Articles

Inferior Olivary nucleus degeneration does not lessen tremor in essential tremor

Louis, Elan D.; Diaz, Daniel T.; Kuo, Sheng-Han; Gan, Shi-Rui; Cortes, Etty Paola; Vonsattel, Jean Paul; Faust, Phyllis L.; Columbia University. Pathology and Cell Biology; Columbia University. Taub Institute; Columbia University. Neurology

Background
In traditional models of essential tremor, the inferior olivary nucleus was posited to play a central role as the pacemaker for the tremor. However, recent data call this disease model into question.


Case presentation
Our patient had progressive, long-standing, familial essential tremor. Upper limb tremor began at age 10 and worsened over time. It continued to worsen during the nine-year period he was enrolled in our brain donation program (age 85 – 94 years), during which time the tremor moved from the moderate to severe range on examination. On postmortem examination at age 94, there were degenerative changes in the cerebellar cortex, as have been described in the essential tremor literature. Additionally, there was marked degeneration of the inferior olivary nucleus, which was presumed to be of more recent onset. Such degeneration has not been previously described in essential tremor postmortems. Despite the presence of this degeneration, the patient’s tremor not only persisted but it continued to worsen during the final decade of his life.


Conclusions
Although the pathophysiology of essential tremor is not completely understood, evidence such as this suggests that the inferior olivary nucleus does not play a critical role in the generation of tremor in these patients.

Files

  • thumnail for 40673_2018_Article_80.pdf 40673_2018_Article_80.pdf application/pdf 1.94 MB Download File

Also Published In

Title
Cerebellum & Ataxias
DOI
https://doi.org/10.1186/s40673-018-0080-3

More About This Work

Published Here
March 9, 2018

Notes

Essential tremor, Cerebellum, Inferior olivary nucleus, Neurodegenerative, Purkinje cell, Pathology