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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 6/2014

01-06-2014 | Movement Disorders (M Okun, Section Editor)

Understanding Essential Tremor: Progress on the Biological Front

Author: Elan D. Louis

Published in: Current Neurology and Neuroscience Reports | Issue 6/2014

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Abstract

For many years, little was written about the underlying biology of ET, despite its high prevalence. Discussions of disease mechanisms were dominated by a focus on tremor physiology. The traditional model of ET, the olivary model, was proposed in the 1970s. The model suffers from several critical problems, and its relevance to ET has been questioned. Recent mechanistic research has focused on the cerebellum. Clinical and neuroimaging studies strongly implicate the importance of this brain region in ET. Recent mechanistic research has been grounded more in tissue-based changes (i.e., postmortem studies of the brain). These studies have collectively and systematically identified a sizable number of changes in the ET cerebellum, and have led to a new model of ET, referred to as the cerebellar degenerative model. Hence, there is a renewed interest in the science behind the biology of ET. How the new understanding of ET will translate into treatment changes is an open question.
Literature
1.
Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord. 2010;25(5):534–41.PubMedCrossRef
2.
Benito-León J, Bermejo-Pareja F, Morales JM, Vega S, Molina JA. Prevalence of essential tremor in three elderly populations of central Spain. Mov Disord. 2003;18(4):389–94.PubMedCrossRef
3.
Hardesty DE, Maraganore DM, Matsumoto JY, Louis ED. Increased risk of head tremor in women with essential tremor: longitudinal data from the Rochester Epidemiology Project. Mov Disord. 2004;19(5):529–33.PubMedCrossRef
4.
Louis ED, Rios E, Applegate LM, Hernandez NC, Andrews HF. Jaw tremor: prevalence and clinical correlates in three essential tremor case samples. Mov Disord. 2006;21(11):1872–8.PubMedCrossRef
5.•
Gitchel GT, Wetzel PA, Baron MS. Slowed saccades and increased square wave jerks in essential tremor. Tremor Other Hyperkinet Mov (N Y). 2013;3.http://​tremorjournal.​org/​article/​view/​178. Sixty ET patients and 60 age-matched controls were studied using a video-based eye tracker to assess binocular eye position. Oculomotor function was assessed while subjects followed random horizontally and vertically step-displaced targets. In contrast to normally swift onset and efficient acceleration/deceleration movements, saccades in ET patients were characterized by abnormally prolonged latencies and slowed velocity profiles. This study demonstrated the presence of novel oculomotor deficits in patients with ET, which are distinct from the eye movement dysfunctions of other movement disorders. The findings support a role of cerebellar dysfunction in disease pathogenesis.
6.
7.
Kronenbuerger M, Konczak J, Ziegler W, et al. Balance and motor speech impairment in essential tremor. Cerebellum. 2009;8(3):389–98.PubMedCrossRef
8.
Putzke JD, Whaley NR, Baba Y, Wszolek ZK, Uitti RJ. Essential tremor: predictors of disease progression in a clinical cohort. J Neurol Neurosurg Psychiatry. 2006;77(11):1235–7.PubMedCentralPubMedCrossRef
9.
Louis ED, Agnew A, Gillman A, Gerbin M, Viner AS. Estimating annual rate of decline: prospective, longitudinal data on arm tremor severity in two groups of essential tremor cases. J Neurol Neurosurg Psychiatry. 2011;82(7):761–5.PubMedCentralPubMedCrossRef
10.
Louis ED, Ford B, Frucht S, Barnes LF, X-Tang M, Ottman R. Risk of tremor and impairment from tremor in relatives of patients with essential tremor: a community-based family study. Ann Neurol. 2001;49(6):761–9.PubMedCrossRef
11.
Louis ED, Gerbin M, Galecki M. Essential tremor 10, 20, 30, 40: clinical snapshots of the disease by decade of duration. Eur J Neurol. 2013;20(6):949–54.PubMedCentralPubMedCrossRef
12.
