Functional corticomuscular connection during reaching is weakened following stroke

ObjectiveTo investigate the functional connection between motor cortex and muscles, we measured electroencephalogram–electromyogram (EEG–EMG) coherence of stroke patients and controls.MethodsEight healthy controls and 21 patients with shoulder and elbow coordination deficits were enrolled. All subjects performed a reaching task involving shoulder flexion and elbow extension. EMG of the anterior deltoid (AD) and brachii muscles (BB, TB) and 64-channel scalp EEG were recorded during the task. Time-frequency coherence was calculated using the bivariate autoregressive model.ResultsStroke patients had significantly lower corticomuscular coherence compared with healthy controls for the AD and BB muscles at both the beta (20–30 Hz) and lower gamma (30–40 Hz) bands during the movement. BH procedure (FDR) identified a reduced corticomuscular coherence for stroke patients in 11 of 15 scalp area–muscle combinations. There was no statistically significant difference between stroke patients and control subjects according to coherence in other frequency bands.ConclusionPoorly recovered stroke survivors with persistent upper-limb motor deficits exhibited significantly lower gamma-band corticomuscular coherence in performing a reaching task.SignificanceThe study suggests poor brain-muscle communication or poor integration of the EEG and EMG signals in higher frequency band during reaching task may reflect an underlying mechanism producing movement deficits post-stroke.     

Corticomuscular coherence: a review.

Corticomuscular coherence measured between electroencephalography (EEG), magnetoencephalography, or local field potentials and electromyography (EMG) should be helpful in understanding the cortical control of movement. EEG-EMG coherence and phase spectra depend on the types of EEG derivation and current source density function of EEG appears to be the most appropriate for computation of EEG-EMG coherence. A new model for the interpretation of the phase spectra ("constant phase shift plus constant time lag model") shows that cortical surface negative potentials are phase-locked to EMG firing. There are functional differences of EEG-EMG coherence among the alpha, beta, and gamma bands suggesting differences in their possible generator mechanisms. Since corticomuscular coherence is a noninvasive measure of corticomotoneuronal function in a specific frequency range, clinical application of this method might be very fruitful in tremor research.     

Differentiating phase shift and delay in narrow band coherent signals

OBJECTIVE: Differentiating between a fixed activation pattern (phase shift) and conduction time (time delay) in rhythmic signals has important physiological implications but is methodologically difficult. METHODS: Delay was estimated by the maximising coherence method and phase spectra calculated between (i) a narrow band-pass filtered AR2 process and its delayed copy for different phase shifts, (ii) the surface EMGs from two antagonistic forearm muscles with reciprocal alternating activity, and (iii) EEG and EMG data from 11 recordings in five Parkinsonian tremor patients. RESULTS: Estimated delays between the versions of the AR2 process resembled the real delay and were not significantly biased by the phase-shifts. The reciprocal alternating pattern of muscle activation was shown to be a pure phase-shift without any time delay. The phase between tremor-coherent cortical electrodes and EMG showed opposite signs and differed by 3pi/4-pi between the antagonistic muscles. Bidirectional delays between contralateral cortex and EMG did not differ between the antagonists and were in keeping with fast corticospinal transmission and feedback to the cortex for both muscles. CONCLUSIONS: Phase shifts and delays reflect different mechanisms in tremor related oscillatory interactions. SIGNIFICANCE: The maximising coherence method can differentiate between them.     

High functional connectivity of tremor related subthalamic neurons in Parkinson’s disease

ObjectiveTremor is a core symptom of Parkinson’s disease (PD). The subthalamic nucleus (STN) seems to be crucial for tremor pathophysiology considering that deep brain stimulation (DBS) of the STN leads to an effective reduction of Parkinsonian tremor. Here, we investigate the functional connectivity between STN neurons in patients with Parkinsonian tremor.MethodsSTN activity was analyzed in 7 patients with Parkinsonian rest tremor who underwent stereotactic surgery for DBS. Spike activity was registered in different depths of the STN using an array of five microelectrodes. Interneuronal coherence within the STN was analyzed.ResultsSignificant interneuronal coherence at the tremor frequency was detected in 78 out of 145 neurons. In contrast, interneuronal coherence in the beta band occurred only in 26 out of 145 neurons. Functional connectivity at the tremor frequency can be characterized by a slowly decaying exponential curve which describes coherence between STN neurons as a function of interneuronal distances between 0 and 4 mm.ConclusionsSpatially distributed synchronization at the tremor frequency seems to be a key feature of STN pathophysiology in patients with Parkinsonian tremor.SignificanceThe findings suggest a subthalamic tremor network which is widely extended and strongly coupled.     

Investigating the Effects of Peripheral Electrical Stimulation on Corticomuscular Functional Connectivity Stroke Survivors

Background: Electrical stimulation (ES) in the periphery can induce brain plasticity and has been used clinically to promote motor recovery in patients with central nervous system lesion. Electroencephalogram (EEG) and electromyogram (EMG) are readily applicable in clinical settings and can detect real-time functional connectivity between motor cortex and muscles with EEG–EMG (corticomuscular) coherence.

Objective: The purpose of this study was to determine whether EEG–EMG coherence can detect changes in corticomuscular control induced by peripheral ES.

