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No reliable gray matter changes in essential tremor

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Abstract

Background

Voxel-based morphometry (VBM) has been used to study human brain gray matter (GM) alterations in essential tremor (ET) for over one decade. However, the literature revealed heterogeneous findings.

Methods

We therefore conducted a coordinate-based meta-analysis to synthesize the VBM studies to examine which brain regions show the most reliable GM alterations in patients with ET relative to healthy controls.

Results

A total of 16 original VBM studies, comprising 387 patients with ET and 355 healthy controls, were included in this meta-analysis. This quantitative meta-analysis revealed no evidence of robust and reliable alterations in regional brain GM structures in ET. Meta-regression analyses indicate that many moderators (e.g., MR field strength, statistical methodology, age, onset age, gender, illness severity, illness duration, and family history) account for some of the heterogeneity in GM across studies.

Conclusions

High heterogeneity in GM alterations across studies may reflect true heterogeneity in ET regarding the clinic, etiology, and pathology, as well as possibly the VBM methodological variations. Currently, this heterogeneity limits the use of VBM as a reliable tool to distinguish ET from healthy controls. In order to improve reproducibility of VBM results in ET, future research may benefit from increasing the sample size, comprehensively subtyping ET phenotypes, and using well-designed and standardized imaging acquisition and analytical protocols. Furthermore, data sharing should be considered as a high priority.

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Abbreviations

AES-SDM:

Anisotropic effect-size signed differential mapping

ET:

Essential tremor

FTM-TRS:

Fahn-Tolosa-Marin Tremor Rating Scale

GM:

Gray matter

MNI:

Montreal Neurological Institute

MRI:

Magnetic resonance imaging

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SDM:

Seed-based d Mapping

VBM:

Voxel-based morphometry

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Acknowledgements

We thank all the authors of the included studies.

Funding

This work was supported by the National Natural Science Foundation of China (81630028, 81601161), the Key Research and Development Program of Jiangsu Province of China (BE2016610), the National Key Research and Development Program of China (2016YFC1300504), and the Jiangsu Province Key Medical Discipline (ZDXKA2016020).

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  1. Rong Luo and PingLei Pan contributed equally to this work

Authors and Affiliations

  1. Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321 Zhongshan Road, Nanjing, Jiangsu Province, 210008, People’s Republic of China

    Rong Luo & Yun Xu

  2. Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, People’s Republic of China

    Rong Luo & PingLei Pan

  3. Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, People’s Republic of China

    PingLei Pan

  4. Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, People’s Republic of China

    Yun Xu

  5. Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, People’s Republic of China

    Yun Xu

  6. Laboratory of Reproductive Medicine, Department of Physiology, Nanjing Medical University, No. 818 Tianyuan East Road, Nanjing, Jiangsu Province, 211166, People’s Republic of China

    Ling Chen

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Luo, R., Pan, P., Xu, Y. et al. No reliable gray matter changes in essential tremor. Neurol Sci 40, 2051–2063 (2019). https://doi.org/10.1007/s10072-019-03933-0

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