Quantification and Modulation of Tremor in Rapid Upper Limb Movements

Abstract

Tremor is a manifestation of a variety of human neurodegenerative diseases, notably Parkinson’s disease (PD), a chronic disease that affects one in 100 people over age 60 years. Recent research indicates that more than five million worldwide have PD. This disease is primarily caused by a progressive loss of dopamine neurons in the nigrostriatal system that leads to widespread motor symptoms such as bradykinesia, rigidity, tremor and postural instability. Although the diagnosis of PD remains clinical, advances in functional and structural imaging have improved the ability to differentiate between PD and Essential Tremor (ET), as well as between different akinetic-rigid syndromes. No definitive test or biomarker is available for PD, so the rate of misdiagnosis is relatively high. It is therefore crucial to be able to characterize tremor in PD and ET as it is a very common feature at the onset of both diseases. This is made possible with a combination of a neuroscientific and methodological multi-modal imaging approaches, namely kinetic recording methods using accelerometers to quantify tremor amplitude and frequency and functional magnetic resonance imaging (fMRI). These allow the identification of the neural underpinnings of tremor in both PD and ET patients, which in fact have been surprisingly difficult to decipher. In this work we aim to find which tasks involving upper limb movements are suitable to modulate both PD and ET tremor. The same tasks are considered with and without added loading. The resulting analysis will allow designing an efficient fMRI protocol aiming at the identification of the cortical circuits responsible for the modulation of tremor.