Abstract
BackgroundEssential tremor (ET) is a common movement disorder characterized by kinetic, postural and intention tremors. Mounting evidence suggests an underlying dysfunction of the cerebellum or cerebellar system. While few recent studies report impairments in timing control of finger movements in ET, timing control of gait has not been examined to date. We compared timing control of gait in ET patients vs. controls, and further assessed the association of these timing impairments with tremor severity among the ET patients. One-hundred-fifty-five ET patients and 60 age-matched controls underwent a comprehensive neurological assessment and gait analysis, which included walking at a criterion step frequency (cadence) with a metronome (timing production) and walking at a criterion step frequency after the metronome was turned off (timing reproduction). Outcomes of interest for both conditions were timing accuracy (measured by cadence error) and timing precision (measured by cadence variability). We also assessed cadence and step time across conditions.ResultsCadence was lower in ET patients than controls (p < 0.03), whereas step time was similar for ET patients and controls. Accuracy (cadence error) and precision (cadence variability) were not different in ET patients compared with controls. Cranial tremor score was significantly associated with cadence (timing production condition, p = 0.003 and timing reproduction condition, p = 0.0001) and cadence error (timing production condition, p = 0.01). Kinetic tremor and intention tremor scores were not associated with gait measures.ConclusionsET patients do not demonstrate impairments in timing control of gait as compared with matched controls. Prior work shows that patients with cerebellar dysfunction demonstrate selective impairments in timing of discrete movements (such as finger tapping) but not continuous movements (such as circle drawing). Taken together, these results support the hypothesis that the cerebellum may be important for timing control of discrete rather than continuous movements.
Highlights
Essential tremor (ET) is a common movement disorder characterized by kinetic, postural and intention tremors
The purpose of this study was (1) to examine if gait timing control was impaired in ET patients compared with age-matched controls while walking at a self-selected preferred speed and while walking with an external timing cue and (2) to examine whether timing impairments are related to clinical measures of disease severity
Target interception using a key press movement was impaired in ET patients with head tremor, suggesting that the cerebellum may be implicated in predictive timing of discrete movements [23]
Summary
Essential tremor (ET) is a common movement disorder characterized by kinetic, postural and intention tremors. While few recent studies report impairments in timing control of finger movements in ET, timing control of gait has not been examined to date. We compared timing control of gait in ET patients vs controls, and further assessed the association of these timing impairments with tremor severity among the ET patients. One-hundred-fifty-five ET patients and 60 age-matched controls underwent a comprehensive neurological assessment and gait analysis, which included walking at a criterion step frequency (cadence) with a metronome (timing production) and walking at a criterion step frequency after the metronome was turned off (timing reproduction). Gait abnormalities include decreased speed (beyond that seen with aging) and impaired dynamic balance – ET patients spend greater time in double support while walking at a preferred speed and have more mis-steps during tandem gait [7, 9]. Gait impairments in ET result in an increase in fall risk [11, 12]
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