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Clinical Heterogeneity of Essential Tremor: Understanding Neural Substrates of Action Tremor Subtypes

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Abstract

Essential tremor (ET) is a common movement disorder affecting millions of people. Studies of ET patients and perturbations in animal models have provided a foundation for the neural networks involved in its pathophysiology. However, ET encompasses a wide variability of phenotypic expression, and this may be the consequence of dysfunction in distinct subcircuits in the brain. The cerebello-thalamo-cortical circuit is a common substrate for the multiple subtypes of action tremor. Within the cerebellum, three sets of cerebellar cortex-deep cerebellar nuclei connections are important for tremor. The lateral hemispheres and dentate nuclei may be involved in intention, postural and isometric tremor. The intermediate zone and interposed nuclei could be involved in intention tremor. The vermis and fastigial nuclei could be involved in head and proximal upper extremity tremor. Studying distinct cerebellar circuitry will provide important framework for understanding the clinical heterogeneity of ET.

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Funding

This work was supported by National Institutes of Health R01NS104423, R01NS118179, R01NS124854.

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  1. Department of Neurology, Columbia University, New York, NY, 10032, USA

    Alexander Fanning & Sheng-Han Kuo

  2. Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA

    Alexander Fanning & Sheng-Han Kuo

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Conceptualization: AF; Formal analysis and investigation: AF and SK; Resources: SK; Writing - Original Draft: AF; Writing - Review & Editing: AF and SK; Funding Acquisition: SK; Supervision: SK.

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Fanning, A., Kuo, SH. Clinical Heterogeneity of Essential Tremor: Understanding Neural Substrates of Action Tremor Subtypes. Cerebellum (2023). https://doi.org/10.1007/s12311-023-01551-3

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