Louis ED, Benito-León J, Ottman R, Bermejo-Pareja F. A population-based study of mortality in essential tremor. Neurology. 2007;69(21):1982–9.PubMedCrossRef
13.
Benito-León J, Bermejo-Pareja F, Louis ED. Incidence of essential tremor in three elderly populations of central Spain. Neurology. 2005;64(10):1721–5.PubMedCrossRef
14.
Louis ED, Thawani SP, Andrews HF. Prevalence of essential tremor in a multiethnic, community-based study in northern Manhattan, New York, N.Y. Neuroepidemiology. 2009;32(3):208–14.PubMedCentralPubMedCrossRef
15.
16.
Stefansson H, Steinberg S, Petursson H, et al. Variant in the sequence of the LINGO1 gene confers risk of essential tremor. Nat Genet. 2009;41(3):277–9.PubMedCentralPubMedCrossRef
17.
Thier S, Lorenz D, Nothnagel M, et al. Polymorphisms in the glial glutamate transporter SLC1A2 are associated with essential tremor. Neurology. 2012;79(3):243–8.PubMedCentralPubMedCrossRef
18.••
Testa CM. Key issues in essential tremor genetics research: where are we now and how can we move forward? Tremor Other Hyperkinet Mov (N Y). 2013; 3:http://​tremorjournal.​org/​article/​view/​105. Genetics research is an avenue towards understanding ET. Advances have been made in genetic linkage and association; however, causal mutations have not been forthcoming. This disappointing lack of progress has opened productive discussions on the challenges in ET research and, more specifically, ET genetics research, including fundamental assumptions in the field. The article discusses several inherent features of ET that complicate genetic linkage and association studies.
19.
20.•
Louis ED, Benito-León J, Moreno-García S, et al. Blood harmane (1-methyl-9H-pyrido[3,4-b]indole) concentration in essential tremor cases in Spain. Neurotoxicology. 2013;34:264–8. Environmental correlates for ET are largely unexplored. Harmane is a potent tremor-producing neurotoxin found in the diet. In this study, blood harmane concentrations were quantified by a well-established high-performance liquid chromatography method, and the median harmane concentrations were higher a group of 62 familial ET patients compared with a group of 138 controls, suggesting that this neurotoxin could be an etiological agent of interest in ET.PubMedCentralPubMedCrossRef
21.
Louis ED, Benito-León J, Bermejo-Pareja F. Population-based study of baseline ethanol consumption and risk of incident essential tremor. J Neurol Neurosurg Psychiatry. 2009;80(5):494–7.PubMedCentralPubMedCrossRef
22.
Louis ED. ‘Essential tremor’ or ‘the essential tremors’: is this one disease or a family of diseases? Neuroepidemiology. 2013;42(2):81–9.PubMedCrossRef
23.
24.
Louis ED. Essential tremor and other forms of kinetic tremor. In: Grimaldi G, Manto M, editors. Mechanisms and emerging therapies in tremor disorders. New York: Springer; 2013. p. 167–201.CrossRef
25.
Louis ED. Re-thinking the biology of essential tremor: from models to morphology. Parkinsonism Relat Disord. 2014;20 Suppl 1:S88–93.PubMedCrossRef
26.
27.
DeLong MR. Possible involvement of central pacemakers in clinical disorders of movement. Fed Proc. 1978;37(8):2171–5.PubMed
28.
Deuschl G, Elble RJ. The pathophysiology of essential tremor. Neurology. 2000;54 Suppl 4:S14–20.PubMed
29.
Llinás R, Volkind RA. The olivo-cerebellar system: functional properties as revealed by harmaline-induced tremor. Exp Brain Res. 1973;18(1):69–87.PubMedCrossRef
30.
31.
32.
Martin FC, Le Thu A, Handforth A. Harmaline-induced tremor as a potential preclinical screening method for essential tremor medications. Mov Disord. 2005;20(3):298–305.PubMedCrossRef
33.
