title: A preliminary study of the neuroanatomical correlates of primary writing tremor: role of cerebellum.
abstract: BACKGROUND
  To explore the neuroanatomical correlates of primary writing tremor (PWT) and the role of cerebellum, using advanced structural neuroimaging. Till date, there are no studies exploring the gray and white matter changes using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) in PWT.
  
  
  METHODS
  Ten male patients with PWT were evaluated clinically and with magnetic resonance imaging. VBM and DTI images of patients were compared with that of 10 healthy male subjects. Spatially unbiased infra-tentorial template (SUIT) analysis was done to investigate the alterations of cerebellar gray matter. Region-of-interest analysis was performed on regions observed to be significantly different on DTI analysis.
  
  
  RESULTS
  The mean duration of illness and mean age of the patients were 3.5 ± 1.9 and 51.7 ± 8.6 years, respectively. On VBM analysis, the cluster of gray matter atrophy was found in bilateral cerebellar areas of culmen and left declive, right superior and medial frontal gyrus, bilateral middle frontal gyrus, bilateral anterior cingulate gyrus, and bilateral parahippocampal gyrus. DTI showed significantly reduced fractional anisotrophy of the anterior thalamic radiation, cingulum, and inferior fronto-occipital fasciculus in PWT patients compared to controls. The axial diffusivity, mean diffusivity, and radial diffusivity maps did not reveal any significant differences. On SUIT analysis, significant atrophy was found in right uvula and semilunar lobule in patients with PWT compared to controls.
  
  
  CONCLUSIONS
  Our study found that patients with PWT had predominant gray matter atrophy in parts of cerebellum and frontal lobe along with white matter changes of the cingulum and frontal lobe connections.
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.|Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India.
authors.forename: Ketan
authors.initials: K
authors.lastname: Jhunjhunwala
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.
authors.forename: Lija
authors.initials: L
authors.lastname: George
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.
authors.forename: Raviteja
authors.initials: R
authors.lastname: Kotikalapudi
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.
authors.forename: Pradeep Kumar
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.|Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Lenka
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.|Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India.
authors.forename: Albert
authors.initials: A
authors.lastname: Stezin
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.
authors.forename: Rajini M
authors.initials: RM
authors.lastname: Naduthota
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Departments of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India.
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Departments of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India.
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India. palpramod@hotmail.com.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Pal
mesh_terms: D000328:Adult; D001284:Atrophy / Q000000981:diagnostic imaging / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D020821:Dystonic Disorders / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology*; D006236:Handwriting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014202:Tremor / Q000000981:diagnostic imaging / Q000473:pathology*; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: DTI; Primary writing tremor; SUIT; VBM