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Welton T, Chew G, Mai AS, Ng JH, Chan LL, Tan EK. Association of Gene Expression and Tremor Network Structure. Mov Disord 2024. [PMID: 38769620 DOI: 10.1002/mds.29831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Transcriptomic changes in the essential tremor (ET)-associated cerebello-thalamo-cortical "tremor network" and their association to brain structure have not been investigated. OBJECTIVE The aim was to characterize molecular changes associated with network-level imaging-derived phenotypes (IDP) found in ET. METHODS We performed an imaging-transcriptomic study in British adults using imaging-genome-wide association study summary statistics (UK Biobank "BIG40" cohort; n = 33,224, aged 40-69 years). We imputed imaging-transcriptomic associations for 184 IDPs and analyzed functional enrichment of gene modules and aggregate network-level phenotypes. Validation was performed in cerebellar-tissue RNA-sequencing data from ET patients and controls (n = 55). RESULTS Among 237,896 individual predicted gene expression levels for 6063 unique genes/transcripts, we detected 2269 genome-wide significant associations (Bonferroni P < 2.102e-7, 0.95%). These were concentrated in intracellular volume fraction measures of white matter pathways and in genes with putative links to tremor (MAPT, ARL17A, KANSL1, SPPL2C, LRRC37A4P, PLEKHM1, and FMNL1). Whole-tremor-network cortical thickness was associated with a gene module linked to mitochondrial organization and protein quality control (r = 0.91, P = 2e-70), whereas white-gray T1-weighted magnetic resonance imaging (MRI) contrast in the tremor network was associated with a gene module linked to sphingolipid synthesis and ethanolamine metabolism (r = -0.90, P = 2e-68). Imputed association effect sizes and RNA-sequencing log-fold change in the validation dataset were significantly correlated for cerebellar peduncular diffusion MRI phenotypes, and there was a close overlap of significant associations between both datasets for gray matter phenotypes (χ2 = 6.40, P = 0.006). CONCLUSIONS The identified genes and processes are potential treatment targets for ET, and our results help characterize molecular changes that could in future be used for patient treatment selection or prognosis prediction. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Welton
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Gabriel Chew
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing Han Ng
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - Ling Ling Chan
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Eng-King Tan
- Department of Research, National Neuroscience Institute, Singapore, Singapore
- Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
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Passaretti M, Piervincenzi C, Baione V, Pasqua G, Colella D, Pietracupa S, Petsas N, Angelini L, Cannavacciuolo A, Paparella G, Berardelli A, Pantano P, Bologna M. The Role of Cerebellum and Basal Ganglia Functional Connectivity in Altered Voluntary Movement Execution in Essential Tremor. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01699-6. [PMID: 38761352 DOI: 10.1007/s12311-024-01699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
Substantial evidence highlights the role of the cerebellum in the pathophysiology of tremor in essential tremor (ET), although its potential involvement in altered movement execution in this condition remains unclear. This study aims to explore potential correlations between the cerebellum and basal ganglia functional connectivity and voluntary movement execution abnormalities in ET, objectively assessed with kinematic techniques. A total of 20 patients diagnosed with ET and 18 healthy subjects were enrolled in this study. Tremor and repetitive finger tapping were recorded using an optoelectronic kinematic system. All participants underwent comprehensive 3T-MRI examinations, including 3D-T1 and blood-oxygen-level dependent (BOLD) sequences during resting state. Morphometric analysis was conducted on the 3D-T1 images, while a seed-based analysis was performed to investigate the resting-state functional connectivity (rsFC) of dorsal and ventral portions of the dentate nucleus and the external and internal segments of the globus pallidus. Finally, potential correlations between rsFC alterations in patients and clinical as well as kinematic scores were assessed. Finger tapping movements were slower in ET than in healthy subjects. Compared to healthy subjects, patients with ET exhibited altered FC of both dentate and globus pallidus with cerebellar, basal ganglia, and cortical areas. Interestingly, both dentate and pallidal FC exhibited positive correlations with movement velocity in patients, differently from that we observed in healthy subjects, indicating the higher the FC, the faster the finger tapping. The findings of this study indicate the possible role of both cerebellum and basal ganglia in the pathophysiology of altered voluntary movement execution in patients with ET.
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Affiliation(s)
- Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Piervincenzi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Viola Baione
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gabriele Pasqua
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Sara Pietracupa
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Nikolaos Petsas
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | | | | | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
- IRCCS Neuromed, Pozzilli, IS, Italy.
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Orsucci D, Tessa A, Caldarazzo Ienco E, Trovato R, Natale G, Bilancieri G, Giuntini M, Napolitano A, Salvetti S, Vista M, Santorelli FM. Clinical and genetic features of dominant Essential Tremor in Tuscany, Italy: FUS, CAMTA1, ATXN1 and beyond. J Neurol Sci 2024; 460:123012. [PMID: 38626532 DOI: 10.1016/j.jns.2024.123012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE Essential Tremor (ET) is one of the most common neurological disorders. In most instances ET is inherited as an autosomal dominant trait with age-related penetrance (virtually complete in advanced age); however, ET genetics remains elusive. The current study aims to identify possibly pathogenic genetic variants in a group of well-characterized ET families. METHODS 34 individuals from 14 families with dominant ET were clinically evaluated and studied by whole exome sequencing studies (after excluding trinucleotide expansion disorders). RESULTS Most patients had pure ET. In 4 families, exome studies could identify a genetic variant potentially able to significantly alter the protein structure (CADD >20, REVEL score > 0.25), shared by all the affected individuals (in CAMTA1, FUS, MYH14, SGCE genes). In another family there were two variants in dominant genes (PCDH9 and SQSTM1). Moreover, an interrupted "intermediate" trinucleotide expansion in ATXN1 ("SCA1") was identified in a further family with pure ET. CONCLUSION Combining our observations together with earlier reports, we can conclude that ET genes confirmed in at least two families to date include CAMTA1 and FUS (reported here), as well as CACNA1G, NOTCH2NLC and TENM4. Most cases of familial ET, inherited with an autosomal dominant inheritance, may result from "mild" variants of many different genes that, when affected by more harmful genetic variants, lead to more severe neurological syndromes (still autosomal dominant). Thus, ET phenotype may be the "mild", incomplete manifestation of many other dominant neurogenetic diseases. These findings further support evidence of genetic heterogeneity for such disease(s). Author's keywords: cerebellar ataxias, movement disorders, neurogenetics, rare neurological disorders, tremor.
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Affiliation(s)
- D Orsucci
- Unit of Neurology, San Luca Hospital, Lucca, Italy.
| | - A Tessa
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | | | - R Trovato
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - G Natale
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - G Bilancieri
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - M Giuntini
- Unit of Neurology, San Luca Hospital, Lucca, Italy
| | - A Napolitano
- Unit of Neurology, Apuane Hospital, Massa Carrara, Italy
| | - S Salvetti
- Unit of Neurology, San Luca Hospital, Lucca, Italy
| | - M Vista
- Unit of Neurology, San Luca Hospital, Lucca, Italy
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Patel MD, Patel M, Jani R, Patel KG, Patel P, Gandhi SK. Essential Tremors: A Literature Review of Current Therapeutics. Cureus 2024; 16:e59451. [PMID: 38826876 PMCID: PMC11141324 DOI: 10.7759/cureus.59451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Essential tremors (ETs) commonly manifest as involuntary shaking of the hands that disrupt daily activities. These tremors involve the central motor network of the cerebellum, thalamus, and cortical networks, leading to different clinical phenotypes. The goal of this review was to establish evidence-based recommendations for effective care and simplify decisions for those dealing with ET. For this narrative literature review, we conducted a thorough search using core keywords such as "essential tremor" and "therapy." From the 27 selected articles, relevant data were presented regarding pathophysiology, medications, and other treatment options, with necessary supplemental data such as side effects and use cases. This paper examines treatments for ET, including commonly prescribed medications such as propranolol and primidone; invasive treatments such as deep brain stimulation, focused ultrasound thalamotomy, transcranial magnetic stimulation, and some surgical methods; and non-invasive methods such as the neuromodulation technique of transcutaneous afferent patterned stimulation. Overall, this study presents a synthesized understanding of the currently available modalities for managing ETs. It is intended to guide care providers in choosing the best possible method to contain symptoms.
