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$MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor$

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SPECT perfusion patterns distinguish psychogenic from essential tremor.

K Czarnecki¹, D T Jones, M S Burnett

¹Department of Neurology, Mayo Clinic College of Medicine, 200 2nd Street SW, Rochester, MN 55905, USA.

Parkinsonism & Related Disorders

|February 15, 2011

Summary

Functional brain imaging reveals distinct cerebral blood flow patterns differentiating psychogenic tremor (PT) from essential tremor (ET). Deactivation in the default mode network may indicate psychogenic movement disorders.

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Area of Science:

Neuroscience
Medical Imaging
Neurology

Background:

Psychogenic movement disorders present diagnostic and therapeutic challenges due to limited understanding of underlying brain mechanisms.
Functional brain imaging techniques are increasingly employed to investigate these disorders.

Purpose of the Study:

To identify unique cerebral perfusion patterns that distinguish psychogenic tremor (PT) from essential tremor (ET).

Main Methods:

Single-photon emission computed tomography (SPECT) imaging was used to assess cerebral blood flow (CBF) in patients with PT, ET, and healthy controls.
Imaging was conducted both at rest and during a tremor-inducing motor task.

Main Results:

Essential tremor (ET) showed increased relative cerebral blood flow (rCBF) in the cerebellum and left inferior frontal gyrus at rest, and in the supplementary motor area (SMA) and contralateral motor cortex during tasks, with decreased rCBF in the cerebellum and visual cortex.
Psychogenic tremor (PT) exhibited increased rCBF in the left inferior frontal gyrus and left insula at rest.
During motor tasks, PT patients displayed increased rCBF in the cerebellum and reduced rCBF in the anterior default mode network.

Conclusions:

Distinct cerebral perfusion patterns during rest and motor tasks differentiate PT from ET.
The observed deactivation of the default mode network in PT could potentially serve as a biomarker for psychogenic movement disorders.