AUTHOR=Becktepe Jos S. , Busse Johannes , Jensen-Kondering Ulf , Toedt Inken , Wolff Stephan , Zeuner Kirsten E. , Berg Daniela , Granert Oliver , Deuschl Günther 

TITLE=White Matter Hyperintensities Are Associated With Severity of Essential Tremor in the Elderly

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.694286

DOI=10.3389/fneur.2021.694286

ISSN=1664-2295

ABSTRACT=Background:
Essential tremor (ET) occurs with steeply increasing prevalence in the elderly and apart from disease duration, age is independently associated with an increase of tremor amplitude and a decrease of frequency. White matter hyperintensities (WMH) are a common finding in the elderly and their role in the pathophysiology of ET is unknown. The aims of this study were to examine whether ET patients differ in their total or region-specific WMH volumes from healthy controls and to determine the impact of WMH on tremor characteristics.
Methods:
47 ET patients and 39 age-matched healthy controls underwent a thorough clinical assessment and 3T MRI. Total WMH volumes were derived from T2-weighted fluid attenuated inverse recovery (FLAIR) MR images. Additionally, region of interest based WMH volumes for the JHU (Johns Hopkins University) white matter tracts and labels were calculated and WMH were assessed semi quantitatively by using the Fazekas scale.
Results:
ET patients and healthy controls did not differ in their total or tract-specific WMH volumes or Fazekas´s scores. However, WMH volume was significant positively correlated with tremor severity on the TETRAS scale and there was a significant negative correlation with the mean accelerometric tremor frequency. In a multiple linear regression model including disease duration, age and age-adjusted total WMH volume, only the WMH volume significantly predicted tremor severity while age and disease duration were not significant. 
Conclusion:
We found evidence for a direct association between WMH volume and tremor severity. If confirmed by larger studies, our findings could explain the well-known relation between age and tremor severity.