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Affiliation(s)
- Maurya D Patel
- Department of Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Muskaan Patel
- Department of Internal Medicine, Hinduhridaysamrat Balasaheb Thackeray Medical College (HBTMC) and Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, IND
| | - Rutva Jani
- Department of Internal Medicine, C.U. Shah Medical College and Hospital, Surendranagar, IND
| | - Kishan G Patel
- Department of Internal Medicine, B.J. Medical College, Ahmedabad, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, M.P. Shah Government Medical College, Jamnagar, Jamnagar, IND
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Udwani SK, Desai SD. Epidemiologic Disparities and Challenges in Non-parkinsonian Tremor Disorders Research: A Scoping Review Emphasizing the Indian Context. Ann Indian Acad Neurol 2024; 27:122-130. [PMID: 38751925 PMCID: PMC11093173 DOI: 10.4103/aian.aian_36_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Non-parkinsonian tremors represent a heterogeneous spectrum of movement disorders where knowledge gaps persist regarding epidemiology, pathophysiology, and clinical burden. This scoping review aimed to systematically consolidate literature on these disorders in India across the domains of prevalence, biological mechanisms, psychiatric comorbidity, disability impact, and quality of life. A systematic search was undertaken across databases to identify studies on non-parkinsonian tremors in India. Extracted data were synthesized descriptively under themes spanning reported prevalence estimates and variability, proposed biological processes, psychiatric symptom rates, stigma perceptions, and quality-of-life deficits. Methodological appraisal was undertaken. Twenty-nine studies reported prevalence estimates displaying wide variability from 0.09% to 22% for essential tremor, partly attributable to definitional inconsistencies. Proposed pathologic processes centered on cerebellar dysfunction, neurotransmitter disturbances, and genetic risks. Nine studies revealed variable anxiety (6.8%-90%) and depression (3.4%-60%) rates among essential tremor patients, while two indicated perceived stigma. Five studies unanimously concurred significant quality of life impairment in essential tremors. Evidence of dystonic tremor, functional tremor, and other tremors was limited. This review exposed critical knowledge gaps and methodological limitations, while systematically evaluating the Indian literature on non-parkinsonian tremors concerning epidemiology, mechanisms, and clinical burden. Large-scale collaborative research applying standardized diagnostic criteria is imperative to determine contemporary prevalence statistics and comprehensively characterize the multifaceted disability footprint to inform patient-centric models optimizing diagnosis and holistic care.
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Affiliation(s)
- Sachin K. Udwani
- Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Soaham D. Desai
- Department of Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Kawazoe T, Sugaya K, Nakata Y, Okitsu M, Takahashi K. Two distinct degenerative types of nigrostriatal dopaminergic neuron in the early stage of parkinsonian disorders. Clin Park Relat Disord 2024; 10:100242. [PMID: 38405025 PMCID: PMC10883825 DOI: 10.1016/j.prdoa.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction The present study characterized the degeneration of nigrostriatal dopaminergic neurons in the early stages of parkinsonian disorders using integrative neuroimaging analysis with neuromelanin-sensitive MRI and 123I-FP-CIT dopamine transporter (DAT) SPECT. Methods Thirty-one, 30, and 29 patients with progressive supranuclear palsy (PSP), corticobasal syndrome (CBS) with abnormal specific binding ratio (SBR) in either hemisphere (mean ± 2SD), and parkinsonism-predominant multiple system atrophy (MSA-P), respectively, were enrolled. Neuromelanin-related contrast (NRC) in the substantia nigra (NRCSN) and locus coeruleus (NRCLC) and the SBR of DAT SPECT were measured. All the patients underwent both examinations simultaneously within five years after symptom onset. After adjusting for interhemispheric asymmetry on neuromelanin-related MRI contrast using the Z-score, linear regression analysis of the NRCSN and SBR was performed for the most- and least-affected hemispheres, as defined by the interhemispheric differences per variable (SBR, NRCSN, standardized [SBR + NRCSN]) in each patient. Results Although the variables did not differ significantly between PSP and CBS, a significant correlation was found for CBS in the most-affected hemisphere for all the definitions, including the clinically defined, most-affected hemisphere. No significant correlation was found between the NRCSN and SBR for any of the definitions in either PSP or MSA-P. Conclusion Together with the findings of our previous study of dementia with Lewy bodies (DLB) and Parkinson's disease (PD), the present findings indicated that neural degeneration in the disorders examined may be categorized by the significance of the NRCSN-SBR correlation in PD and CBS and its non-significance in DLB, PSP, and MSA-P.
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Affiliation(s)
- Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | | | - Masato Okitsu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Tokyo, Japan
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7
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Sharifi S, Buijink AWG, Luft F, Scheijbeler EP, Potters WV, van Wingen G, Heida T, Bour LJ, van Rootselaar AF. Differences in Olivo-Cerebellar Circuit and Cerebellar Network Connectivity in Essential Tremor: a Resting State fMRI Study. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1123-1136. [PMID: 36214998 PMCID: PMC10657290 DOI: 10.1007/s12311-022-01486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
The olivo-cerebellar circuit is thought to play a crucial role in the pathophysiology of essential tremor (ET). Whether olivo-cerebellar circuit dysfunction is also present at rest, in the absence of clinical tremor and linked voluntary movement, remains unclear. Assessing this network in detail with fMRI is challenging, considering the brainstem is close to major arteries and pulsatile cerebrospinal fluid-filled spaces obscuring signals of interest. Here, we used methods tailored to the analysis of infratentorial structures. We hypothesize that the olivo-cerebellar circuit shows altered intra-network connectivity at rest and decreased functional coupling with other parts of the motor network in ET. In 17 ET patients and 19 healthy controls, we investigated using resting state fMRI intracerebellar functional and effective connectivity on a dedicated cerebellar atlas. With independent component analysis, we investigated data-driven cerebellar motor network activations during rest. Finally, whole-brain connectivity of cerebellar motor structures was investigated using identified components. In ET, olivo-cerebellar pathways show decreased functional connectivity compared with healthy controls. Effective connectivity analysis showed an increased inhibitory influence of the dentate nucleus towards the inferior olive. Cerebellar independent component analyses showed motor resting state networks are less strongly connected to the cerebral cortex compared to controls. Our results indicate the olivo-cerebellar circuit to be affected at rest. Also, the cerebellum is "disconnected" from the rest of the motor network. Aberrant activity, generated within the olivo-cerebellar circuit could, during action, spread towards other parts of the motor circuit and potentially underlie the characteristic tremor of this patient group.
