The Cerebellum

, Volume 8, Issue 3, pp 389–398 | Cite as

Balance and Motor Speech Impairment in Essential Tremor

  • Martin Kronenbuerger
  • Jürgen Konczak
  • Wolfram Ziegler
  • Paul Buderath
  • Benedikt Frank
  • Volker A. Coenen
  • Karl Kiening
  • Peter Reinacher
  • Johannes Noth
  • Dagmar Timmann


The pathogenesis of essential tremor (ET) is still under debate. Several lines of evidence indicate that ET is associated with cerebellar dysfunction. The aim of the present study was to find corroborating evidence for this claim by investigating balance and speech impairments in patients with ET. In addition, the effect of deep brain stimulation (DBS) on balance and speech function was studied. A group of 25 ET patients including 18 with postural and/or simple kinetic tremor (ETpt) and seven ET patients with additional clinical signs of cerebellar dysfunction (ETc) was compared to 25 healthy controls. In addition, 12 ET patients with thalamic DBS participated in the study. Balance control was assessed during gait and stance including tandem gait performed on a treadmill as well as static and dynamic posturography. Motor speech control was analyzed through syllable repetition tasks. Signs of balance impairment were found in early stages and advanced stages of ET. During locomotion, ET patients exhibited an increased number of missteps and shortened stride length with tandem gait. ETc patients and, to a lesser extent, ETpt patients had increased postural instability in dynamic posturography conditions that are sensitive to vestibular or vestibulocerebellar dysfunction. ETc but not ETpt patients exhibited significantly increased syllable durations. DBS had no discernable effect on speech performance or balance control. We conclude that the deficits in balance as well as the subclinical signs of dysarthria in a subset of patients confirm and extend previous findings that ET is associated with an impairment of the cerebellum.


Cerebellum Posturography Gait Dysarthria Deep brain stimulation 



The authors wish to thank Beate Brol for technical support. This study was supported by a research grant to M. K. from the Medical Faculty, University Hospital Aachen, RWTH Aachen, Germany.

Supplementary material

12311_2009_111_MOESM1_ESM.doc (40 kb)
Table (Electronic Supplementary Material) Body dimensions of the participants (DOC 40 kb)


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Martin Kronenbuerger
    • 1
  • Jürgen Konczak
    • 2
  • Wolfram Ziegler
    • 3
  • Paul Buderath
    • 4
  • Benedikt Frank
    • 4
  • Volker A. Coenen
    • 5
  • Karl Kiening
    • 6
  • Peter Reinacher
    • 7
  • Johannes Noth
    • 1
  • Dagmar Timmann
    • 4
  1. 1.Department of NeurologyUniversity Hospital Aachen, RWTH AachenAachenGermany
  2. 2.Human Sensorimotor Control LaboratoryUniversity of MinnesotaMinneapolisUSA
  3. 3.Clinical Neuropsychology Research Group, Clinic for NeuropsychologyBogenhausen City Clinic München GmbHMunichGermany
  4. 4.Department of NeurologyUniversity of Duisburg-EssenEssenGermany
  5. 5.Section of Stereotaxy and Magnetic Resonance Imaging Based Neurosurgery, Department of NeurosurgeryUniversity Hospital BonnBonnGermany
  6. 6.Department of NeurosurgeryUniversity Hospital HeidelbergHeidelbergGermany
  7. 7.Department of NeurosurgeryUniversity Hospital Aachen, RWTH AachenAachenGermany

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