Brain, Vol. 123, No. 8, 1568-1580,
August 2000
© 2000 Oxford University Press
Essential tremor and cerebellar dysfunction Clinical and kinematic analysis of intention tremor
Department of Neurology, Christian-Albrechts-University of Kiel, Germany
Correspondence to:
Professor Dr Günther Deuschl, Neurologische Klinik der Christian-Albrechts-Universität zu Kiel, Niemannsweg 147, 2405 Kiel, 24105 Kiel, Germany E-mail: g.deuschl{at}neurologie.uni-kiel.de
The cerebellum is assumed to play a major role in the pathophysiology of essential tremor (ET). As intention tremor is considered one of the classical features of cerebellar disease, we have assessed a large group of patients with ET for the semiology of the tremor and have performed objective quantitative analysis of a grasping movement in patients with ET, cerebellar disease and a normal control group. We found 25% of the patients to have a moderate or severe kinetic tremor with clear-cut features of a classical intention tremor. Another 33% of the patients had a mild intentional component of their kinetic tremor. Patients with intention tremor (ETIT) did not differ from those with predominant postural tremor (ETPT) with respect to alcohol sensitivity of the tremor and the frequency of a family history. ETIT patients were older and more often showed head and trunk involvement. The onset of this intention tremor has been assessed retrospectively. It was found to begin at a randomly distributed time interval after the onset of the postural tremor, but older patients had a shorter time to development of intention tremor. Quantitative accelerometry of postural tremor showed similar tremor frequencies in both patient groups, but ETIT patients had a slightly larger tremor amplitude. Quantitative analysis of a grasping movement using an infrared-camera system was performed in two subgroups of the patients with ETPT and ETIT and control groups with cerebellar disease or normal subjects. The intention tremor could be quantified objectively as an increased amplitude of curvature during the deceleration and target phase of the movement. The amplitude measurements of intention tremor were clearly abnormal and of comparable magnitude for ETPT and cerebellar disease. Additionally, the patients with ETIT had a significantly slowed grasping movement during the deceleration and target period. Hypermetria was significantly increased for the patients with ETIT and cerebellar disease. We conclude that intention tremor is a feature of ET. ETIT patients have abnormalities of their upper limb function compatible with cerebellar disease. This suggests that patients with more advanced ET show abnormalities of cerebellar functions.
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