Handforth A, Krahl SE. Suppression of harmaline-induced tremor in rats by vagus nerve stimulation. Mov Disord. 2001;16(1):84–8.PubMedCrossRef
34.
O'Hearn E, Molliver ME. The olivocerebellar projection mediates ibogaine-induced degeneration of Purkinje cells: a model of indirect, trans-synaptic excitotoxicity. J Neurosci. 1997;17(22):8828–41.PubMed
35.
O'Hearn E, Molliver ME. Administration of a non-NMDA antagonist, GYKI 52466, increases excitotoxic Purkinje cell degeneration caused by ibogaine. Neuroscience. 2004;127(2):373–83.PubMedCrossRef
36.
Elble RJ. Animal models of action tremor. Mov Disord. 1998;13 Suppl 3:35–9.PubMed
37.
Louis ED. Essential tremor: evolving clinicopathological concepts in an era of intensive post-mortem enquiry. Lancet Neurol. 2010;9(6):613–22.PubMedCrossRef
38.
de Oliveira RB, Howlett MC, Gravina FS, et al. Pacemaker currents in mouse locus coeruleus neurons. Neuroscience. 2010;170(1):166–77.PubMedCrossRef
39.
Penington NJ, Tuckwell HC. Properties of IA in a neuron of the dorsal raphe nucleus. Brain Res. 2012;1449:60–8.PubMedCrossRef
40.
Jahnsen H, Llinás R. Ionic basis for the electro-responsiveness and oscillatory properties of guinea-pig thalamic neurones in vitro. J Physiol. 1984;349:227–47.PubMedCentralPubMed
41.
Hansen ST, Meera P, Otis TS, Pulst SM. Changes in Purkinje cell firing and gene expression precede behavioral pathology in a mouse model of SCA2. Hum Mol Genet. 2013;22(2):271–83.PubMedCentralPubMedCrossRef
42.
Wills AJ, Jenkins IH, Thompson PD, Findley LJ, Brooks DJ. Red nuclear and cerebellar but no olivary activation associated with essential tremor: a positron emission tomographic study. Ann Neurol. 1994;36(4):636–42.PubMedCrossRef
43.
Louis ED, Babij R, Cortés E, Vonsattel JP, Faust PL. The inferior olivary nucleus: a postmortem study of essential tremor cases versus controls. Mov Disord. 2013;28(6):779–86.PubMedCentralPubMedCrossRef
44.
Hubble JP, Busenbark KL, Pahwa R, Lyons K, Koller WC. Clinical expression of essential tremor: effects of gender and age. Mov Disord. 1997;12(6):969–72.PubMedCrossRef
45.
Parisi SL, Héroux ME, Culham EG, Norman KE. Functional mobility and postural control in essential tremor. Arch Phys Med Rehabil. 2006;87(10):1357–64.PubMedCrossRef
46.
Louis ED, Rios E, Rao AK. Tandem gait performance in essential tremor: clinical correlates and association with midline tremors. Mov Disord. 2010;25(11):1633–8.PubMedCentralPubMedCrossRef
47.
Rao AK, Gillman A, Louis ED. Quantitative gait analysis in essential tremor reveals impairments that are maintained into advanced age. Gait Posture. 2011;34(1):65–70.PubMedCentralPubMedCrossRef
48.
Deuschl G, Wenzelburger R, Löffler K, Raethjen J, Stolze H. Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor. Brain. 2000;123(8):1568–80.PubMedCrossRef
49.
Leegwater-Kim J, Louis ED, Pullman SL, et al. Intention tremor of the head in patients with essential tremor. Mov Disord. 2006;21(11):2001–5.PubMedCrossRef
50.
Avanzino L, Bove M, Tacchino A, et al. Cerebellar involvement in timing accuracy of rhythmic finger movements in essential tremor. Eur J Neurosci. 2009;30(10):1971–9.PubMedCrossRef
51.
Trillenberg P, Führer J, Sprenger A, et al. Eye-hand coordination in essential tremor. Mov Disord. 2006;21(3):373–9.PubMedCrossRef
52.
