Resetting tremor by single and paired transcranial magnetic stimulation in Parkinson's disease and essential tremor.

Ming-Kuei Lu Shang-Ming Chiou Ulf Ziemann Hui-Chun Huang Yu-Wan Yang Chon-Haw Tsai

Clin Neurophysiol

Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, Medical College, China Medical University, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Science, China Medical University, Taichung, Taiwan. Electronic address:

Published: December 2015

This study investigates how different brain areas (primary motor cortex, supplementary motor area, and cerebellar cortex) contribute to tremors in Parkinson's disease (PD) and essential tremor (ET) using transcranial magnetic stimulation (TMS).
Results indicate that TMS applied to the primary motor cortex (M1) significantly affects tremors in PD and ET, with M1 playing a more crucial role in PD tremors compared to ET tremors.
The findings highlight the importance of using a tremor-resetting index (RI) to understand the different brain functions related to tremor types, suggesting potential implications for treatment strategies.

Objective: The pathogenesis of tremor in Parkinson's disease (PD) and essential tremor (ET) is not fully understood. This study tested the role of primary motor cortex (M1), supplementary motor area (SMA) and cerebellar cortex on PD and ET tremor by single- and paired-pulse transcranial magnetic stimulation (TMS).

Methods: Ten PD patients with resting tremor, six of them also with postural tremor, and ten ET patients with postural tremor were studied. Randomized single- and paired-pulse TMS with an interstimulus interval of 100 ms were delivered over M1, SMA and cerebellum. TMS effects were evaluated by calculating a tremor-resetting index (RI).

Results: Single- vs. paired-pulse TMS showed no difference. M1-TMS and SMA-TMS but not by cerebellar TMS induced a significant RI in PD and ET. M1-TMS resulted in a significantly higher RI in PD than ET. Furthermore, M1-TMS in PD but not in ET resulted in a significantly higher RI than SMA-TMS.

Conclusions: Findings suggest a stronger involvement of M1 in resting and postural tremor in PD than postural tremor in ET.

Significance: RI provides a useful marker to explore the differential functional role of M1, SMA and cerebellum in PD vs. ET tremor.

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http://dx.doi.org/10.1016/j.clinph.2015.02.010	DOI Listing

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