The Central Oscillatory Network Of Orthostatic Tremor

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The Central Oscillatory Network Of Orthostatic Tremor

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Movement Disorders 2013
Sydney, Australia June 16-20, 2013.
The Central Oscillatory Network Of Orthostatic Tremor
Hellriegel , H., Muthuraman , M., Paschen , S., Hofschulte , F., Reese , R., Volkmann , J., Witt , K.
Kiel, Germany

Objective:
To analyze the pathologic central network in patients with orthostatic tremor using dynamic imaging of coherent sources.

Background:
Orthostatic tremor is a movement disorder which involves the legs and trunk when standing upright and is relieved during sitting. The pathological central network involved in orthostatic tremor is still unknown.

Methods:
15 patients with orthostatic tremor were analysed with high resolution EEG. Tremor was recorded with surface EMG from tibialis anterior and quadriceps muscles on both legs. EEG was recorded in parallel with a standard 64 channel recording system. The dynamic imaging of coherent source analysis was used which applies a spatial filter to find the sources in the brain that are coherent with the peripheral tremor signal.

Results:
The network for the tremor frequency constituted a unilateral network of primary leg area, supplementary motor area, primary sensory cortex, two prefrontal/premotor sources, thalamus and cerebellum for the whole 30
seconds segment after standing. In all the patients the source signal coherence dynamics was analysed for the primary leg area and the thalamus source signals with tibialis anterior muscle which showed high coherence for the whole 30 seconds for the contralateral side but coherence markedly decreased after 15 seconds for the ipsilateral side.

Conclusions:
The results help us to understand the pathological network of orthostatic tremor and give a hint that the thalamus takes part in the tremor generation, but at the same time the thalamo-cortical network changes from bilateral to unilateral whereas the peripheral coupling remains unaltered. This indicates that thalamus is not the main source of this tremor.

Hellriegel, H., Muthuraman, M., Paschen, S., Hofschulte, F., Reese, R., Volkmann, J., et al; The central oscillatory network of orthostatic tremor [abstract]. Movement Disorders 2013;28 Suppl 1 :970
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