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Affiliation(s)
- Sarvi Sharifi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Arthur W G Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Frauke Luft
- Department of Biomedical Signals and Systems, University of Twente, TechMed Centre, Enschede, The Netherlands
| | - Elliz P Scheijbeler
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Wouter V Potters
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tjitske Heida
- Department of Biomedical Signals and Systems, University of Twente, TechMed Centre, Enschede, The Netherlands
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Ghosh N, Eidson E, Derrick E, Lester-Smith RA. Breathy Voice as a Compensatory Strategy for Essential Vocal Tremor: A Single Case Experiment Across Participants. J Voice 2023:S0892-1997(23)00311-9. [PMID: 38007363 DOI: 10.1016/j.jvoice.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE Essential vocal tremor (EVT) manifests as nearly rhythmic modulations of fundamental frequency (fo) and intensity and causes a shaky voice. Although research on behavioral therapy for EVT is limited, previous studies have shown that a breathy voice reduces the perception of simulated EVT and might be an effective compensatory strategy. The current study aimed to measure the acoustical and perceptual effects of a breathy voice strategy in speakers with EVT. STUDY DESIGN A single-case experimental design (SCED) was used to investigate acoustical effects, and a pair comparison listening task was used to investigate perceptual effects. METHODS Three participants with EVT matched five different levels of breathiness produced by a computational model. Acoustical analyses of the rate and extent of fo and intensity modulation were performed to estimate EVT severity for baseline and treatment trials. Statistical analyses were completed using Tau-U. Twenty novice listeners participated in the perceptual study to determine if treatment trials sounded less "shaky" than baseline trials. Statistical analyses were completed using one sample t tests. RESULTS The acoustical effects were variable across different levels of breathiness for all three participants. All participants were able to adjust their levels of breathiness based on auditory models and verbal cues but did not achieve the target levels of breathiness. Listeners did not perceive the breathy trials to be less "shaky" than baseline trials for any level of breathiness. CONCLUSION The breathy voice strategy had variable effects on the acoustical measures of EVT, supporting the use of a single-case experimental design to investigate the effectiveness of behavioral treatment for EVT. Listeners perceived breathy trials to be "shakier" than baseline trials, which was inconsistent with our hypothesis and previous studies of EVT. Future research should evaluate the use of a breathy voice in speakers with confirmed laryngeal tremor, optimize cueing for breathiness, and provide more opportunities to practice the breathy strategy.
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Affiliation(s)
- Nayanika Ghosh
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, Texas.
| | - Elizabeth Eidson
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, Texas
| | - Elaina Derrick
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, Texas
| | - Rosemary A Lester-Smith
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, Texas
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Yu CH, Lench DH, Cooper C, Rowland NC, Takacs I, Revuelta G. Deep brain stimulation for essential tremor versus essential tremor plus: should we target the same spot in the thalamus? Front Hum Neurosci 2023; 17:1271046. [PMID: 38021224 PMCID: PMC10644388 DOI: 10.3389/fnhum.2023.1271046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background Although ET is a phenomenologically heterogeneous condition, thalamic DBS appears to be equally effective across subtypes. We hypothesized stimulation sites optimized for individuals with essential tremor (ET) would differ from individuals with essential tremor plus syndrome (ET-plus). We examined group differences in optimal stimulation sites within the ventral thalamus and their overlap of with relevant white matter tracts. By capturing these differences, we sought to determine whether ET subtypes are associated with anatomically distinct neural pathways. Methods A retrospective chart review was conducted on ET patients undergoing VIM DBS at MUSC between 01/2012 and 02/2022. Clinical, demographic, neuroimaging, and DBS stimulation parameter data were collected. Clinical characteristics and pre-DBS videos were reviewed to classify ET and ET-plus cohorts. Patients in ET-plus cohorts were further divided into ET with dystonia, ET with ataxia, and ET with others. DBS leads were reconstructed using Lead-DBS and the volume of tissue activated (VTA) overlap was performed using normative connectomes. Tremor improvement was measured by reduction in a subscore of tremor rating scale (TRS) post-DBS lateralized to the more affected limb. Results Sixty-eight ET patients were enrolled after initial screening, of these 10 ET and 24 ET-plus patients were included in the final analyses. ET group had an earlier age at onset (p = 0.185) and underwent surgery at a younger age (p = 0.096). Both groups achieved effective tremor control. No significant differences were found in lead placement or VTA overlap within ventral thalamus. The VTA center of gravity (COG) in the ET-plus cohort was located dorsal to that of the ET cohort. No significant differences were found in VTA overlap with the dentato-rubral-thalamic (DRTT) tracts or the ansa lenticularis. Dystonia was more prevalent than ataxia in the ET-plus subgroups (n = 18 and n = 5, respectively). ET-plus with dystonia subgroup had a more medial COG compared to ET-plus with ataxia. Conclusion VIM DBS therapy is efficacious in patients with ET and ET-plus. There were no significant differences in optimal stimulation site or VTA overlap with white-matter tracts between ET, ET-plus and ET-plus subgroups.
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Affiliation(s)
- Cherry H. Yu
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Daniel H. Lench
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Christine Cooper
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Nathan C. Rowland
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Istvan Takacs
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Gonzalo Revuelta
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
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Kindler C, Upadhyay N, Purrer V, Schmeel FC, Borger V, Scheef L, Wüllner U, Boecker H. MRgFUS of the nucleus ventralis intermedius in essential tremor modulates functional connectivity within the classical tremor network and beyond. Parkinsonism Relat Disord 2023; 115:105845. [PMID: 37717502 DOI: 10.1016/j.parkreldis.2023.105845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/24/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) of the thalamic ventral intermediate nucleus is an incisionless lesional treatment for essential tremor. OBJECTIVE To examine relationships between tremor severity and functional connectivity in patients with essential tremor and to assess long-term changes in the tremor network after sonication of the ventral intermediate nucleus. METHODS Twenty-one patients with essential tremor (70.33 ± 11.32 years) were included in the final analysis and underwent resting state functional magnetic resonance imaging at 3 T before and 6 months after treatment. Tremor severity (Fahn-Tolosa-Marin Clinical Rating Scale) was evaluated and functional connectivity was investigated using independent component analysis. RESULTS MRgFUS of the thalamic ventral intermediate nucleus reduced contralateral tremor effectively. Multiple regression analysis revealed exclusively negative correlations between FC and tremor severity, notably in the right cerebellar lobe VI and the left cerebellar lobe VIIIa (cerebellar network), in the left occipital fusiform gyrus (lateral visual network), the anterior division of the left superior temporal gyrus (fronto-parieto-temporal network), and in the posterior division of the left parahippocampal gyrus and the bilateral lingual gyri (default mode network). Six months after treatment, increased functional connectivity was observed in almost all tremor-associated clusters, except the cluster localized in the left cerebellum. CONCLUSIONS Our findings suggest that tremor-related activity in essential tremor extends beyond the classical cerebellar network, additionally involving areas related to visual processing. Functional restoration of network activity after sonication of the ventral intermediate nucleus is observed within the classical tremor network (cerebellum) and notably also in visual processing areas.
