Long-latency feedback responses preserved in Essential Tremor patients
Essential tremor (ET), one of the most common movement disorders, affects patients with involuntary oscillations of the limbs, more frequently during movement. The pathophysiology of this disorder remains poorly understood, however a previous study reported movement execution impairments during motor adaptation. In this study, ET patients (N=24) and aged-matched healthy volunteers (HV, N=28) performed a postural perturbation task with kinematics and surface muscular activity recordings. After maintaining the hand in a target, participants experienced unpredictable perturbations and were instructed to counteract the perturbation and steer their hand back to the starting position. In addition, we analyzed the dentate nucleus (DN) resting state functional connectivity of a subgroup of 20 ET and HV participants. DN were segmented using Quantitative Susceptibility Mapping (QSM). During the postural perturbation task, compared to HVs, ET patients experienced perturbation-dependent deficits when stopping and stabilizing their hand in the final target. The early muscular responses (Long Latency Responses - LLR) of ET patients were preserved following the perturbation reflecting intact sensory feedback. We showed that these end-of-movement difficulties with intact LLRs can be explained by a model of upperlimb control erroneoulsy compensating for the sensory feedback delay. Accumulations of errors with movement time resulted in oscillations with properties similar to ET symptoms. This delay-compensation operation has been linked with cerebellum, which integrates with the previous hypotheses of ET origin and brings a new explanation of the tremor.
