Atrophy of cerebellar peduncles in essential tremor: a machine learning–based volumetric analysis
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Subtle cerebellar signs are frequently observed in essential tremor (ET) and may be associated with cerebellar dysfunction. This study aims to evaluate the macrostructural integrity of the superior, middle, and inferior cerebellar peduncles (SCP, MCP, ICP) and cerebellar gray and white matter (GM, WM) volumes in patients with ET, and compare these volumes between patients with and without cerebellar signs (ETc and ETnc).
Forty patients with ET and 37 age- and gender-matched healthy controls were recruited. Atlas-based region-of-interest analysis of the SCP, MCP, and ICP and automated analysis of cerebellar GM and WM volumes were performed. Peduncular volumes were employed in a multi-variate classification framework to attempt discrimination of ET from controls.
Significant atrophy of bilateral MCP and ICP and bilateral cerebellar GM was observed in ET. Cerebellar signs were present in 20% of subjects with ET. Comparison of peduncular and cerebellar volumes between ETnc and ETc revealed atrophy of right SCP, bilateral MCP and ICP, and left cerebellar WM in ETc. The multi-variate classifier could discriminate between ET and controls with a test accuracy of 86.66%.
Patients with ET have significant atrophy of cerebellar peduncles, particularly the MCP and ICP. Additional atrophy of the SCP is observed in the ETc group. These abnormalities may contribute to the pathogenesis of cerebellar signs in ET.
• Patients with ET have significant atrophy of bilateral middle and inferior cerebellar peduncles and cerebellar gray matter in comparison with healthy controls.
• Patients of ET with cerebellar signs have significant atrophy of right superior cerebellar peduncle, bilateral middle and inferior cerebellar peduncle, and left cerebellar white matter in comparison with ET without cerebellar signs.
• A multi-variate classifier employing peduncular volumes could discriminate between ET and controls with a test accuracy of 86.66%.
KeywordsEssential tremor Middle cerebellar peduncle Atrophy Cerebellum Machine learning
Age at onset
Diffusion tensor imaging
Essential tremor with cerebellar signs
Essential tremor without cerebellar signs
Fahn-Tolosa-Marin tremor rating scale
Inferior cerebellar peduncle
Middle cerebellar peduncle
Magnetic resonance imaging
Receiver operating characteristics
Region of interest
Superior cerebellar peduncle
Support vector machine
This study has received funding by Department of Science and Technology – Science and Engineering Research Board (DST-SERB) (ECR/2016/000808) who provided partial funding for setting up the computing facility.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Pramod Kumar Pal.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects are part of the cohort have been part of previous studies from our group:
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Bhalsing KS, Kumar KJ, Saini J, Yadav R, Gupta AK, Pal PK. White matter correlates of cognitive impairment in essential tremor. AJNR Am J Neuroradiol. 2015;36(3):448–45.
Bhalsing KS, Upadhyay N, Kumar KJ et al (2014) Association between cortical volume loss and cognitive impairments in essential tremor. Eur J Neurol 21:874–883.
• Case-control study
• Performed at one institution
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