Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia.
Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
J Neural Transm (Vienna). 2017 Dec;124(12):1509-1514. doi: 10.1007/s00702-017-1798-4. Epub 2017 Nov 2.
Tremor in people with multiple sclerosis (MS) is a frequent and debilitating symptom with a relatively poorly understood pathophysiology. To determine the relationship between clinical tremor severity and structural magnetic resonance imaging parameters. Eleven patients with clinically definite MS and right-sided upper limb tremor were studied. Tremor severity was assessed using the Bain score (overall severity, writing, and Archimedes spiral drawing). Cerebellar dysfunction was assessed using the Scale for the Assessment and Rating of Ataxia. Dystonia was assessed using the Global Dystonia Scale adapted for upper limb. For all subjects, volume was calculated for the thalamus from T1-weighted volumetric scans using Freesurfer. Superior cerebellar peduncle (SCP) cross-sectional areas were measured manually. The presence of lesions was visually determined and the lesion volumes were calculated by the lesion growth algorithm as implemented in the Lesion Segmentation Toolbox. Right thalamic volume negatively correlated with Bain tremor severity score (ρ = - 0.65, p = 0.03). Left thalamic volume negatively correlated with general Bain tremor severity score (ρ = - 0.65, p = 0.03) and the Bain writing score (ρ = - 0.65, p = 0.03). Right SCP area negatively correlated with Bain writing score (ρ = - 0.69, p = 0.02). Finally, Bain Archimedes score was significantly higher in patients with lesions in the contralateral thalamus. Whole brain lesion load showed no relationship with tremor severity. These results implicate degeneration of key structures within the cerebello-thalamic pathway as pathological substrates for tremor in MS patients.
多发性硬化症（MS）患者的震颤是一种常见且使人虚弱的症状，其病理生理学相对了解较少。为了确定临床震颤严重程度与结构磁共振成像参数之间的关系。研究了 11 例临床确诊的多发性硬化症和右侧上肢震颤患者。使用 Bain 评分（总体严重程度、书写和阿基米德螺旋绘图）评估震颤严重程度。使用共济失调评估量表评估小脑功能障碍。使用适应于上肢的全球肌张力障碍量表评估肌张力障碍。对于所有受试者，均使用 Freesurfer 从 T1 加权容积扫描中计算丘脑的体积。手动测量上小脑脚（SCP）的横截面积。通过 Lesion Segmentation Toolbox 中实现的病变生长算法，通过视觉确定病变的存在并计算病变体积。右侧丘脑体积与 Bain 震颤严重程度评分呈负相关（ρ=-0.65，p=0.03）。左侧丘脑体积与一般 Bain 震颤严重程度评分（ρ=-0.65，p=0.03）和 Bain 书写评分（ρ=-0.65，p=0.03）呈负相关。右侧 SCP 面积与 Bain 书写评分呈负相关（ρ=-0.69，p=0.02）。最后，Bain Archimedes 评分在对侧丘脑有病变的患者中明显更高。全脑病变负荷与震颤严重程度无关。这些结果表明，小脑-丘脑通路内关键结构的退化是 MS 患者震颤的病理基础。
