Objective: In this pilot exploratory study, we aimed to search possible related brain microstructural changes of sleep disturbances (SD) in essential tremor  (ET) patients.

Background: ET is complex, neurodegenerative, family of disorder which includes many motor and non motor symptoms. SD have defined as non motor symptom of ET. But underlying neuropathology of SD is still unknown.

Method: 33 ET patients were recruited for the study. Consensus Statement on the classification of tremors from the task force on tremor of the International Parkinson and Movement Disorder Society (2018) ET criteria were applied. Fahn Tolosa Marin tremor rating scale (FTM-TRS) was used to evaluate the severity of the disease. SD was evaluated by Pittsburg sleep quality index (PSQI).A total score of ≥ 5 indicates a ‘poor’ sleeper.  Microstructural brain changes were evaluated using diffusion tensor imaging (DTI), which was reported using fractional anisotropy (FA), mean diffusivity (MD), apparent diffusion coefficient (ADC), radial diffusivity (RD), and axial diffusivity (AD) values. DTI findings were compared between patients reporting SD and patients not reporting SD using independent sample t-tests (Mann-Whitney U tests were used for non normally distributed samples). Due to the exploratory nature of these analyses, between group differences were considered to be significant at p ≤ 0.05 (uncorrected).

Results: The mean age was 52.15 ± 19.12 years, there were 10 (30.3%) men and 23 (69.7%) women in our study group. The mean duration of tremor was12.14 ± 9.64 years. The mean PSQI score was 5.76 ± 4.04. According to PSQI scores,13 patients had SD. The mean score of patients reporting SD was 9.77 ± 3.47 vs. the mean score of patients not reporting SD 3.15 ± 1.31. Right red nucleus FA (p = 0.02), AD (p<0.01) and right superior cerebellar peduncle ADC (p= 0.04), AD (p<0.01), MD (p= 0.04) values were differed between groups.

Conclusion: In our study we found microstructural changes of superior cerebellar peduncle and red nucleus in patient with SD. Superior cerebellar (from the dentate and interposed nuclei) projections enter the red nucleus. Participation of the cerebellum in the regulation of the sleep-wakefulness cycle through the superior cerebellar peduncle has long been known. This was a pilot study and more research must be done to support these evidence.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sleep-disturbances-in-essential-tremor-a-pilot-investigation-of-the-related-brain-microstructural-changes-using-diffusion-tensor-imaging/