BACKGROUND: An evolving pathophysiological concept of essential tremor (ET) points to diffuse brain network involvement, which emphasizes the need to investigate white matter (WM) changes associated with motor symptoms of ET. OBJECTIVES: To investigate ET-related WM changes and WM correlates of tremor severity using tremor clinical rating scales and accelerometry. METHODS: Tract-based spatial statistics (TBSS) approach was utilized to compare 3 Tesla diffusion tensor imaging (DTI) data from 12 ET patients and 10 age- and gender-matched healthy individuals. Clinical scales, tremor frequency and amplitude as measured by accelerometry were correlated with DTI data. RESULTS: ET patients demonstrated mean (MD) and radial diffusivity (RD) abnormalities in tracts involved in primary and associative motor functions such as bilateral corticospinal tracts, the superior longitudinal fascicles, and the corpus callosum but also in nonmotor regions including the inferior fronto-occipital and longitudinal fascicles, cingulum bundles, anterior thalamic radiations, and uncinate fascicles. A combined tremor frequency and amplitude score correlated with RD and MD in extensive WM areas, which partially overlapped the regions that were associated with tremor frequency. No significant relationship was found between DTI measures and clinical rating scales scores. CONCLUSIONS: The results show that ET-related diffusion WM changes and their correlates with tremor severity are preferentially located in the primary and associative motor areas. In contrast, a relationship between WM was not detected with clinical rating scales. Accelerometry parameters may, therefore, serve as a potentially useful clinical measures that relate to WM deficits in ET.

Department of Medicine 3 Clinical Division of Endocrinology and Metabolism Medical University of Vienna Vienna Austria

Department of Neurology University of Minnesota Minneapolis Minnesota

Department of Psychiatry University of Minnesota Minneapolis Minnesota

Department of Radiology Center for Magnetic Resonance Research University of Minnesota Minneapolis Minnesota

Division of Biostatistics University of Minnesota Minneapolis Minnesota

Division of Clinical Behavioral Neuroscience Department of Pediatrics University of Minnesota Minneapolis Minnesota

High Field MR Centre Department of Biomedical Imaging and Image guided Therapy Medical University of Vienna Vienna Austria

Minnesota Supercomputing Institute University of Minnesota Minneapolis Minnesota

Multimodal and Functional Neuroimaging Research Group Central European Institute of Technology Masaryk University Brno Czech Republic

Neurology Service Veterans Affairs Medical Center Minneapolis Minnesota

Psychology Department Sun Yet Sen University Guangzhou Guangdong China

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