Differentiation of tremor disorders with fMRI: A novel quantitative approach

S. Sharifi, W. Mugge, F. Luft, A.C. Schouten, T.H. Heida, L.J. Bour, A.F. van Rootselaar

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    Objective: To develop fMRI-based tools in tremor diagnostics and to demonstrate their clinical applicability. Background: Due to overlapping features of tremor disorders, clinical diagnostic tools are limited. Although seldomly used in diagnostic assessment of tremor, fMRI of pathological brain networks underlying tremor could aid accurate and early diagnosis. fMRI of the closed loop behaviour of the sensorimotor system may manifest itself differently with different tremor disorders and has not been fully explored yet in diagnostics.

    Methods: Following a literature review that we performed on neuroimaging studies in essential tremor (ET), we developed a novel fMRI setup to investigate pathological brain networks related to tremor. An MR-compatible wrist manipulator, to perturb the sensorimotor loop, is combined with movement measures.

    Results: Our review showed that current findings are consistent with the hypothesis that the cerebellothalamo-cortical network is involved in ET with a major role for the cerebellum. To date, imaging techniques roughly are divided into structural (n=11) and functional methods (n=24). Limitations include heterogeneity of ET symptoms, spatial resolution and inability to directly relate tremor to functional images. The typical nature of a sensorimotor loop is generally not taken into account. We have developed a high-end novel experimental setup within the MR-environment including artifact-free movement measures (EMG, accelerometry) and a MR-compatible wrist manipulator to apply perturbations. Perturbations applied close to pathological tremor frequencies provide sensory input in passive conditions and manipulate motor action in active conditions.

    Conclusions: We introduce a multimodal fMRI set-up manipulating the sensorimotor loop to identify faulty brain circuitries. This system can potentially lead to a novel quantitative diagnostic tool for differentiating tremor and other movement disorders.
    Original languageEnglish
    Pages (from-to)157
    Number of pages1
    JournalMovement disorders
    Issue numberSuppl. 1
    Publication statusPublished - 2013


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