title: Essential head tremor is associated with cerebellar vermis atrophy: a volumetric and voxel-based morphometry MR imaging study.
abstract: OBJECTIVE
  Our aim was to investigate the presence of brain gray matter (GM) abnormalities in patients with different forms of essential tremor (ET).
  
  
  METHODS
  We used optimized voxel-based morphometry (VBM) and manually traced single region-of-interest analysis in 50 patients with familial ET and in 32 healthy subjects. Thirty patients with ET had tremor of the arms (a-ET), whereas the remaining 20 patients had both arm and head tremor (h-ET).
  
  
  RESULTS
  VBM showed marked atrophy of the cerebellar vermis in the patients with h-ET with respect to healthy subjects (P(corrected) < .001). Patients with a-ET showed a trend toward a vermal GM volume loss that did not reach a significant difference with respect to healthy controls (P(uncorrected) < .01). The region-of-interest analysis showed a reduction of the cerebellar volume (CV) in the h-ET group (98.2 +/- 13.6 mm(3)) compared with healthy controls (110.5 +/- 15.5 mm(3), P < .012) as well as in the entire vermal area (790.3 +/- 94.5 mm(2), 898.6 +/- 170.6 mm(2), P < .04 in h-ET and control groups, respectively).
  
  
  CONCLUSIONS
  Atrophy of the cerebellar vermis detected in patients with h-ET strongly supports the evidence for the involvement of the cerebellum in the pathophysiology of ET. The lack of a significant CV loss observed in patients with a-ET suggests that a-ET and h-ET might represent distinct subtypes of the same disease.
authors.affiliation: Institute of Neurological Sciences, National Research Council, Piano Lago di Mangone, Cosenza, Italy. a.quattrone@isn.cnr.it
authors.forename: A
authors.initials: A
authors.lastname: Quattrone
authors.forename: A
authors.initials: A
authors.lastname: Cerasa
authors.forename: D
authors.initials: D
authors.lastname: Messina
authors.forename: G
authors.initials: G
authors.lastname: Nicoletti
authors.forename: G E
authors.initials: GE
authors.lastname: Hagberg
authors.forename: L
authors.initials: L
authors.lastname: Lemieux
authors.forename: F
authors.initials: F
authors.lastname: Novellino
authors.forename: P
authors.initials: P
authors.lastname: Lanza
authors.forename: G
authors.initials: G
authors.lastname: Arabia
authors.forename: M
authors.initials: M
authors.lastname: Salsone
mesh_terms: D000368:Aged; D001132:Arm / Q000294:innervation; D001284:Atrophy; D001921:Brain / Q000473:pathology; D002531:Cerebellum / Q000473:pathology*; D020329:Essential Tremor / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D006257:Head / Q000294:innervation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009929:Organ Size