Essential Tremor, the Cerebellum, and Motor Timing: Towards Integrating Them into One Complex Entity

Essential tremor (ET) is the most common movement disorder in humans. It is characterized by a postural and kinetic tremor most commonly affecting the forearms and hands. Isolated head tremor has been found in 1–10% of patients, suggesting that ET may be a composite of several phenotypes. The exact pathophysiology of ET is still unknown. ET has been repeatedly shown as a disorder of mild cerebellar degeneration, particularly in postmortem studies. Clinical observations, electrophysiological, volumetric and functional imaging studies all reinforce the fact that the cerebellum is involved in the generation of ET. However, crucial debate exists as to whether ET is a neurodegenerative disease. Data suggesting that it is neurodegenerative include postmortem findings of pathological abnormalities in the brainstem and cerebellum, white matter changes on diffusion tensor imaging, and clinical studies demonstrating an association with cognitive and gait changes. There is also conflicting evidence against ET as a neurodegenerative disease: the improvement of gait abnormalities with ethanol administration, lack of gray matter volume loss on voxel-based morphometry, failure to confirm the prominent presence of Lewy bodies in the locus ceruleus, and other pathological findings. To clarify this issue, future research is needed to describe the mechanism of cellular changes in the ET brain and to understand the order in which they occur. The cerebellum has been shown to be involved in the timing of movement and sensation, acting as an internal timing system that provides the temporal representation of salient events spanning hundreds of milliseconds. It has been reported that cerebellar timing function is altered in patients with ET, showing an increased variability of rhythmic hand movements as well as diminished performance during predictive motor timing task. Based on current knowledge and observations, we argue that ET is essentially linked with cerebellar degeneration, or at least cerebellar dysfunction, together with disturbance of motor timing. We explain the context of our current understanding on this topic, highlighting possible clinical consequences for patients suffering from ET and future research directions

The mechanisms of movement control and time estimation in cervical dystonia patients

Traditionally, the pathophysiology of cervical dystonia has been regarded mainly in relation to neurochemical abnormities in the basal ganglia. Recently, however, substantial evidence has emerged for cerebellar involvement. While the absence of neurological "cerebellar signs" in most dystonia patients may be considered at least provoking, there are more subtle indications of cerebellar dysfunction in complex, demanding tasks. Specifically, given the role of the cerebellum in the neural representation of time, in the millisecond range, dysfunction to this structure is considered to be of greater importance than dysfunction of the basal ganglia. In the current study, we investigated the performance of cervical dystonia patients on a computer task known to engage the cerebellum, namely, the interception of a moving target with changing parameters (speed, acceleration, and angle) with a simple response (pushing a button). The cervical dystonia patients achieved significantly worse results than a sample of healthy controls. Our results suggest that the cervical dystonia patients are impaired at integrating incoming visual information with motor responses during the prediction of upcoming actions, an impairment we interpret as evidence of cerebellar dysfunction

Linking Essential Tremor to the Cerebellum: Physiological Evidence.

Essential tremor (ET), clinically characterized by postural and kinetic tremors, predominantly in the upper extremities, originates from pathological activity in the dynamic oscillatory network comprising the majority of nodes in the central motor network. Evidence indicates dysfunction in the thalamus, the olivocerebellar loops, and intermittent cortical engagement. Pathology of the cerebellum, a structure with architecture intrinsically predisposed to oscillatory activity, has also been implicated in ET as shown by clinical, neuroimaging, and pathological studies. Despite electrophysiological studies assessing cerebellar impairment in ET being scarce, their impact is tangible, as summarized in this review. The electromyography-magnetoencephalography combination provided the first direct evidence of pathological alteration in cortico-subcortical communication, with a significant emphasis on the cerebellum. Furthermore, complex electromyography studies showed disruptions in the timing of agonist and antagonist muscle activation, a process generally attributed to the cerebellum. Evidence pointing to cerebellar engagement in ET has also been found in electrooculography measurements, cerebellar repetitive transcranial magnetic stimulation studies, and, indirectly, in complex analyses of the activity of the ventral intermediate thalamic nucleus (an area primarily receiving inputs from the cerebellum), which is also used in the advanced treatment of ET. In summary, further progress in therapy will require comprehensive electrophysiological and physiological analyses to elucidate the precise mechanisms leading to disease symptoms. The cerebellum, as a major node of this dynamic oscillatory network, requires further study to aid this endeavor.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Neural correlates of cue-unique outcome expectations under differential outcomes training: an fMRI study

In conditional discriminative choice learning, one learns the relations between discriminative/cue stimuli, associated choices, and their outcomes. When each correct cue-choice occurrence is followed by a cue-unique trial outcome (differential outcomes, DO, procedure), learning is faster and more accurate than when all correct cue-choice occurrences are followed by a common outcome (CO procedure)—differential outcomes effect (DOE). Superior DO performance is theorized to be mediated by the additional learning of cue-unique outcome expectations that "enrich" the prospective code available over the delay between cue and choice. We anticipated that such learned expectations comprise representations of expected outcomes. Here, we conducted an event-related functional MR imaging (fMRI) analysis of healthy adults who trained concurrently in two difficult but similar perceptual discrimination tasks under DO and CO procedures, respectively, and displayed the DOE. Control participants performed related tasks that differentially biased them towards delay-period retrospection versus prospection. Indeed, when differential outcomes were sensory–perceptual events (visual vs. auditory), delay-period expectations were experienced as sensory-specific imagery of the respectively expected outcome content, generated by sensory-specific cortices. Visual-specific imagery additionally activated stimulus-specific representations in prefrontal, lateral and medial frontal, fusiform and cerebellar regions, whereas auditory-specific imagery recruited claustrum/insula. Posterior parietal cortex (PPC), BA 39, was non-modality specific in mediating delay-period cue-unique outcome expectations. Greater hippocampal involvement in retrospection than prospection contrasted against the PPC's role in prospection. Time course analyses of hippocampal versus PPC responses suggest the DOE derives from an earlier transition from retrospection to prospection, which taps into long-term associative memory—more enduring

The multifaceted nature of the relationship between performance and brain activity in motor sequence learning.

