI) data from 12 ET patients and 10 age- and gender-matched healthy individuals. Clinical scales, tremor frequency and amplitude as measured by accelerometry were correlated with DTI data. RESULTS ET patients demonstrated mean (MD) and radial diffusivity (RD) abnormalities in tracts involved in primary and associative motor functions such as bilateral corticospinal tracts, the superior longitudinal fascicles, and the corpus callosum but also in nonmotor regions including the inferior fronto-occipital and longitudinal fascicles, cingulum bundles, anterior thalamic radiations, and uncinate fascicles. A combined tremor frequency and amplitude score correlated with RD and MD in extensive WM areas, which partially overlapped the regions that were associated with tremor frequency. No significant relationship was found between DTI measures and clinical rating scales scores. CONCLUSIONS The results show that ET-related diffusion WM changes and their correlates with tremor severity are preferentially located in the primary and associative motor areas. In contrast, a relationship between WM was not detected with clinical rating scales. Accelerometry parameters may, therefore, serve as a potentially useful clinical measures that relate to WM deficits in ET.
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Affiliation(s)
- Igor Nestrasil
- Division of Clinical Behavioral NeuroscienceDepartment of PediatricsUniversity of MinnesotaMinneapolisMinnesota
| | - Alena Svatkova
- Division of Clinical Behavioral NeuroscienceDepartment of PediatricsUniversity of MinnesotaMinneapolisMinnesota
- Department of Medicine III, Clinical Division of Endocrinology and MetabolismMedical University of ViennaViennaAustria
- Multimodal and Functional Neuroimaging Research GroupCentral European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
| | - Kyle D. Rudser
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMinnesota
| | | | - Amy Wakumoto
- Division of Clinical Behavioral NeuroscienceDepartment of PediatricsUniversity of MinnesotaMinneapolisMinnesota
| | - Bryon A. Mueller
- Department of PsychiatryUniversity of MinnesotaMinneapolisMinnesota
| | - Petr Bednařík
- Multimodal and Functional Neuroimaging Research GroupCentral European Institute of TechnologyMasaryk UniversityBrnoCzech Republic
- Department of RadiologyCenter for Magnetic Resonance ResearchUniversity of MinnesotaMinneapolisMinnesota
- High Field MR CentreDepartment of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Paul Tuite
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesota
| | - Xiang Wu
- Psychology DepartmentSun Yet‐Sen UniversityGuangzhouGuangdongChina
| | - Khalaf Bushara
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesota
- Neurology ServiceVeterans Affairs Medical CenterMinneapolisMinnesota
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