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Affiliation(s)
- Christine Kindler
- Department of Neurology, University Hospital Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Neeraj Upadhyay
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Division 'Clinical Functional Imaging', Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Veronika Purrer
- Department of Neurology, University Hospital Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Lukas Scheef
- Division 'Clinical Functional Imaging', Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Henning Boecker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Division 'Clinical Functional Imaging', Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
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11
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Nayak R, Lee J, Sotoudehnia S, Chang SY, Fatemi M, Alizad A. Mapping Pharmacologically Evoked Neurovascular Activation and Its Suppression in a Rat Model of Tremor Using Functional Ultrasound: A Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6902. [PMID: 37571686 PMCID: PMC10422538 DOI: 10.3390/s23156902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
Functional ultrasound (fUS), an emerging hemodynamic-based functional neuroimaging technique, is especially suited to probe brain activity and primarily used in animal models. Increasing use of pharmacological models for essential tremor extends new research to the utilization of fUS imaging in such models. Harmaline-induced tremor is an easily provoked model for the development of new therapies for essential tremor (ET). Furthermore, harmaline-induced tremor can be suppressed by the same classic medications used for essential tremor, which leads to the utilization of this model for preclinical testing. However, changes in local cerebral activities under the effect of tremorgenic doses of harmaline have not been completely investigated. In this study, we explored the feasibility of fUS imaging for visualization of cerebral activation and deactivation associated with harmaline-induced tremor and tremor-suppressing effects of propranolol. The spatial resolution of fUS using a high frame rate imaging enabled us to visualize time-locked and site-specific changes in cerebral blood flow associated with harmaline-evoked tremor. Intraperitoneal administration of harmaline generated significant neural activity changes in the primary motor cortex and ventrolateral thalamus (VL Thal) regions during tremor and then gradually returned to baseline level as tremor subsided with time. To the best of our knowledge, this is the first functional ultrasound study to show the neurovascular activation of harmaline-induced tremor and the therapeutic suppression in a rat model. Thus, fUS can be considered a noninvasive imaging method for studying neuronal activities involved in the ET model and its treatment.
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Affiliation(s)
- Rohit Nayak
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Jeyeon Lee
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Setayesh Sotoudehnia
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Su-Youne Chang
- Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
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12
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Lee ES, Lee P, Kim MS, Chang SK, Jo SW, Lee SA, Kang SY. Cortical mean diffusivity is reliable in measuring brain abnormalities in drug-naïve essential tremor patients. Clin Neurol Neurosurg 2023; 230:107796. [PMID: 37236003 DOI: 10.1016/j.clineuro.2023.107796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/30/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Essential tremor (ET) is a common movement disorder, but the pathogenesis is poorly understood. Several associated brain areas were reported with inconsistent results due to heterogeneous populations. It is necessary to analyze a more homogeneous patient group. METHODS We recruited 25 drug-naïve ET patients and 36 age- and sex-matched controls. All participants were right-handed. ET. ET was defined according to diagnostic criteria of the Consensus Statement of the Movement Disorder Society on Tremor. ET patients were divided into sporadic (SET) and familial ET (FET). We assessed tremor severity in ET. The cortical microstructural changes were compared between ET patients and controls using mean diffusivity (MD) of diffusion tensor imaging, and cortical thickness. The correlation of tremor severity with the cortical MD and thickness were respectively analyzed. RESULTS MD values were increased in the insular, precuneus, medial orbitofrontal, posterior, and isthmus cingulate and temporo-occipital areas in ET. In comparison between SET and FET, MD values were higher in the superior and caudal middle frontal, postcentral, and temporo-occipital regions in FET. The cortical thickness of ET patients was more increased in the left lingual gyrus and lower in the right bankssts gyrus. We could not find any correlation of tremor severity with the MD values in ET patients. Still, there was a positive correlation with the cortical thickness of the frontal and parietal areas. CONCLUSIONS Our results support the idea that ET is a disorder that disrupts widespread brain regions and indicates that cortical MD may be more sensitive to measure brain abnormalities than cortical thickness.
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Affiliation(s)
- Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, the Republic of Korea
| | - Peter Lee
- KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, the Republic of Korea
| | - Min Seung Kim
- Department of Neurology, Dongtan Sacred Heart Hospital Hallym University College of Medicine, Hwaseong, the Republic of Korea
| | - Suk Ki Chang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, the Republic of Korea
| | - Sang Won Jo
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, the Republic of Korea
| | - Seun Ah Lee
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, the Republic of Korea
| | - Suk Yun Kang
- Department of Neurology, Dongtan Sacred Heart Hospital Hallym University College of Medicine, Hwaseong, the Republic of Korea.
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13
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Timmers ER, Klamer MR, Marapin RS, Lammertsma AA, de Jong BM, Dierckx RAJO, Tijssen MAJ. [ 18F]FDG PET in conditions associated with hyperkinetic movement disorders and ataxia: a systematic review. Eur J Nucl Med Mol Imaging 2023; 50:1954-1973. [PMID: 36702928 PMCID: PMC10199862 DOI: 10.1007/s00259-023-06110-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: 08/02/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To give a comprehensive literature overview of alterations in regional cerebral glucose metabolism, measured using [18F]FDG PET, in conditions associated with hyperkinetic movement disorders and ataxia. In addition, correlations between glucose metabolism and clinical variables as well as the effect of treatment on glucose metabolism are discussed. METHODS A systematic literature search was performed according to PRISMA guidelines. Studies concerning tremors, tics, dystonia, ataxia, chorea, myoclonus, functional movement disorders, or mixed movement disorders due to autoimmune or metabolic aetiologies were eligible for inclusion. A PubMed search was performed up to November 2021. RESULTS Of 1240 studies retrieved in the original search, 104 articles were included. Most articles concerned patients with chorea (n = 27), followed by ataxia (n = 25), dystonia (n = 20), tremor (n = 8), metabolic disease (n = 7), myoclonus (n = 6), tics (n = 6), and autoimmune disorders (n = 5). No papers on functional movement disorders were included. Altered glucose metabolism was detected in various brain regions in all movement disorders, with dystonia-related hypermetabolism of the lentiform nuclei and both hyper- and hypometabolism of the cerebellum; pronounced cerebellar hypometabolism in ataxia; and striatal hypometabolism in chorea (dominated by Huntington disease). Correlations between clinical characteristics and glucose metabolism were often described. [18F]FDG PET-showed normalization of metabolic alterations after treatment in tremors, ataxia, and chorea. CONCLUSION In all conditions with hyperkinetic movement disorders, hypo- or hypermetabolism was found in multiple, partly overlapping brain regions, and clinical characteristics often correlated with glucose metabolism. For some movement disorders, [18F]FDG PET metabolic changes reflected the effect of treatment.
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Affiliation(s)
- Elze R Timmers
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marrit R Klamer
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Ramesh S Marapin
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands.
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14
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Bianco MG, Quattrone A, Sarica A, Aracri F, Calomino C, Caligiuri ME, Novellino F, Nisticò R, Buonocore J, Crasà M, Vaccaro MG, Quattrone A. Cortical involvement in essential tremor with and without rest tremor: a machine learning study. J Neurol 2023:10.1007/s00415-023-11747-6. [PMID: 37145157 DOI: 10.1007/s00415-023-11747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION There is some debate on the relationship between essential tremor with rest tremor (rET) and the classic ET syndrome, and only few MRI studies compared ET and rET patients. This study aimed to explore structural cortical differences between ET and rET, to improve the knowledge of these tremor syndromes. METHODS Thirty-three ET patients, 30 rET patients and 45 control subjects (HC) were enrolled. Several MR morphometric variables (thickness, surface area, volume, roughness, mean curvature) of brain cortical regions were extracted using Freesurfer on T1-weighted images and compared among groups. The performance of a machine learning approach (XGBoost) using the extracted morphometric features was tested in discriminating between ET and rET patients. RESULTS rET patients showed increased roughness and mean curvature in some fronto-temporal areas compared with HC and ET, and these metrics significantly correlated with cognitive scores. Cortical volume in the left pars opercularis was also lower in rET than in ET patients. No differences were found between ET and HC. XGBoost discriminated between rET and ET with mean AUC of 0.86 ± 0.11 in cross-validation analysis, using a model based on cortical volume. Cortical volume in the left pars opercularis was the most informative feature for classification between the two ET groups. CONCLUSION Our study demonstrated higher cortical involvement in fronto-temporal areas in rET than in ET patients, which may be linked to the cognitive status. A machine learning approach based on MR volumetric data demonstrated that these two ET subtypes can be distinguished using structural cortical features.
