AUTHOR=He Runcheng , Qin Yan , Zhou Xun , Liu Zhenhua , Xu Qian , Guo Jifeng , Yan Xinxiang , Tang Beisha , Zeng Sheng , Sun Qiying 

TITLE=The effect of regional white matter hyperintensities on essential tremor subtypes and severity

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 14 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.933093

DOI=10.3389/fnagi.2022.933093

ISSN=1663-4365

ABSTRACT=Objectives
To investigate the effect of regional white matter hyperintensities (WMHs) on Essential tremor (ET) subtypes and to explore the association between WMHs load and the severity of motor and non-motor symptoms in ET patients.
Methods
A cohort of 176 ET patients (including 86 pure ET and 90 ET plus patients) and 91 normal controls (NC) was consecutively recruite. Demographic, clinical and imaging characteristics were compared between individuals with pure ET, ET plus, and NC. The cross-sectional association among regional WMHs and the severity of tremor and non-motor symptoms was assessed within each group. 
Results
Compared with pure ET subgroup, ET plus subgroup demonstrated higher TETRAS scores, NMSS scores, and lower MMSE scores (all P<0.05). Periventricular and lobar WMHs of pure ET subgroup intermediated between NC subjects and ET plus subgroup. WMHs in frontal horn independently increased the odds of ET (OR=1.784, P<0.001). The age (P=0.021), WMHs in frontal lobe (P=0.014), and WMHs in occipital lobe (P=0.020) showed significant impact on TETRAS part Ⅱ scores in ET plus subgroup. However, only the disease duration was positively associated with TETRAS part Ⅱ scores in pure ET patients (P=0.028). In terms of non-motor symptoms, NMSS scores of total ET patients were associated with disease duration (P=0.0293), TETRAS part Ⅰ scores (P=0.017) , and WMHs scores in frontal lobe (P=0.033).MMSE scores were associated with age (P=0.027), body mass index (BMI) (P=0.006, education level (P<0.001), and the body of the lateral ventricle WMH (P=0.005).
Conclusions
Our results indicated the WMHs in frontal horn could lead to an increased risk of developing ET. WMHs may be used to differentiate pure ET and ET plus. Furthermore, WMHs in frontal and occipital lobe are strong predictors of worse tremor severity in ET plus subgroup. Regional WMHs are associated with cognitive impairment in ET patients.