Bares M, Lungu OV, Husárová I, Gescheidt T. Predictive motor timing performance dissociates between early diseases of the cerebellum and Parkinson's disease. Cerebellum. 2010;9(1):124–35.PubMedCrossRef
53.
Farkas Z, Szirmai I, Kamondi A. Impaired rhythm generation in essential tremor. Mov Disord. 2006;21(8):1196–9.PubMedCrossRef
54.
Dupuis MJ, Delwaide PJ, Boucquey D, Gonsette RE. Homolateral disappearance of essential tremor after cerebellar stroke. Mov Disord. 1989;4(2):183–7.PubMedCrossRef
55.
Rajput AH, Maxood K, Rajput A. Classic essential tremor changes following cerebellar hemorrhage. Neurology. 2008;71(21):1739–40.PubMedCrossRef
56.
Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000;342(7):461–8.PubMedCrossRef
57.
Benabid AL, Pollak P, Seigneuret E, Hoffmann D, Gay E, Perret J. Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir Suppl (Wien). 1993;58:39–44.
58.•
Passamonti L, Cerasa A, Quattrone A. Neuroimaging of essential tremor: what is the evidence for cerebellar involvement? Tremor Other Hyperkinet Mov (N Y). 2012;2:http://​tremorjournal.​org/​article/​view/​67 . The authors discussed the neuroimaging research investigating the brain structure and function of ET patients relative to healthy controls. They concluded that current neuroimaging research provides converging evidence for the role of the cerebellum in the pathophysiology of ET, although some inconsistencies exist, particularly in structural studies. These inconsistencies may depend on the high clinical heterogeneity of ET as well as on differences among the experimental methods used across studies.
59.
Bucher SF, Seelos KC, Dodel RC, Reiser M, Oertel WH. Activation mapping in essential tremor with functional magnetic resonance imaging. Ann Neurol. 1997;41(1):32–40.PubMedCrossRef
60.
Jenkins IH, Bain PG, Colebatch JG, et al. A positron emission tomography study of essential tremor: evidence for overactivity of cerebellar connections. Ann Neurol. 1993;34(1):82–90.PubMedCrossRef
61.
Colebatch JG, Findley LJ, Frackowiak RS, Marsden CD, Brooks DJ. Preliminary report: activation of the cerebellum in essential tremor. Lancet. 1990;336(8722):1028–30.PubMedCrossRef
62.
Louis ED, Shungu DC, Chan S, Mao X, Jurewicz EC, Watner D. Metabolic abnormality in the cerebellum in patients with essential tremor: a proton magnetic resonance spectroscopic imaging study. Neurosci Lett. 2002;333(1):17–20.PubMedCrossRef
63.
Pagan FL, Butman JA, Dambrosia JM, Hallett M. Evaluation of essential tremor with multi-voxel magnetic resonance spectroscopy. Neurology. 2003;60(8):1344–7.PubMedCrossRef
64.
Shin DH, Han BS, Kim HS, Lee PH. Diffusion tensor imaging in patients with essential tremor. AJNR Am J Neuroradiol. 2008;29(1):151–3.PubMedCrossRef
65.
Klein JC, Lorenz B, Kang JS, et al. Diffusion tensor imaging of white matter involvement in essential tremor. Hum Brain Mapp. 2011;32(6):896–904.PubMedCrossRef
66.
Nicoletti G, Manners D, Novellino F, et al. Diffusion tensor MRI changes in cerebellar structures of patients with familial essential tremor. Neurology. 2010;74(12):988–94.PubMedCrossRef
67.
Benito-León J, Alvarez-Linera J, Hernández-Tamames JA, Alonso-Navarro H, Jiménez-Jiménez FJ, Louis ED. Brain structural changes in essential tremor: voxel-based morphometry at 3-Tesla. J Neurol Sci. 2009;287(1–2):138–42.PubMedCrossRef
68.