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Affiliation(s)
- Maria Giovanna Bianco
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessia Sarica
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Federica Aracri
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Camilla Calomino
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Fabiana Novellino
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Rita Nisticò
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Jolanda Buonocore
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Marianna Crasà
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Aldo Quattrone
- Department of Medical and Surgical Sciences, Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy.
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15
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Lenka A, Pandey S. Dystonia and tremor: Do they have a shared biology? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:413-439. [PMID: 37482399 DOI: 10.1016/bs.irn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Dystonia and tremor are the two most commonly encountered hyperkinetic movement disorders encountered in clinical practice. While there has been substantial progress in the research on these two disorders, there also exists a lot of gray areas. Entities such as dystonic tremor and tremor associated with dystonia occupy a major portion of the "gray zone". In addition, there is a marked clinical heterogeneity and overlap of several clinical and epidemiological features among dystonia and tremor. These facts raise the possibility that dystonia and tremor could be having shared biology. In this chapter, we revisit critical aspects of this possibility that may have important clinical and research implications in the future. We comprehensively review the points in favor and against the theory that dystonia and tremor have shared biology from clinical, epidemiological, genetic and neuroimaging studies.
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Affiliation(s)
- Abhishek Lenka
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, United States
| | - Sanjay Pandey
- Department of Neurology, Amrita Hospital, Faridabad, Delhi National Capital Region, India.
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16
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Angelini L, Paparella G, De Biase A, Maraone A, Panfili M, Berardelli I, Cannavacciuolo A, Di Vita A, Margiotta R, Fabbrini G, Berardelli A, Bologna M. Longitudinal study of clinical and neurophysiological features in essential tremor. Eur J Neurol 2023; 30:631-640. [PMID: 36437695 PMCID: PMC10107502 DOI: 10.1111/ene.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Essential tremor (ET) is a common and heterogeneous disorder characterized by postural/kinetic tremor of the upper limbs and other body segments and by non-motor symptoms, including cognitive and psychiatric abnormalities. Only a limited number of longitudinal studies have comprehensively and simultaneously investigated motor and non-motor symptom progression in ET. Possible soft signs that configure the ET-plus diagnosis are also under-investigated in follow-up studies. We aimed to longitudinally investigate the progression of ET manifestations by means of clinical and neurophysiological evaluation. METHODS Thirty-seven ET patients underwent evaluation at baseline (T0) and at follow-up (T1; mean interval ± SD = 39.89 ± 9.83 months). The assessment included the clinical and kinematic evaluation of tremor and voluntary movement execution, as well as the investigation of cognitive and psychiatric disorders. RESULTS A higher percentage of patients showed tremor in multiple body segments and rest tremor at T1 as compared to T0 (all p-values < 0.01). At T1, the kinematic analysis revealed reduced finger-tapping movement amplitude and velocity as compared to T0 (both p-values < 0.001). The prevalence of cognitive and psychiatric disorders did not change between T0 and T1. Female sex, absence of family history, and rest tremor at baseline were identified as predictive factors of worse disease progression. CONCLUSIONS ET progression is characterized by the spread of tremor in multiple body segments and by the emergence of soft signs. We also identified possible predictors of disease worsening. The results contribute to a better understanding of ET classification and pathophysiology.
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Affiliation(s)
- Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Annalisa Maraone
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Panfili
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Antonella Di Vita
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Margiotta
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
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17
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Wang Y, Yang J, Cai M, Liu X, Lu K, Lou Y, Li Z. Application of optimized convolutional neural networks for early aided diagnosis of essential tremor: Automatic handwriting recognition and feature analysis. Med Eng Phys 2023; 113:103962. [PMID: 36966002 DOI: 10.1016/j.medengphy.2023.103962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
Essential tremor (ET) is one of the most common neurological disorders, and its mainly clinical symptoms, including patient hand's kinetic tremor, dystonia, ataxia, etc., would influence the daily life of patients inordinately. Current ET diagnosis highly replies on the clinical evaluation and neurological examination, so the objective measurement indicators are particularly important in the auxiliary diagnosis of ET. In this research, the Archimedes spiral line freehand sketching samples without template assistance is collected and the Convolutional Neural Network (CNN) model of optimized structure is adopted to fully analyze the tremor, spacing of turns, shape, etc. shown in the handwriting samples of patients with ET, including the following main process: characteristics extraction, model visualization and subregional relevance evaluation. Dropout is used as a regularization technique in the network structure. The test group consisted of 50 patients with confirmed ET and the control group consisted of 40 healthy individuals. The main research objectives of this paper comprise two points: on the one hand, to achieve effective automatic classification of patients with ET and healthy controls using a scheme combining deep learning and simple hand mapping for the purpose of primary disease screening; on the other hand, to design sub-regional automatic classification experiments to demonstrate that Archimedean spiral hand drawings of patients with ET do have distinct local features, and to lay the experimental foundation for future hand drawing-based automatic aid for the identification of a variety of neurodegenerative diseases. Our model's average accuracy rate in test set reaches 89.3%, and average AUC is 0.972, with favorable stability and generalization performance. Besides, subregional characteristics recognition proofs that the spiral line samples of most of the patients with ET show more category-related characteristics in the local area of upper right, which provides evidences and theory update for predecessors' medical research.
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Affiliation(s)
- Yanwen Wang
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Jiayu Yang
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China
| | - Miao Cai
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Xiaoli Liu
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Kang Lu
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China
| | - Yue Lou
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Zhu Li
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China.
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18
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Srinivasan SR. Targeting Circuit Abnormalities in Neurodegenerative Disease. Mol Pharmacol 2023; 103:38-44. [PMID: 36310030 DOI: 10.1124/molpharm.122.000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023] Open
Abstract
Despite significant improvement in our ability to diagnose both common and rare neurodegenerative diseases and understand their underlying biologic mechanisms, there remains a disproportionate lack of effective treatments, reflecting the complexity of these disorders. Successfully advancing novel treatments for neurodegenerative disorders will require reconsideration of traditional approaches, which to date have focused largely on specific disease proteins or cells of origin. This article proposes reframing these diseases as conditions of dysfunctional circuitry as a complement to ongoing efforts. Specifically reviewed is how aberrant spiking is a common downstream mechanism in numerous neurodegenerative diseases, often driven by dysfunction in specific ion channels. Surgical modification of this electrical activity via deep brain stimulation is already an approved modality for many of these disorders. Therefore, restoring proper electrical activity by targeting these channels pharmacologically represents a viable strategy for intervention, not only for symptomatic management but also as a potential disease-modifying therapy. Such an approach is likely to be a promising route to treating these devastating disorders, either as monotherapy or in conjunction with current drugs. SIGNIFICANCE STATEMENT: Despite extensive research and improved understanding of the biology driving neurodegenerative disease, there has not been a concomitant increase in approved therapies. Accordingly, it is time to shift our perspective and recognize these diseases also as disorders of circuitry to further yield novel drug targets and new interventions. An approach focused on treating dysfunctional circuitry has the potential to reduce or reverse patient symptoms and potentially modify disease course.
