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Adrian J. Wills, MRCP; leuan H. Jenkins, MRCP; Philip D. Thompson, PhD, FRACP; Leslie J. Findley, MD, FRCP; David J. Brooks, MD, FRCP

Arch Neurol. 1995;52(3):299-305.

Abstract
Objective
To compare the abnormal patterns of cerebral activation associated with essential and writing tremors.

Design
Positron emission tomography using oxygen 15—labeled water was utilized to determine regional cerebral blood flow. Positron emission tomography images that were taken of the brain in individual patients were coregistered with magnetic resonance images of the same brain to ascertain accurate localization of cerebral activation in single patients. Patients with essential tremor underwent scanning at rest, during involuntary postural tremor, and during passive wrist oscillation. Normal control subjects underwent scanning at rest and during voluntary and passive wrist oscillation. Patients with writing tremor underwent scanning while they were holding a pen to paper with consequent involuntary tremor and again while they were holding a pen in the same supinated arm without tremor.

Setting
Research hospital.

Patients or Other Participants
Seven patients with essential tremor, six patients with writing tremor, and six matched control subjects.

Interventions
None.

Main Outcome Measures
Regional cerebral blood flow.

Results
Essential tremor was associated with abnormal bilateral cerebellar, red nuclear, and thalamic activation. Writing tremor was also associated with abnormal bilateral cerebellar activation. Voluntary wrist oscillation in control subjects caused only ipsilateral cerebellar activation. These findings were evident in single patients, when positron emission tomography images were coregistered with magnetic resonance images and on group analysis of the pooled positron emission tomography data after transformation into stereotaxic space.

Conclusion
These results indicate that both essential and writing tremors are associated with abnormal bilateral overactivity of cerebellar connections.

Author Affiliations
From the MRC Cyclotron Unit, Hammersmith Hospital (Drs Wills, Jenkins, and Brooks), and the Institute of Neurology (Drs Thompson, Findley, and Brooks), London, England.

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