White matter rather than gray matter damage characterizes essential tremor
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We investigated changes in gray matter (GM) and white matter (WM) in the whole brain, including both cortical and subcortical structures, and their relationship with tremor severity, psychiatric symptoms, and cognitive impairment in patients affected by essential tremor (ET).
We studied 19 ET patients and 15 healthy subjects (HS). All the subjects underwent a 3-T MRI study based on 3D-T1 and diffusion tensor images. For the GM analysis, cortical thickness was assessed by using the Computational Anatomy Tool, basal ganglia and thalamus volumes by using the FMRIB software library, and cerebellum lobular volumes by using the spatial unbiased atlas template. For the WM assessment, we performed a voxel-wise analysis by means of tract-based spatial statistics. Patients’ tremor severity and psychiatric and cognitive disorders were evaluated by means of standard clinical scales. Neuroimaging data were correlated with clinical scores.
We found significantly smaller right and left thalamic volumes in ET patients than in HS, which correlated with cognitive scores. We did not observe any significant differences either in cortical thickness or in cerebellar lobular volumes between patients and HS. WM abnormalities were detected in most hemisphere bundles, particularly in the corticospinal tract, cerebellar peduncles, and corpus callosum. The WM abnormalities significantly correlated with tremor severity, cognitive profile, and depression.
Our study indicates that ET is characterized by several GM and WM changes of both infra- and supratentorial brain structures. The results may help to better understand mechanisms underlying tremor severity and psychiatric and cognitive impairment in ET.
• We performed a comprehensive evaluation of gray and white matter in the same sample of patients with essential tremor using recently developed data analysis methods.
• Essential tremor is characterized by widespread gray and white matter changes in both infra- and supratentorial brain structures. The results may help to better understand motor and non-motor symptoms in patients with essential tremor.
KeywordsEssential tremor Magnetic resonance imaging Gray matter White matter
Three dimensional T1-weighted
Beck Anxiety Inventory
Beck Depression Inventory
Computational Anatomy Tool
Diffusion tensor imaging
Frontal Assessment Battery
FMRIB’s Integrated Registration and Segmentation Tool
FMRIB software library
Fahn-Tolosa-Marin Tremor Rating Scale
Montreal Cognitive Assessment
Magnetic resonance imaging
Statistic parametric mapping version 12
Spatially unbiased infratentorial toolbox
Tract-based spatial statistics
Total intracranial volume
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Prof Patrizia Pantano.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Case-control study
• Performed at one institution
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