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19
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Cheng F, Duan Y, Jiang H, Zeng Y, Chen X, Qin L, Zhao L, Yi F, Tang Y, Liu C. Identifying and distinguishing of essential tremor and Parkinson's disease with grouped stability analysis based on searchlight-based MVPA. Biomed Eng Online 2022; 21:81. [PMID: 36443843 PMCID: PMC9703788 DOI: 10.1186/s12938-022-01050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since both essential tremor (ET) and Parkinson's disease (PD) are movement disorders and share similar clinical symptoms, it is very difficult to recognize the differences in the presentation, course, and treatment of ET and PD, which leads to misdiagnosed commonly. PURPOSE Although neuroimaging biomarker of ET and PD has been investigated based on statistical analysis, it is unable to assist the clinical diagnosis of ET and PD and ensure the efficiency of these biomarkers. The aim of the study was to identify the neuroimaging biomarkers of ET and PD based on structural magnetic resonance imaging (MRI). Moreover, the study also distinguished ET from PD via these biomarkers to validate their classification performance. METHODS This study has developed and implemented a three-level machine learning framework to identify and distinguish ET and PD. First of all, at the model-level assessment, the searchlight-based machine learning method has been used to identify the group differences of patients (ET/PD) with normal controls (NCs). And then, at the feature-level assessment, the stability of group differences has been tested based on structural brain atlas separately using the permutation test to identify the robust neuroimaging biomarkers. Furthermore, the identified biomarkers of ET and PD have been applied to classify ET from PD based on machine learning techniques. Finally, the identified biomarkers have been compared with the previous findings of the biology-level assessment. RESULTS According to the biomarkers identified by machine learning, this study has found widespread alterations of gray matter (GM) for ET and large overlap between ET and PD and achieved superior classification performance (PCA + SVM, accuracy = 100%). CONCLUSIONS This study has demonstrated the significance of a machine learning framework to identify and distinguish ET and PD. Future studies using a large data set are needed to confirm the potential clinical application of machine learning techniques to discern between PD and ET.
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Affiliation(s)
- FuChao Cheng
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - YuMei Duan
- Department of Computer and Software, Chengdu Jincheng College, Chengdu, China
| | - Hong Jiang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zeng
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - XiaoDan Chen
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - Ling Qin
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - LiQin Zhao
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - FaSheng Yi
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China ,Key Laboratory of Pattern Recognition and Intelligent Information Processing, Institutions of Higher Education of Sichuan Province, Chengdu, China
| | - YiQian Tang
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
| | - Chang Liu
- grid.411292.d0000 0004 1798 8975College of Computer, Chengdu University, Chengdu, China
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20
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Functional connectivity of the cortico-subcortical sensorimotor loop is modulated by the severity of nigrostriatal dopaminergic denervation in Parkinson’s Disease. NPJ Parkinsons Dis 2022; 8:122. [PMID: 36171211 PMCID: PMC9519637 DOI: 10.1038/s41531-022-00385-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
To assess if the severity of nigrostriatal innervation loss affects the functional connectivity (FC) of the sensorimotor cortico-striato-thalamic-cortical loop (CSTCL) in Parkinson’s Disease (PD), Resting-State functional MRI and 18F-DOPA PET data, simultaneously acquired on a hybrid PET/MRI scanner, were retrospectively analyzed in 39 PD and 16 essential tremor patients. Correlations between posterior Putamen DOPA Uptake (pPDU) and the FC of the main CSTCL hubs were assessed separately in the two groups, analyzing the differences between the two groups by a group-by-pPDU interaction analysis of the resulting clusters’ FC. Unlike in essential tremor, in PD patients pPDU correlated inversely with the FC of the thalamus with the sensorimotor cortices, and of the postcentral gyrus with the dorsal cerebellum, and directly with the FC of pre- and post-central gyri with both the superior and middle temporal gyri and the paracentral lobule, and of the caudate with the superior parietal cortex. The interaction analysis confirmed the significance of the difference between the two groups in these correlations. In PD patients, the post-central cortex FC, in the clusters correlating directly with pPDU, negatively correlated with both UPDRS motor examination score and Hoehn and Yahr stage, independent of the pPDU, suggesting that these FC changes contribute to motor impairment. In PD, nigrostriatal innervation loss correlates with a decrease in the FC within the sensorimotor network and between the sensorimotor network and the superior temporal cortices, possibly contributing to motor impairment, and with a strengthening of the thalamo-cortical FC, that may represent ineffective compensatory phenomena.
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21
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Loughnan R, Ahern J, Tompkins C, Palmer CE, Iversen J, Thompson WK, Andreassen O, Jernigan T, Sugrue L, Dale A, Boyle MET, Fan CC. Association of Genetic Variant Linked to Hemochromatosis With Brain Magnetic Resonance Imaging Measures of Iron and Movement Disorders. JAMA Neurol 2022; 79:919-928. [PMID: 35913729 PMCID: PMC9344392 DOI: 10.1001/jamaneurol.2022.2030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Importance Hereditary hemochromatosis (HH) is an autosomal recessive genetic disorder that leads to iron overload. Conflicting results from previous research has led some to believe the brain is spared the toxic effects of iron in HH. Objective To test the association of the strongest genetic risk variant for HH on brainwide measures sensitive to iron deposition and the rates of movement disorders in a substantially larger sample than previous studies of its kind. Design, Setting, and Participants This cross-sectional retrospective study included participants from the UK Biobank, a population-based sample. Genotype, health record, and neuroimaging data were collected from January 2006 to May 2021. Data analysis was conducted from January 2021 to April 2022. Disorders tested included movement disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10], codes G20-G26), abnormalities of gait and mobility (ICD-10 codes R26), and other disorders of the nervous system (ICD-10 codes G90-G99). Exposures Homozygosity for p.C282Y, the largest known genetic risk factor for HH. Main Outcomes and Measures T2-weighted and T2* signal intensity from brain magnetic resonance imaging scans, measures sensitive to iron deposition, and clinical diagnosis of neurological disorders. Results The total cohort consisted of 488 288 individuals (264 719 female; ages 49-87 years, largely northern European ancestry), 2889 of whom were p.C282Y homozygotes. The neuroimaging analysis consisted of 836 individuals: 165 p.C282Y homozygotes (99 female) and 671 matched controls (399 female). A total of 206 individuals were excluded from analysis due to withdrawal of consent. Neuroimaging analysis showed that p.C282Y homozygosity was associated with decreased T2-weighted and T2* signal intensity in subcortical motor structures (basal ganglia, thalamus, red nucleus, and cerebellum; Cohen d >1) consistent with substantial iron deposition. Across the whole UK Biobank (2889 p.C282Y homozygotes, 485 399 controls), we found a significantly increased prevalence for movement disorders in male homozygotes (OR, 1.80; 95% CI, 1.28-2.55; P = .001) but not female individuals (OR, 1.09; 95% CI, 0.70-1.73; P = .69). Among the 31 p.C282Y male homozygotes with a movement disorder, only 10 had a concurrent HH diagnosis. Conclusions and Relevance These findings indicate increased iron deposition in subcortical motor circuits in p.C282Y homozygotes and confirm an increased association with movement disorders in male homozygotes. Early treatment in HH effectively prevents the negative consequences of iron overload in the liver and heart. Our work suggests that screening for p.C282Y homozygosity in high-risk individuals also has the potential to reduce brain iron accumulation and to reduce the risk of movement disorders among male individuals who are homozygous for this mutation.
