Essential tremor (ET), clinically characterized by postural and kinetic tremors, predominantly in the upper extremities, originates from pathological activity in the dynamic oscillatory network comprising the majority of nodes in the central motor network. Evidence indicates dysfunction in the thalamus, the olivocerebellar loops, and intermittent cortical engagement. Pathology of the cerebellum, a structure with architecture intrinsically predisposed to oscillatory activity, has also been implicated in ET as shown by clinical, neuroimaging, and pathological studies. Despite electrophysiological studies assessing cerebellar impairment in ET being scarce, their impact is tangible, as summarized in this review. The electromyography-magnetoencephalography combination provided the first direct evidence of pathological alteration in cortico-subcortical communication, with a significant emphasis on the cerebellum. Furthermore, complex electromyography studies showed disruptions in the timing of agonist and antagonist muscle activation, a process generally attributed to the cerebellum. Evidence pointing to cerebellar engagement in ET has also been found in electrooculography measurements, cerebellar repetitive transcranial magnetic stimulation studies, and, indirectly, in complex analyses of the activity of the ventral intermediate thalamic nucleus (an area primarily receiving inputs from the cerebellum), which is also used in the advanced treatment of ET. In summary, further progress in therapy will require comprehensive electrophysiological and physiological analyses to elucidate the precise mechanisms leading to disease symptoms. The cerebellum, as a major node of this dynamic oscillatory network, requires further study to aid this endeavor.

1st Department of Neurology Faculty of Medicine Masaryk University and St Anne's Teaching Hospital Pekařská 53 656 91 Brno Czech Republic

Central European Institute of Technology CEITEC MU Behavioral and Social Neuroscience Research Group Masaryk University Brno Czech Republic

Department of Neurology School of Medicine University of Minnesota Minneapolis MN USA

Department of Psychiatry Université de Montréal Montréal Québec Canada

FNRS ULB Hôpital Erasme Brussels Belgium

Functional Neuroimaging Unit Research Center of the Geriatric Institute Affiliated with the Université de Montréal Montréal Québec Canada

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