Objective:

Our hypothesis was that regional differences in cerebellar gray matter (GM) density may better distinguish essential tremor (ET) cases from controls. 

Background: The pathophysiological basis for ET remains unclear, although evidence increasingly links it to a disordered and perhaps degenerative cerebellum. Prior imaging studies have treated the cerebellum en bloc.

Methods:

Forty ET cases and twenty-five control subjects were imaged using magnetic resonance imaging (MRI).  The cerebellum was segmented into 34 lobes using a Spatially Unbiased Infra-Tentorial Template (SUIT) atlas within the Statistical Parametric Mapping (SPM) analysis package. Age, gender and Montreal Cognitive Assessment (MoCA) scores were regressed out from the statistical models to isolate group effects.  ET subjects were further stratified into phenotypically-defined subgroups. 

Results: When ET cases and controls were compared, there were marginal differences in three lobules: left VIIIa, left VIIIb, and Vermis VIIb. When compared with controls, ET cases with head or jaw tremor had changes in GM density in left and right VIIb, left VIIIA, right IX and Vermis VIIb cerebellar lobules (p= 0.004 – 0.015).  ET cases with voice tremor exhibited changes in the left and right IX and Vermis VIIb and Vermis IX lobules (p= 0.003 – 0.038).  ET cases with severe tremor showed changes in the Left V and Vermis VIIb regions compared to controls.

Conclusions:

We showed that ET cases with various forms of cranial tremor as well as those with more severe tremor differed from controls with respect to cerebellar %GM density, with evidence of GM reduction across several cerebellar regions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gray-matter-density-in-essential-tremor-a-lobule-by-lobule-analysis-of-the-cerebellum/