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Affiliation(s)
- Robert Loughnan
- Department of Cognitive Science, University of California, San Diego, La Jolla
- Population Neuroscience and Genetics, University of California, San Diego, La Jolla
| | - Jonathan Ahern
- Department of Cognitive Science, University of California, San Diego, La Jolla
| | - Cherisse Tompkins
- Department of Cognitive Science, University of California, San Diego, La Jolla
| | - Clare E. Palmer
- Center for Human Development, University of California, San Diego, La Jolla
| | - John Iversen
- Center for Human Development, University of California, San Diego, La Jolla
| | - Wesley K. Thompson
- Population Neuroscience and Genetics, University of California, San Diego, La Jolla
- Division of Biostatistics, Department of Radiology, University of California, San Diego, La Jolla
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Ole Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terry Jernigan
- Department of Cognitive Science, University of California, San Diego, La Jolla
- Center for Human Development, University of California, San Diego, La Jolla
- Department of Radiology, University of California, San Diego School of Medicine, La Jolla
- Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla
| | - Leo Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Department of Psychiatry, University of California, San Francisco
| | - Anders Dale
- Department of Cognitive Science, University of California, San Diego, La Jolla
- Department of Radiology, University of California, San Diego School of Medicine, La Jolla
- Department of Neuroscience, University of California, San Diego School of Medicine, La Jolla
- Center for Multimodal Imaging and Genetics, University of California, San Diego School of Medicine, La Jolla
| | - Mary E. T. Boyle
- Department of Cognitive Science, University of California, San Diego, La Jolla
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chun Chieh Fan
- Population Neuroscience and Genetics, University of California, San Diego, La Jolla
- Center for Multimodal Imaging and Genetics, University of California, San Diego School of Medicine, La Jolla
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, Oklahoma
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22
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Sharifi S, Luft F, de Boer L, Buijink AWG, Mugge W, Schouten AC, Heida T, Bour LJ, van Rootselaar AF. Closing the loop: Novel quantitative fMRI approach for manipulation of the sensorimotor loop in tremor. Neuroimage 2022; 262:119554. [PMID: 35963505 DOI: 10.1016/j.neuroimage.2022.119554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 10/31/2022] Open
Abstract
Tremor is thought to be an effect of oscillatory activity within the sensorimotor network. To date, the underlying pathological brain networks are not fully understood. Disentangling tremor activity from voluntary motor output and sensorimotor feedback systems is challenging. To better understand the intrinsic sensorimotor fingerprint underlying tremor, we aimed to disentangle the sensorimotor system into driving (motor) and feedback/compensatory (sensory) neuronal involvement, and aimed to pinpoint tremor activity in essential tremor (ET) and tremor-dominant Parkinson's disease (PD) with a novel closed-loop approach. Eighteen ET patients, 14 tremor-dominant PD patients, and 18 healthy controls were included. An MR-compatible wrist manipulator was employed during functional MRI (fMRI) while muscle activity during (in)voluntary movements was concurrently recorded using electromyography (EMG). Tremor was quantified based on EMG and correlated to brain activity. Participants performed three tasks: an active wrist motor task, a passive wrist movement task, and rest (no wrist movement). The results in healthy controls proved that our experimental paradigm activated the expected motor and sensory networks separately using the active (motor) and passive (sensory) task. ET patients showed similar patterns of activation within the motor and sensory networks. PD patients had less activity during the active motor task in the cerebellum and basal ganglia compared to ET and healthy controls. EMG showed that in ET, tremor fluctuations correlated positively with activity in the inferior olive region, and that in PD tremor fluctuations correlated positively with cerebellar activity. Our novel approach with an MR-compatible wrist manipulator, allowed to investigate the involvement of the motor and sensory networks separately, and as such to better understand tremor pathophysiology. In ET sensorimotor network function did not differ from healthy controls. PD showed less motor-related activity. Focusing on tremor, our results indicate involvement of the inferior olive in ET tremor modulation, and cerebellar involvement in PD tremor modulation.
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Affiliation(s)
- S Sharifi
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands.
| | - F Luft
- Department of Biomedical Signals and Systems, TechMed Centre, University of Twente, Enschede, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
| | - L de Boer
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands
| | - A W G Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
| | - W Mugge
- Faculty of Mechanical, Maritime and Materials Engineering, Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - A C Schouten
- Faculty of Mechanical, Maritime and Materials Engineering, Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - T Heida
- Department of Biomedical Signals and Systems, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - L J Bour
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands
| | - A F van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, D2-113, P.O. Box 22660, Amsterdam 1100 DD, the Netherlands; BIC Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
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23
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Vidailhet M. Editorial: Innovation and resilience in movement disorders: abundance of creative science despite the covid-19 period. Curr Opin Neurol 2022; 35:482-484. [PMID: 35856916 DOI: 10.1097/wco.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marie Vidailhet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Salpêtrière, DMU Neuroscience 6, Paris, France
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24
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Cosentino S, Shih LC. Does essential tremor increase risk of cognitive impairment and dementia? Yes. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:195-231. [PMID: 35750363 DOI: 10.1016/bs.irn.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Essential Tremor (ET), by definition, is a disorder of movement. Yet over the years, epidemiologic, clinical, pathologic, and neuroimaging studies have converged to reveal a cognitive side of ET. The cognitive symptoms in ET are heterogeneous and are likely to reflect heterogeneous underlying mechanisms. In this chapter, we review and synthesize a diverse set of studies from both population-based settings to cohorts with more detailed investigations into cognition to consider the various mechanisms by which cognitive symptoms may emerge in a subset of individuals with ET. As part of our analysis, we consider questions surrounding ET diagnosis and the possibility of comorbid disease as potential factors that, upon closer examination, appear to strengthen the argument in favor of ET as a risk factor for dementia. Importantly, we also consider the clinical relevance of cognitive impairment in ET. While ET is not universally characterized by significant cognitive deficits, the data from epidemiological, cognitive, neuroimaging, and postmortem neuropathologic studies converge to reveal an increased risk for cognitive impairment and dementia among individuals with ET. We conclude by offering directions for future research, and a neurocognitive framework with which to consider existing findings and to use in the design of novel studies dedicated to clarifying the basis, nature, and course of cognitive impairments in ET.
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Affiliation(s)
- Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, United States; Department of Neurology, Columbia University Irving Medical Center, New York, United States.
| | - Ludy C Shih
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston Medical Center, Boston, Massachusetts, United States; Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States.
