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Characteristics of Tremor Induced by Lesions of the Cerebellum

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Abstract

It is a clinical experience that acute lesions of the cerebellum induce pathological tremor, which tends to improve. However, quantitative characteristics, imaging correlates, and recovery of cerebellar tremor have not been systematically investigated. We studied the prevalence, quantitative parameters measured with biaxial accelerometry, and recovery of pathological tremor in 68 patients with lesions affecting the cerebellum. We also investigated the correlation between the occurrence and characteristics of tremor and lesion localization using 3D T1-weighted MRI images which were normalized and segmented according to a spatially unbiased atlas template for the cerebellum. Visual assessment detected pathological tremor in 19% while accelerometry in 47% of the patients. Tremor was present both in postural and intentional positions, but never at rest. Two types of pathological tremor were distinguished: (1) low-frequency tremor in 36.76% of patients (center frequency 2.66 ± 1.17 Hz) and (2) normal frequency–high-intensity tremor in 10.29% (center frequency 8.79 ± 1.43 Hz). The size of the lesion did not correlate with the presence or severity of tremor. Involvement of the anterior lobe and lobule VI was related to high tremor intensity. In all followed up patients with acute cerebellar ischemia, the tremor completely recovered within 8 weeks. Our results indicate that cerebellar lesions might induce pathological postural and intentional tremor of 2–3 Hz frequency. Due to its low frequency and low amplitude, quantitative tremorometry is neccessary to properly identify it. There is no tight correlation between lesion localization and quantitative characteristics of cerebellar tremor.

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Acknowledgements

We are grateful to our patients and to our colleagues of the National Institute of Clinical Neurosciences who were involved in patient management. We aknowledge the contribution of Gréta Zaja to data processing. We thank Dr. András Horváth for his valuable comments on the manuscript.

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Authors and Affiliations

  1. Department of Neurology, National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, 1145, Hungary

    Andrea Kovács & Anita Kamondi

  2. János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Üllői út 26., Budapest, 1085, Hungary

    Andrea Kovács

  3. Department of Neuroradiology, National Institute of Clinical Neurosciences, Budapest, Hungary

    Máté Kiss

  4. Department of Neuroimaging Research, Dent Neurologic Institute, Amherst, NY, USA

    Nándor Pintér

  5. Department of Neurology, Semmelweis University, Budapest, Hungary

    Imre Szirmai & Anita Kamondi

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  1. Andrea Kovács
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Correspondence to Anita Kamondi.

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Supplementary Figure 1.

The relation of center and peak frequency in controls and in patients with physiologic and pathological tremor. a. Box-plot illustration of center frequency and peak frequency in the three groups in postural position. Data of 68 patients and 30 controls are summarized. Center frequency does not differ between controls and patients with physiologic tremor, however in patients with pathological tremor, it is decreased, and it is almost identical to the low peak frequency of this cohort. b. Bimodal power spectra of a control subject with physiologic tremor, showing center frequency (black) and peak frequency (red). Power spectra of patients with physiologic tremor showed the same pattern. c. Unimodal power spectra of patient 24MJ with pathological tremor, showing overlapping center frequency (black) and peak frequency (red). (PNG 446 kb)

High Resolution Image (TIF 302 kb)

Supplementary Figure 2.

Power spectra presenting gradual increase of center frequency and frequency dispersion of cerebellar tremor as sign of recovery after acute ischemic cerebellar lesion. a. Power spectrum of postural tremor in a patient 4 days after he suffered acute cerebellar stroke. Center frequency and peak frequency were almost the same (CF=2.6 Hz, PF=2.51 Hz), while frequency dispersion was remarkably low (FD=0.19 Hz); b. By day 10, center frequency became higher and it was clearly distinguishable from the peak frequency (CF=2.9 Hz, PF=2.19 Hz). The proportion of higher frequencies in the power spectrum increased which was demonstrated by the elevated frequency dispersion (FD=2.02 Hz); c. By day 21 both the center frequency (CF=5.7 Hz) and the frequency dispersion (FD=3.47 Hz) became normal. The peak frequency did not change (PF=2.19 Hz). Red line: peak frequency; Continuous black line: center frequency; Dashed line; lower and upper values of frequency dispersion. (PNG 548 kb)

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Kovács, A., Kiss, M., Pintér, N. et al. Characteristics of Tremor Induced by Lesions of the Cerebellum. Cerebellum 18, 705–720 (2019). https://doi.org/10.1007/s12311-019-01027-3

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