title: Balance and motor speech impairment in essential tremor.
abstract: The pathogenesis of essential tremor (ET) is still under debate. Several lines of evidence indicate that ET is associated with cerebellar dysfunction. The aim of the present study was to find corroborating evidence for this claim by investigating balance and speech impairments in patients with ET. In addition, the effect of deep brain stimulation (DBS) on balance and speech function was studied. A group of 25 ET patients including 18 with postural and/or simple kinetic tremor (ETpt) and seven ET patients with additional clinical signs of cerebellar dysfunction (ETc) was compared to 25 healthy controls. In addition, 12 ET patients with thalamic DBS participated in the study. Balance control was assessed during gait and stance including tandem gait performed on a treadmill as well as static and dynamic posturography. Motor speech control was analyzed through syllable repetition tasks. Signs of balance impairment were found in early stages and advanced stages of ET. During locomotion, ET patients exhibited an increased number of missteps and shortened stride length with tandem gait. ETc patients and, to a lesser extent, ETpt patients had increased postural instability in dynamic posturography conditions that are sensitive to vestibular or vestibulocerebellar dysfunction. ETc but not ETpt patients exhibited significantly increased syllable durations. DBS had no discernable effect on speech performance or balance control. We conclude that the deficits in balance as well as the subclinical signs of dysarthria in a subset of patients confirm and extend previous findings that ET is associated with an impairment of the cerebellum.
authors.affiliation: Department of Neurology, University Hospital Aachen, RWTH Aachen, Aachen 52074, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kronenbuerger
authors.forename: Jürgen
authors.initials: J
authors.lastname: Konczak
authors.forename: Wolfram
authors.initials: W
authors.lastname: Ziegler
authors.forename: Paul
authors.initials: P
authors.lastname: Buderath
authors.forename: Benedikt
authors.initials: B
authors.lastname: Frank
authors.forename: Volker A
authors.initials: VA
authors.lastname: Coenen
authors.forename: Karl
authors.initials: K
authors.lastname: Kiening
authors.forename: Peter
authors.initials: P
authors.lastname: Reinacher
authors.forename: Johannes
authors.initials: J
authors.lastname: Noth
authors.forename: Dagmar
authors.initials: D
authors.lastname: Timmann
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002531:Cerebellum / Q000503:physiopathology*; D046690:Deep Brain Stimulation / Q000379:methods*; D020329:Essential Tremor / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007807:Language Tests; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D013064:Speech Disorders / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D013223:Statistics as Topic; D055815:Young Adult