The 'learning and performance' conundrum has for a long time puzzled the field of cognitive neuroscience. Deciphering the genuine functional neuroanatomy of motor sequence learning, among that of other skills, has thereby been hampered. The main caveat is that changes in neural activity that inherently accompany task practice may not only reflect the learning process per se, but also the basic motor implementation of improved performance. Previous research has attempted to control for a performance confound in brain activity by adopting methodologies that prevent changes in performance. However, blocking the expression of performance is likely to distort the very nature of the motor sequence learning process, and may thus represent a major confound in itself. In the present study, we postulated that both learning-dependent plasticity mechanisms and learning-independent implementation processes are nested within the relationship that exists between performance and brain activity. Functional magnetic resonance imaging (fMRI) was used to map brain responses in healthy volunteers while they either (a) learned a novel sequence, (b) produced a highly automatized sequence or (c) executed non-sequential movements matched for speed frequency. In order to dissociate between qualitatively distinct, but intertwined, relationships between performance and neural activity, our analyses focused on correlations between variations in performance and brain activity, and how this relationship differs or shares commonalities between conditions. Results revealed that activity in the putamen and contralateral lobule VI of the cerebellum most strongly correlated with performance during learning per se, suggesting their key role in this process. By contrast, activity in a parallel cerebellar network, as well as in motor and premotor cortical areas, was modulated by performance during learning and during one or both control condition(s), suggesting the primary contribution of these areas in motor implementation, either as a function or not of the sequential content of movements. Our findings thus highlight the multifaceted nature of the link between performance and brain activity, and suggest that different components of the striato-cortical and cerebello-cortical motor loops play distinct, but complementary, roles during early motor sequence learning.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Clinical Investigative Study Similar Circuits but Different Connectivity Patterns Between The Cerebellum, Basal Ganglia, and Supplementary Motor Area In Early Parkinson's Disease Patients and Controls During Predictive Motor Timing

The cerebellum, basal ganglia (BG), and other cortical regions, such as supplementary motor area (SMA) have emerged as important structures dealing with various aspects of timing, yet the modulation of functional connectivity between them during motor timing tasks remains unexplored. METHODS We used dynamic causal modeling to investigate the differences in effective connectivity (EC) between these regions and its modulation by behavioral outcome during a motor timing prediction task in a group of 16 patients with early Parkinson's disease (PD) and 17 healthy controls. Behavioral events (hits and errors) constituted the driving input connected to the cerebellum, and the modulation in connectivity was assessed relative to the hit condition (successful interception of target). RESULTS The driving input elicited response in the target area, while modulatory input changed the specific connection strength. The neuroimaging data revealed similar structure of intrinsic connectivity in both groups with unidirectional connections from cerebellum to both sides of the BG, from BG to the SMA, and then from SMA to the cerebellum. However, the type of intrinsic connection was different between two groups. In the PD group, the connection between the SMA and cerebellum was inhibitory in comparison to the HC group, where the connection was activated. Furthermore, the modulation of connectivity by the performance in the task was different between the two groups, with decreased connectivity between the cerebellum and left BG and SMA and a more pronounced symmetry of these connections in controls. In the same time, there was an increased EC between the cerebellum and both sides of BG with more pronounced asymmetry (stronger connection with left BG) in patients. In addition, in the PD group the modulatory input strengthened inhibitory connectivity between the SMA and the cerebellum, while in the HC group the excitatory connection was slightly strengthened. CONCLUSIONS Our findings indicate that although early PD subjects and controls use similar functional circuits to maintain a successful outcome in predictive motor timing behavior, the type and strength of EC and its modulation by behavioral performance differ between these two groups. These functional differences might represent the first step of cortical reorganization aimed at maintaining a normal performance in the brain affected by early Parkinson's disease and may have implications for the neuro-rehabilitation field

Functional neuroanatomy associated with the expression of distinct movement kinematics in motor sequence learning.

A broad range of motor skills, such as speech and writing, evolves with the ability to articulate elementary motor movements into novel sequences that come to be performed smoothly through practice. Neuroimaging studies in humans have demonstrated the involvement of the cerebello-cortical and striato-cortical motor loops in the course of motor sequence learning. Nonetheless, the nature of the improvement and brain mechanisms underlying different parameters of movement kinematics are not yet fully ascertained. We aimed at dissociating the cerebral substrates related to the increase in performance on two kinematic indices: velocity, that is the speed with which each single movement in the sequence is produced, and transitions, that is the duration of the gap between these individual movements. In this event-related fMRI experiment, participants practiced an eight-element sequence of finger presses on a keypad which allowed to record those kinematic movement parameters. Velocity was associated with activations in the ipsilateral spinocerebellum (lobules 4-5, 8 and medial lobule 6) and in the contralateral primary motor cortex. Transitions were associated with increased activity in the neocerebellum (lobules 6 bilaterally and lobule 4-5 ipsilaterally), as well as with activations within the right and left putamen and a broader bilateral network of motor cortical areas. These findings indicate that, rather than being the product of a single mechanism, the general improvement in motor performance associated with early motor sequence learning arises from at least two distinct kinematic processes, whose behavioral expressions are supported by partially overlapping and segregated brain networks.JOURNAL ARTICLESCOPUS: ar.jinfo:eu-repo/semantics/publishe