Objective: To determine if lesion localisation correlates with tremor characteristics in patients with focal cerebellar lesion.

Background: It is a clinical experience that acute lesions of the cerebellum induce pathological tremor, which tends to improve. Focal cerebellar lesions might cause a low frequency and low intensity tremor, however, there is still lack of evidence why some patients do, some other patients do not develop pathological tremor. Earlier lesion-symptom mapping studies demonstrated that upper limb movements are somatotopically represented in the anterior lobe and lobule VIII of the cerebellar cortex. It is not known whether focal lesions affecting these structures are associated with the onset of pathological tremor.

Method: We studied the prevalence and quantitative parameters of tremor measured with biaxial accelerometry in 34 patients with focal cerebellar (and brainstem) lesions. Tremor intensity, center frequency, frequency dispersion and proportional power of 0.9-3 Hz range were automatically calculated. Lesion location and lesion size was precisely determined using 3D T1 weighted MRI images which were normalised and segmented according to a spatially unbiased atlas template (SUIT) for the cerebellum.

Results: The size of the lesion did not correlate with the presence or severity of tremor. Lesions with overlapping location caused different types of tremor. The involvement of both the anterior and posterior lobe, paramedian and lateral structures caused pathological tremor. Involvement of the anterior lobe and lobule VI was related to high tremor intensity. Frequency dispersion was significantly lower, the proportional power of 0.9-3 Hz range was significantly higher if the brainstem was affected, too. Brainstem involvement did not affect tremor intensity.

Conclusion: Our results indicate that there is no tight correlation between lesion localisation and tremor characteristics in cerebellar tremor. However, lesions affecting the anterior lobe might be associated with elevated tremor intensity. The interplay between the cerebellum and brainstem provides further evidence that tremor is generated by a network rather than by a single oscillator.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-lesion-localisation-predict-tremor-characteristics-in-patients-with-focal-cerebellar-lesion/