Network-level connectivity is a critical feature distinguishing dystonic tremor and essential tremor

Abstract

Dystonia is a movement disorder characterized by involuntary muscle co-contractions that give rise to disabling movements and postures. A recent expert consensus labelled the incidence of tremor as a core feature of dystonia that can affect body regions both symptomatic and asymptomatic to dystonic features. We are only beginning to understand the neural network-level signatures that relate to clinical features of dystonic tremor. At the same time, clinical features of dystonic tremor can resemble that of essential tremor and present a diagnostic confound for clinicians. Here, we examined network-level functional activation and connectivity in patients with dystonic tremor and essential tremor. The dystonic tremor group included primarily cervical dystonia patients with dystonic head tremor and the majority had additional upper-limb tremor. The experimental paradigm included a precision grip-force task wherein online visual feedback related to force was manipulated across high and low spatial feedback levels. Prior work using this paradigm in essential tremor patients produced exacerbation of grip-force tremor and associated changes in functional activation. As such, we directly compared the effect of visual feedback on grip-force tremor and associated functional network-level activation and connectivity between dystonic tremor and essential tremor patient cohorts to better understand disease-specific mechanisms. Increased visual feedback similarly exacerbated force tremor during the grip-force task in dystonic tremor and essential tremor cohorts. Patients with dystonic tremor and essential tremor were characterized by distinct functional activation abnormalities in cortical regions but not in the cerebellum. We examined seed-based functional connectivity from the sensorimotor cortex, globus pallidus internus, ventral intermediate thalamic nucleus, and dentate nucleus, and observed abnormal functional connectivity networks in dystonic tremor and essential tremor groups relative to controls. However, the effects were far more widespread in the dystonic tremor group as changes in functional connectivity were revealed across cortical, subcortical, and cerebellar regions independent of the seed location. A unique pattern for dystonic tremor included widespread reductions in functional connectivity compared to essential tremor within higher-level cortical, basal ganglia, and cerebellar regions. Importantly, a receiver operating characteristic determined that functional connectivity z-scores were able to classify dystonic tremor and essential tremor with 89% area under the curve, whereas combining functional connectivity with force tremor yielded 94%. These findings point to network-level connectivity as an important feature that differs substantially between dystonic tremor and essential tremor and should be further explored in implementing appropriate diagnostic and therapeutic strategies.

Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor

“…In a recent fMRI study, both patients with DT and patients with ET showed common cerebellar impairment, although patients with DT demonstrated significantly more widespread abnormalities in functional connectivity. 40 Our findings of a comparable tremor control with VIM DBS in DT and ET may support the hypothesis that dysfunction in the cerebello-thalamo-cortical pathway plays a key role in tremor occurrence in both DT and ET. However, the current spread into the adjacent structures, especially the Voa/Vop nuclei, might also contribute to control of tremor and dystonia.…”

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

“…A recent study used functional connectivity data to create profiles to characterize network‐level differences between patients with dystonia and dystonic tremor (DT), ET, and healthy patients . Tasked‐based BOLD fMRI data were acquired during a force‐grip task with low and high degrees of visual feedback.…”

Olfaction as a Marker for Dystonia: Background, Current State and Directions

“…Moreover, a recent review suggests that up to 12% of the subjects with primary dystonia have rest tremor, with most of them having multifocal and segmental dystonia [ 120 ]. Although the two types of tremor are different with regard to when they are present (rest vs. action), both are related to altered activity within a network including the basal ganglia, cerebellum, and sensorimotor cortex, as suggested by functional imaging studies [ 120 , 121 , 122 ].…”