Tremor severity in Parkinson's disease and cortical changes of areas controlling movement sequencing: A preliminary study

Julián Benito-León, J. Ignacio Serrano, Elan D. Louis, Ales Holobar, Juan P. Romero, P. Povalej-Bržan, Félix Bermejo-Pareja, M. Dolores del Castillo, Ignacio J. Posada, Eduardo Rocon

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


There remains much to learn about the changes in cortical anatomy that are associated with tremor severity in Parkinson's disease (PD). For this reason, we used a combination of structural neuroimaging to measure cortical thickness and neurophysiological studies to analyze whether PD tremor was associated with cortex integrity. Magnetic resonance imaging and neurophysiological assessment were performed in 13 nondemented PD patients (9 women, 69.2%) with a clearly tremor-dominant phenotype. Cortical reconstruction and volumetric segmentation were performed with the Freesurfer image analysis software. Assessment of tremor was performed by means of high-density surface electromyography (hdEMG) and inertial measurement units (IMUs). Individual motor unit discharge patterns were identified from surface hdEMG and tremor metrics quantifying motor unit synchronization from IMUs. Increased motor unit synchronization (i.e., more severe tremor) was associated with cortical changes (i.e., atrophy) in wide-spread cortical areas, including caudal middle frontal regions bilaterally (dorsal premotor cortices), left inferior parietal lobe (posterior parietal cortex), left lateral orbitofrontal cortex, cingulate cortex bilaterally, left posterior and transverse temporal cortex, and left occipital lobe, as well as reduced left middle temporal volume. Given that the majority of these areas are involved in controlling movement sequencing, our results support Albert's classic hypothesis that PD tremor may be the result of an involuntary activation of a program of motor behavior used in the genesis of rapid voluntary alternating movements.

Original languageEnglish (US)
Pages (from-to)1341-1352
Number of pages12
JournalJournal of Neuroscience Research
Issue number8
StatePublished - Aug 2018
Externally publishedYes


  • Parkinson's disease tremor
  • cortical thickness
  • electromyography
  • magnetic resonance imaging

ASJC Scopus subject areas

  • Cellular and Molecular Neuroscience


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