White matter correlates of gait and balance dysfunction in essential tremor patients

Background: Essential tremor (ET) is a syndrome characterized by both motor (tremor, gait, and balance dysfunction) and non-motor features like cognitive deficits, depression, sleep, mood, and anxiety disorders. The present study was conducted to characterize the clinical dysfunction and brain localization of gait and balance disturbances in ET patients.

Methods: 174 ET patients and 150 matched healthy controls were evaluated. ET was diagnosed using the Consensus Statement on the Classification of Tremors, from the Task Force on Tremors of the Movement Disorder Society criteria. Participants were assessed by using a structured neuropsychological battery and validated gait scores. Diffusion tensor imaging (DTI) data comprising mean diffusivity, radial diffusivity, axial diffusivity, and fractional anisotropy were analyzed for all subjects.

Results: The mean age of essential tremor cases was 45.1 ± 14.08 years. Male: female ratio in ET cases was 2.5:1. Cognitive impairment was observed in a quarter of ET patients. A significant difference was observed in Berg balance scale scores, tandem gait missteps, and tandem stance time between ET cases and controls (p-value < 0.0001). ET patients with higher tremor scores and head tremors were more aged and had poor gait and cognitive scores (p < 0.0001). In our study, we observed poor gait scores significantly correlated with an increase in mean, radial, and axial diffusivities as well as a decrease in fractional anisotropy over various white matter clusters in the brain. No such correlation was observed among the controls.

Conclusion: The present study demonstrates a correlation between gait scores and DTI metrics suggesting a neuroanatomic basis for gait impairment in ET patients.