Shaking hands: establishing objective parameters to differentiate between essential tremor and Parkinson's disease

Frauke Luft

    Research output: ThesisPhD Thesis - Research UT, graduation UT

    180 Downloads (Pure)


    In 1817, James Parkinson was the first physician to publish his observations about the shaking palsy (later: Parkinson’s disease (PD)) and its differences compared to other tremulous disorders [1]. Nowadays, more than 200 years later, a lot more is known about neurodegenerative disorders. However, the exact pathophysiology is yet unknown. Furthermore, differentiation from other tremulous movement disorders, such as essential tremor (ET)], remains difficult due to overlapping symptoms such as tremor or timing deficits during voluntary movement and common diagnostic tools are often either invasive, time consuming, subjective, expensive and/or not widely available.
    Therefore, in my research I focused on finding objective parameters to differentiate PD from ET that can be measured with commonly available tools. For this purpose we simultaneously measured movement of the hands, using accelerometers, and brain activity using EEG and functional MRI to:
    1. quantify tremor occurrence and identifying corresponding cortical activity.
    2. quantify timing deficits during voluntary movement and identifying corresponding neuronal networks.
    Analyzing cortical activity during tremor revealed cortical involvement in tremor occurrence during rest in PD but not ET. A postural task revealed involvement of the associate and primary visual cortex in ET suggesting that these patients rely on visual guidance for maintaining a posture during tremor. To analyze timing deficits in ET and PD, subjects were asked to perform a bimanual motor task with an without an external cue. In both patient groups areas of motor planning, movement initiation, maintenance and coordination were active. However, activation of additional areas was found in both patient groups.
    From the results we can conclude that objective differentiation between ET and PD might be possible in the future using only commonly available tools. However, there is still a lot of work that needs to be done.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Twente
    • Veltink, Peter H., Supervisor
    • Heida, Tjitske, Co-Supervisor
    Award date25 Mar 2020
    Place of PublicationEnschede
    Print ISBNs978-90-365-4975-2
    Publication statusPublished - 25 Mar 2020


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