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25
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Louis ED, Kuo SH. What's in a Name? Nomenclature of essential tremor: Syndrome or family of diseases? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:1-5. [PMID: 36185589 PMCID: PMC9524858 DOI: 10.1016/s0074-7742(22)00044-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
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26
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Peng J, Yang J, Li N, Lei D, Li J, Duan L, Chen C, Zeng Y, Xi J, Jiang Y, Gong Q, Peng R. Topologically Disrupted Gray Matter Networks in Drug-Naïve Essential Tremor Patients With Poor Sleep Quality. Front Neurol 2022; 13:834277. [PMID: 35557617 PMCID: PMC9086904 DOI: 10.3389/fneur.2022.834277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Sleep disturbances are widespread among patients with essential tremor (ET) and may have adverse effects on patients' quality of life. However, the pathophysiology underlying poor quality of sleep (QoS) in patients with ET remains unclear. Our study aimed to identify gray matter (GM) network alterations in the topological properties of structural MRI related to QoS in patients with ET. Method We enrolled 45 ET patients with poor QoS (SleET), 59 ET patients with normal QoS (NorET), and 66 healthy controls (HC), and they all underwent a three-dimensional T1-weighted MRI scan. We used a graph-theoretical approach to investigate the topological organization of GM morphological networks, and individual morphological brain networks were constructed according to the interregional similarity of GM volume distributions. Furthermore, we performed network-based statistics, and partial correlation analyses between topographic features and clinical characteristics were conducted. Results Global network organization was disrupted in patients with ET. Compared with the NorET group, the SleET group exhibited disrupted topological GM network organization with a shift toward randomization. Moreover, they showed altered nodal centralities in mainly the frontal, temporal, parietal, and cerebellar lobes. Morphological connection alterations within the default mode network (DMN), salience, and basal ganglia networks were observed in the SleET group and were generally more extensive than those in the NorET and HC groups. Alterations within the cerebello-thalamo-(cortical) network were only detected in the SleET group. The nodal degree of the left thalamus was negatively correlated with the Fahn-Tolosa-Marin Tremor Rating Scale score (r = −0.354, p =0.027). Conclusion Our findings suggest that potential complex interactions underlie tremor and sleep disruptions in patients with ET. Disruptions within the DMN and the cerebello-thalamo-(cortical) network may have a broader impact on sleep quality in patients with ET. Our results offer valuable insight into the neural mechanisms underlying poor QoS in patients with ET.
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Affiliation(s)
- Jiaxin Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Nannan Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Du Lei
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Junying Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Liren Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chaolan Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zeng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Xi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Rong Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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27
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Riboldi GM, Frucht SJ. Is essential tremor a family of diseases or a syndrome? A family of diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:7-29. [PMID: 35750371 DOI: 10.1016/bs.irn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
It is now well-established that essential tremor (ET) can manifest with different clinical presentations and progressions (i.e., upper limb tremor, head tremor, voice tremor, lower limb tremor, task- or position-specific tremor, or a combination of those). Common traits and overlaps are identifiable across these different subtypes of ET, including a slow rate of progression, a response to alcohol and a positive family history. At the same time, each of these manifestations are associated with specific demographic, clinical and treatment-response characteristics suggesting a family of diseases rather than a spectrum of a syndrome. Here we summarize the most important clinical, demographic, neuropathological and imagingfeatures of ET and of its subtypes to support ET as a family of identifiable conditions. This classification has relevance for counseling of patients with regard to disease progression and treatment response, as well as for the design of therapeutic clinical trials.
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Affiliation(s)
- Giulietta M Riboldi
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States
| | - Steven J Frucht
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University Langone Health, New York, NY, United States.
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28
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Cho HJ. Is essential tremor a degenerative or an electrical disorder? Electrical disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:103-128. [PMID: 35750360 DOI: 10.1016/bs.irn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Essential tremor (ET) is one of the most common movement disorders, yet we do not have a complete understanding of its pathophysiology. From a phenomenology standpoint, ET is an isolated tremor syndrome of bilateral upper limb action tremor with or without tremor in other body locations. ET is a pathological tremor that arises from excessive oscillation in the central motor network. The tremor network comprises of multiple brain regions including the inferior olive, cerebellum, thalamus, and motor cortex, and there is evidence that a dynamic oscillatory disturbance within this network leads to tremor. ET is a chronic disorder, and the natural history shows a slow progression of tremor intensity with age. There are reported data suggesting that ET follows the disease model of a neurodegenerative disorder, however whether ET is a degenerative or electrical disorder has been a subject of debate. In this chapter, we will review cumulative evidence that ET as a syndrome is a fundamentally electric disorder. The etiology is likely heterogenous and may not be primarily neurodegenerative.
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Affiliation(s)
- Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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29
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Ondo W. Enhancing GABA inhibition is the next generation of medications for essential tremor. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:317-334. [PMID: 35750368 DOI: 10.1016/bs.irn.2022.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
γ-Aminobutyric acid (GABA) is the most prevalent inhibitory CNS neurotransmitter. Activating GABA-A receptors hyperpolarizes cells via Cl- influx, which inhibits action potentials. Although the exact pathophysiologies of tremor are incompletely understood, proposed neuroanatomy extensively implicates GABA pathways. Pathological studies and imaging studies also show GABA abnormalities in patients with ET. Most importantly, medications that activate GABA-A receptors, such as primidone, often improve tremor. Ongoing clinical trials and physiology research should further refine potential future GABAergic targets and treatments, which are currently the most promising targets for pharmacological intervention.
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Affiliation(s)
- William Ondo
- Houston Methodist Hospital, Weill Cornel Medical School, Houston, TX, United States.
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30
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Pan MK, Kuo SH. Essential tremor: Clinical perspectives and pathophysiology. J Neurol Sci 2022; 435:120198. [PMID: 35299120 PMCID: PMC10363990 DOI: 10.1016/j.jns.2022.120198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/01/2021] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Essential tremor (ET) is one of the most common neurological disorders and can be highly disabling. In recent years, studies on the clinical perspectives and pathophysiology have advanced our understanding of ET. Specifically, clinical heterogeneity of ET, with co-existence of tremor and other neurological features such as dystonia, ataxia, and cognitive dysfunction, has been identified. The cerebellum has been found to be the key brain region for tremor generation, and structural alterations of the cerebellum have been extensively studied in ET. Finally, four main ET pathophysiologies have been proposed: 1) environmental exposures to β-carboline alkaloids and the consequent olivocerebellar hyper-excitation, 2) cerebellar GABA deficiency, 3) climbing fiber synaptic pathology with related cerebellar oscillatory activity, 4) extra-cerebellar oscillatory activity. While these four theories are not mutually exclusive, they can represent distinctive ET subtypes, indicating multiple types of abnormal brain circuitry can lead to action tremor. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
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31
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Kosmowska B, Wardas J. The Pathophysiology and Treatment of Essential Tremor: The Role of Adenosine and Dopamine Receptors in Animal Models. Biomolecules 2021; 11:1813. [PMID: 34944457 PMCID: PMC8698799 DOI: 10.3390/biom11121813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022] Open
Abstract
Essential tremor (ET) is one of the most common neurological disorders that often affects people in the prime of their lives, leading to a significant reduction in their quality of life, gradually making them unable to independently perform the simplest activities. Here we show that current ET pharmacotherapy often does not sufficiently alleviate disease symptoms and is completely ineffective in more than 30% of patients. At present, deep brain stimulation of the motor thalamus is the most effective ET treatment. However, like any brain surgery, it can cause many undesirable side effects; thus, it is only performed in patients with an advanced disease who are not responsive to drugs. Therefore, it seems extremely important to look for new strategies for treating ET. The purpose of this review is to summarize the current knowledge on the pathomechanism of ET based on studies in animal models of the disease, as well as to present and discuss the results of research available to date on various substances affecting dopamine (mainly D3) or adenosine A1 receptors, which, due to their ability to modulate harmaline-induced tremor, may provide the basis for the development of new potential therapies for ET in the future.
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Affiliation(s)
| | - Jadwiga Wardas
- Department of Neuropsychopharmacology, Maj Institute of Pharmacology Polish Academy of Sciences, 31-343 Kraków, Poland;
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