European Radiology

, Volume 29, Issue 12, pp 6634–6642 | Cite as

White matter rather than gray matter damage characterizes essential tremor

  • Sara Pietracupa
  • Matteo Bologna
  • Komal Bharti
  • Gabriele Pasqua
  • Silvia Tommasin
  • Francesca Elifani
  • Giulia Paparella
  • Nikolaos Petsas
  • Giovanni Grillea
  • Alfredo Berardelli
  • Patrizia PantanoEmail author
Magnetic Resonance



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.

Key Points

• We performed a comprehensive evaluation of gray and white matter in the same sample of patients with essential tremor using recently developed data analysis methods.

• Essential tremor is characterized by widespread gray and white matter changes in both infra- and supratentorial brain structures. The results may help to better understand motor and non-motor symptoms in patients with essential tremor.


Essential tremor Magnetic resonance imaging Gray matter White matter 



Three dimensional T1-weighted


Axial diffusivity


Beck Anxiety Inventory


Beck Depression Inventory


Computational Anatomy Tool


Cerebrospinal fluid


Diffusion tensor imaging


Essential tremor


Fractional anisotropy


Frontal Assessment Battery


FMRIB’s Integrated Registration and Segmentation Tool


FMRIB software library


Fahn-Tolosa-Marin Tremor Rating Scale


Family-wise error


Gray matter


Healthy subjects


Mean diffusivity


Montreal Cognitive Assessment


Magnetic resonance imaging


Radial diffusivity


Statistic parametric mapping version 12


Spatially unbiased infratentorial toolbox


Tract-based spatial statistics


Time echo


Total intracranial volume


Repetition time


Voxel-based morphometry


White matter



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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Case-control study

• Performed at one institution

Supplementary material

330_2019_6267_MOESM1_ESM.docx (43 kb)
ESM 1 (DOCX 43 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Sara Pietracupa
    • 1
  • Matteo Bologna
    • 1
    • 2
  • Komal Bharti
    • 2
  • Gabriele Pasqua
    • 1
    • 3
  • Silvia Tommasin
    • 2
  • Francesca Elifani
    • 1
  • Giulia Paparella
    • 1
  • Nikolaos Petsas
    • 1
  • Giovanni Grillea
    • 1
  • Alfredo Berardelli
    • 1
    • 2
  • Patrizia Pantano
    • 1
    • 2
    Email author
  1. 1.IRCCS NeuromedPozzilli (IS)Italy
  2. 2.Department of Human NeurosciencesSapienza University of RomeRomeItaly
  3. 3.Department of Medicine and Health ScienceUniversity of MoliseCampobassoItaly

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