Metabolic abnormality in the cerebellum in patients with essential tremor: a proton magnetic resonance spectroscopic imaging study

Abstract The pathological basis for essential tremor (ET) is unknown. We used proton magnetic resonance spectroscopic imaging ( 1 H MRSI) in 16 ET patients and 11 controls to measure levels of intracellular metabolites, including N -acetyl- l -aspartate (NAA) and total choline, relative to total creatine (tCR), in several brain regions (cerebellum, thalamus, basal ganglia). Multislice 1 H MRSI data were acquired on a 1.5 T GE Signa Scanner by prescribing four 15-mm axial-oblique slices. The mean (standard deviation) cerebellar cortical NAA/tCR was reduced in cases compared to controls (1.53 [0.36] versus 1.91 [0.49], P =0.03). There was an inverse association between cerebellar cortical NAA/tCR and dominant arm tremor severity ( r =−0.59, P =0.02). The reduction in cerebellar cortical NAA/tCR indicates that there is neuronal damage or loss in ET, suggesting that ET may be a neurodegenerative disease.