Coherence between low-frequency activation of the motor cortex and tremor in patients with essential tremor.

BACKGROUND In healthy people, rhythmic activation of the motor cortex in the 15-30 Hz frequency range accompanies and contributes to voluntarily-generated postural contractions of contralateral muscle. In patients with Parkinson's disease, an abnormal low-frequency activation of the motor areas of the cortex occurs and has been directly linked to the characteristic 3-6 Hz rest tremor of this disease. We therefore investigated whether the motor cortex is involved in the transmission of the rhythmic motor drive responsible for generating essential tremor. METHODS Non-invasive recordings of activity from the hand area of the motor cortex were made from six patients with essential tremor by magnetoencephalography. The recordings were made simultaneously with the electromyogram recorded from contralateral finger muscles during periods of postural tremor. A statistical spectral analysis was done to determine at which frequencies the two signals were correlated. FINDINGS Spectral analysis of the electromyogram signals showed a significant low-frequency component at the frequency of the tremor bursts. However, there was no coherence between magnetoencephalogram and electromyogram recordings at the tremor frequency, indicating that no correlation existed between the tremor signal and low-frequency activity recorded from the primary motor cortex in individuals with essential tremor. Coherence at frequencies higher than the tremor frequency was similar to that in healthy individuals performing voluntary postural contractions. INTERPRETATION The absence of significant coherence between the magnetoencephalogram and electromyogram at tremor frequencies suggests that in essential tremor the tremor is imposed on the active muscle through descending pathways other than those originating in the primary motor cortex. These findings challenge the model widely used to explain the efficacy of neurosurgical treatment of essential tremor, are in contrast to those of previous studies of parkinsonian rest tremor, and highlight an important difference in the pathophysiology of essential and parkinsonian tremor.