Quattrone A, Cerasa A, Messina D, et al. Essential head tremor is associated with cerebellar vermis atrophy: a volumetric and voxel-based morphometry MR imaging study. AJNR Am J Neuroradiol. 2008;29(9):1692–7.PubMedCrossRef
69.
Cerasa A, Messina D, Nicoletti G, et al. Cerebellar atrophy in essential tremor using an automated segmentation method. AJNR Am J Neuroradiol. 2009;30(6):1240–3.PubMedCrossRef
70.
71.
72.
Louis ED, Faust PL, Vonsattel JP, et al. Neuropathological changes in essential tremor: 33 cases compared with 21 controls. Brain. 2007;130(12):3297–307.PubMedCrossRef
73.
Kuo SH, Erickson-Davis C, Gillman A, Faust PL, Vonsattel JP, Louis ED. Increased number of heterotopic Purkinje cells in essential tremor. J Neurol Neurosurg Psychiatry. 2011;82(9):1038–40.PubMedCrossRef
74.
Erickson-Davis CR, Faust PL, Vonsattel JP, Gupta S, Honig LS, Louis ED. "Hairy baskets" associated with degenerative Purkinje cell changes in essential tremor. J Neuropathol Exp Neurol. 2010;69(3):262–71.PubMedCentralPubMedCrossRef
75.
Kuo SH, Tang G, Louis ED, et al. Lingo-1 expression is increased in essential tremor cerebellum and is present in the basket cell pinceau. Acta Neuropathol. 2013;125(6):879–89.PubMedCentralPubMedCrossRef
76.
Shill HA, Adler CH, Sabbagh MN, et al. Pathologic findings in prospectively ascertained essential tremor subjects. Neurology. 2008;70(16 Pt 2):1452–5.PubMedCrossRef
77.
Rajput A, Robinson CA, Rajput AH. Essential tremor course and disability: A clinicopathologic study of 20 cases. Neurology. 2004;62(6):932–6.PubMedCrossRef
78.
Critchley M, Greenfield JG. Olivo-ponto-cerebellar atrophy. Brain. 1948;71:343–64.CrossRef
79.
Louis ED, Yi H, Erickson-Davis C, Vonsattel JP, Faust PL. Structural study of Purkinje cell axonal torpedoes in essential tremor. Neurosci Lett. 2009;450(3):287–91.PubMedCentralPubMedCrossRef
80.
Louis ED, Ma K, Babij R, et al. Neurofilament protein levels: quantitative analysis in essential tremor cerebellar cortex. Neurosci Lett. 2012;518(1):49–54.PubMedCentralPubMedCrossRef
81.
Grimaldi G, Manto M. Is essential tremor a Purkinjopathy? The role of the cerebellar cortex in its pathogenesis. Mov Disord. 2013;28(13):1759–61.PubMedCrossRef
82.
Liem RK, Leung CL. Neuronal intermediate filament overexpression and neurodegeneration in transgenic mice. Exp Neurol. 2003;184(1):3–8.PubMedCrossRef
83.
Cleveland DW, Rothstein JD. From Charcot to Lou Gehrig: deciphering selective motor neuron death in ALS. Nat Rev Neurosci. 2001;2(11):806–19.PubMedCrossRef
84.
Robertson J, Kriz J, Nguyen MD, Julien JP. Pathways to motor neuron degeneration in transgenic mouse models. Biochimie. 2002;84(11):1151–60.PubMedCrossRef
85.
Rossi F, Jankovski A, Sotelo C. Differential regenerative response of Purkinje cell and inferior olivary axons confronted with embryonic grafts: environmental cues versus intrinsic neuronal determinants. J Comp Neurol. 1995;359(4):663–77.PubMedCrossRef
86.
Bravin M, Savio T, Strata P, Rossi F. Olivocerebellar axon regeneration and target reinnervation following dissociated Schwann cell grafts in surgically injured cerebella of adult rats. Eur J Neurosci. 1997;9(12):2634–49.PubMedCrossRef
87.
