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Cerebellar Continuous Theta Burst Stimulation in Essential Tremor

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Abstract

The pathophysiological mechanisms of essential tremor (ET) are still not entirely clear. In the present study, we aimed to investigate the cerebello-thalamo-cortical connectivity in ET using the cerebellar continuous theta burst stimulation (cTBS) and possible effects on tremor and reaching movements. Sixteen patients with ET and 11 healthy subjects underwent two experimental sessions: (i) cTBS over the right cerebellar hemisphere (real cerebellar cTBS) and (ii) cTBS over the neck muscles (sham cerebellar cTBS). The two sessions were performed at least 1 week apart. The effects of real and sham cerebellar cTBS were quantified as excitability changes on contralateral primary motor cortex, as well as possible changes of postural tremor and reaching movements on the ipsilateral arm. Primary motor cortex excitability was assessed by recording the input/output curve of the motor-evoked potentials from the right first dorsal interosseous muscle. Tremor was rated clinically. Objective assessment of tremor and reaching movements was performed using kinematic techniques. Real cerebellar cTBS reduced the excitability in the contralateral primary motor cortex in healthy subjects though not in patients with ET. There was no significant change in tremor severity and reaching movements, as assessed by clinical examination or kinematic techniques, after real or sham cerebellar cTBS in patients with ET. Finally, there was no correlation between individual changes of M1 excitability and kinematic measures of tremor and reaching movement abnormalities in patients with ET. The results suggest that functional cerebello-thalamo-cortical connectivity tested by cTBS is abnormal in ET and that cerebellar cTBS does not ameliorate tremor in this condition.

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Abbreviations

AMT:

Active motor threshold

ANOVA:

Analysis of variance

CTC:

Cerebello-thalamo-cortical

cTBS:

Continuous theta burst stimulation

EMG:

Electromyographic

ET:

Essential tremor

FTM:

Fahn-Tolosa-Marin

FDI:

First dorsal interosseous

I/O:

Input–output

LTD:

Long-term depression

MSO:

Maximal stimulator output

MEP:

Motor-evoked potential

M1:

Primary motor cortex

rTMS:

Repetitive transcranial magnetic stimulation

RMT:

Resting motor threshold

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Conflict of Interest

The authors report no financial interests or potential conflicts of interest.

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Authors and Affiliations

  1. Neuromed Institute IRCCS, Via Atinense n 18, Pozzilli, 86077, IS, Italy

    Matteo Bologna, Antonella Conte, Giovanni Fabbrini & Alfredo Berardelli

  2. Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell’Università, 30, 00185, Rome, Italy

    Lorenzo Rocchi, Giorgio Leodori, Giulia Paparella, Nashaba Kahn, Giovanni Fabbrini & Alfredo Berardelli

Authors
  1. Matteo Bologna
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  2. Lorenzo Rocchi
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  3. Giorgio Leodori
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  4. Giulia Paparella
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  5. Antonella Conte
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  6. Nashaba Kahn
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  7. Giovanni Fabbrini
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  8. Alfredo Berardelli
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Corresponding author

Correspondence to Alfredo Berardelli.

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Supplementary Table 1

Repeated measure ANOVA on reaching movement kinematics. Significant effects are bold type printed. (DOCX 27 kb)

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Bologna, M., Rocchi, L., Leodori, G. et al. Cerebellar Continuous Theta Burst Stimulation in Essential Tremor. Cerebellum 14, 133–141 (2015). https://doi.org/10.1007/s12311-014-0621-0

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  • DOI: https://doi.org/10.1007/s12311-014-0621-0

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