Buijink A W G, Broersma M, van der Stouwe A M M, van Wingen G A, Groot P F C, Speelman J D, Maurits N M, van Rootselaar A F
Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Parkinsonism Relat Disord. 2015 Apr;21(4):383-8. doi: 10.1016/j.parkreldis.2015.02.003. Epub 2015 Feb 11.
Cerebellar circuits are hypothesized to play a central role in the pathogenesis of essential tremor. Rhythmic finger tapping is known to strongly engage the cerebellar motor circuitry. We characterize cerebellar and, more specifically, dentate nucleus function, and neural correlates of cerebellar output in essential tremor during rhythmic finger tapping employing functional MRI.
Thirty-one propranolol-sensitive essential tremor patients with upper limb tremor and 29 healthy controls were measured. T2*-weighted EPI sequences were acquired. The task consisted of alternating rest and finger tapping blocks. A whole-brain and region-of-interest analysis was performed, the latter focusing on the cerebellar cortex, dentate nucleus and inferior olive nucleus. Activations were also related to tremor severity.
In patients, dentate activation correlated positively with tremor severity as measured by the tremor rating scale part A. Patients had reduced activation in widespread cerebellar cortical regions, and additionally in the inferior olive nucleus, and parietal and frontal cortex, compared to controls.
The increase in dentate activation with tremor severity supports involvement of the dentate nucleus in essential tremor. Cortical and cerebellar changes during a motor timing task in essential tremor might point to widespread changes in cerebellar output in essential tremor.
小脑回路被认为在特发性震颤的发病机制中起核心作用。已知有节奏的手指敲击会强烈激活小脑运动回路。我们利用功能磁共振成像（functional MRI），在有节奏的手指敲击过程中，对特发性震颤患者的小脑，更具体地说是齿状核功能，以及小脑输出的神经关联进行了特征描述。
对31名患有上肢震颤的普萘洛尔敏感型特发性震颤患者和29名健康对照者进行了测量。采集了T2*加权回波平面成像（EPI）序列。任务包括交替的休息和手指敲击组块。进行了全脑和感兴趣区域分析，后者聚焦于小脑皮质、齿状核和下橄榄核。激活情况也与震颤严重程度相关。
在患者中，齿状核激活与震颤严重程度呈正相关，震颤严重程度通过震颤评定量表A部分进行测量。与对照组相比，患者在广泛的小脑皮质区域，以及额外在下橄榄核、顶叶和额叶皮质的激活减少。
齿状核激活随震颤严重程度增加，支持齿状核参与特发性震颤。特发性震颤患者在运动定时任务期间的皮质和小脑变化，可能表明特发性震颤中小脑输出存在广泛变化。
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