Dusart I, Sotelo C. Lack of Purkinje cell loss in adult rat cerebellum following protracted axotomy: degenerative changes and regenerative attempts of the severed axons. J Comp Neurol. 1994;347(2):211–32.PubMedCrossRef
88.
Chan-Palay V. The recurrent collaterals of Purkinje cell axons: a correlated study of the rat's cerebellar cortex with electron microscopy and the Golgi method. Z Anat Entwicklungsgesch. 1971;134(2):200–34.PubMedCrossRef
89.
Dusart I, Morel MP, Wehrlé R, Sotelo C. Late axonal sprouting of injured Purkinje cells and its temporal correlation with permissive changes in the glial scar. J Comp Neurol. 1999;408(3):399–418.PubMedCrossRef
90.
Carulli D, Buffo A, Strata P. Reparative mechanisms in the cerebellar cortex. Prog Neurobiol. 2004;72(6):373–98.PubMedCrossRef
91.
Rossi F, Jankovski A, Sotelo C. Target neuron controls the integrity of afferent axon phenotype: a study on the Purkinje cell-climbing fiber system in cerebellar mutant mice. J Neurosci. 1995;15(3 Pt 1):2040–56.PubMed
92.••
Babij R, Lee M, Cortés E, Vonsattel JP, Faust PL, Louis ED. Purkinje cell axonal anatomy: quantifying morphometric changes in essential tremor versus control brains. Brain. 2013;136(10):3051–61. The authors performed a detailed morphological analysis of the Purkinje cell axonal compartment in 49 ET and 39 control brains, using calbindin D28k immunohistochemistry on 100-μm cerebellar cortical vibratome tissue sections. They documented a range of changes in the Purkinje cell axonal compartment in ET. Several of these changes are likely to be compensatory changes in response to Purkinje cell injury, thus illustrating an important feature of Purkinje cells, which is that they are relatively resistant to damage and are capable of mobilizing a broad range of axonal responses to injury.PubMedCentralPubMedCrossRef
93.
Mentis GZ, Díaz E, Moran LB, Navarrete R. Early alterations in the electrophysiological properties of rat spinal motoneurones following neonatal axotomy. J Physiol. 2007;582(3):1141–61.PubMedCentralPubMedCrossRef
94.
Ma WY, Vacca-Galloway LL. Reduced branching and length of dendrites detected in cervical spinal cord motoneurons of Wobbler mouse, a model for inherited motoneuron disease. J Comp Neurol. 1991;311(2):210–22.PubMedCrossRef
95.
March PA, Thrall MA, Brown DE, Mitchell TW, Lowenthal AC, Walkley SU. GABAergic neuroaxonal dystrophy and other cytopathological alterations in feline Niemann-Pick disease type C. Acta Neuropathol. 1997;94(2):164–72.PubMedCrossRef
96.
Sasaki S, Iwata M. Dendritic synapses of anterior horn neurons in amyotrophic lateral sclerosis: an ultrastructural study. Acta Neuropathol. 1996;91(3):278–83.PubMedCrossRef
97.
Rossi F, Borsello T, Strata P. Exposure to kainic acid mimics the effects of axotomy in cerebellar Purkinje cells of the adult rat. Eur J Neurosci. 1994;6(3):392–402.PubMedCrossRef
98.
Louis ED, Mazzoni P, Ma KJ, et al. Essential tremor with ubiquitinated intranuclear inclusions and cerebellar degeneration. Clin Neuropathol. 2012;31(3):119–26.PubMedCentralPubMedCrossRef
99.
Louis ED, Faust PL, Vonsattel JP. Purkinje cell loss is a characteristic of essential tremor: towards a more mature understanding of pathogenesis. Parkinsonism Relat Disord. 2012;18(8):1003–4.PubMedCrossRef
Metadata
Title
Understanding Essential Tremor: Progress on the Biological Front
Author
Elan D. Louis
Publication date
01-06-2014
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 6/2014
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-014-0450-z

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