Methods: Fifteen healthy young adults and 15 stroke survivors received 40-min electrical stimulation session on median nerve. The stimulation (1-ms rectangular pulse, 100 Hz) was delivered with a 20-s on–20-s off cycle, and the intensity was set at the subjects’ highest tolerable level without muscle contraction or pain. Both before and after the stimulation session, subjects performed a 20-s steady-hold thumb flexion at 50% maximal voluntary contraction (MVC) while EEG and EMG were collected.

Results: Our results demonstrated that after ES, EEG–EMG coherence in gamma band increased significantly for 22.1 and 48.6% in healthy adults and stroke survivors, respectively. In addition, after ES, force steadiness was also improved in both groups, as indicated by the decrease in force fluctuation during steady-hold contraction (?1.7% MVC and ?3.9%MVC for healthy and stroke individuals, respectively).

Conclusions: Our results demonstrated that EEG–EMG coherence can detect ES-induced changes in the neuromuscular system. Also, because gamma coherence is linked to afferent inputs encoding, improvement in motor performance is likely related to ES-elicited strong sensory input and enhanced sensorimotor integration.     

Tremor-correlated cortical activity detected by electroencephalography.

OBJECTIVE: In this study we investigated whether cortical activity related to Parkinsonian resting tremor can be detected by electroencephalography (EEG). METHODS: Seven patients with idiopathic Parkinson's disease suffering from unilateral tremor participated in the study. Electromyography (EMG) signals arising from the wrist extensor and flexor muscles as well as a high resolution EEG were recorded simultaneously. Coherencies between EEG and EMG were calculated. RESULTS: In all patients, we found highly significant coherencies at the tremor frequency or its first harmonic between the tremor EMG and contralateral EEG channels. There were no significant coherencies between the tremor EMG and ipsilateral EEG channels. Isocoherency maps illustrating the topography of the coherencies over the scalp showed that the maximum coherencies were situated over the cortical motor areas. In one case, a high coherency was also found over the parietal cortex. CONCLUSIONS: The results show for the first time that tremor-correlated cortical activity can be detected by electroencephalography. The findings underline that motor areas of the cerebral cortex are involved in the neuronal network generating resting tremor in Parkinson's disease.     

Corticomuscular coherence is increased in the small postural tremor of Parkinson's disease.

The mechanisms and electrophysiological characteristics of the postural tremor in Parkinson's disease (PD) have not been defined. We hypothesized that PD subjects with small amplitude postural tremor would show increased corticomuscular coherence at certain frequencies compared to PD subjects without visible tremor. Four groups of participants were studied: (1) Control without postural tremor, (2) Control with small amplitude postural tremor, (3) PD without postural tremor, and (4) PD with small amplitude postural tremor. Accelerometry and electroencephalography-electromyography fast-fourier transform and corticomuscular coherence spectra were generated. Findings showed (1) elevated corticomuscular coherence centered at 12-18 Hz in PD with small amplitude postural tremor; (2) 5-12 Hz accelerometer frequency peaks that did not shift with increasing weight loads in some individuals; and (3) 5-8 Hz accelerometer peaks that shifted frequency with increasing weight loads, consistent with a peripheral-mechanical oscillator in all groups. The small amplitude postural tremor in PD arises from heterogeneous oscillator mechanisms. The discovery of increased corticomuscular coupling shows cortical involvement in the small amplitude postural tremor of PD.     

Physiological and harmonic components in neural and muscular coherence in Parkinsonian tremor.

OBJECTIVE: To differentiate physiological from harmonic components in coherence analysis of the tremor-related neural and muscular signals by comparing power, cross-power and coherence spectra. METHODS: Influences of waveform, burst-width and additional noise on generating harmonic peaks in the power, cross-power and coherence spectra were studied using simulated signals. The local field potentials (LFPs) of the subthalamic nucleus (STN) and the EMGs of the contralateral forearm muscles in PD patients with rest tremor were analysed. RESULTS: (1) Waveform had significant effect on generating harmonics; (2) noise significantly decreased the coherence values in a frequency-dependent fashion; and (3) cross-spectrum showed high resistance to harmonics. Among six examples of paired LFP-EMG signals, significant coherence appeared at the tremor frequency only, both the tremor and double tremor frequencies and the double-tremor frequency only. CONCLUSIONS: In coherence analysis of neural and muscular signals, distortion in waveform generates significant harmonic peaks in the coherence spectra and the coherence values of both physiological and harmonic components are modulated by extra noise or non-tremor related activity. SIGNIFICANCE: The physiological or harmonic nature of a coherence peak at the double tremor frequency may be differentiated when the coherence spectra are compared with the power and in particular the cross-power spectra.     

Corticomuscular coherence in acute and chronic stroke

ObjectiveMotor recovery after stroke is attributed to neuronal plasticity, however not all post-stroke neuronal changes relate to regaining fine motor control. Corticomuscular coherence (CMC) is a measure allowing to trace neuronal reorganizations which are functionally relevant for motor recovery. Contrary to previous studies which were performed only in chronic stage, we measured CMC in patients with stroke at both acute and chronic stroke stages.MethodsFor the detection of CMC we used multichannel EEG and EMG recordings along with an optimization algorithm for the detection of corticomuscular interactions.ResultsIn acute stroke, the CMC amplitude was larger on the unaffected side compared to the affected side and also larger compared to the unaffected side in the chronic period. Additionally, CMC peak frequencies on both sides decreased in the acute compared to the chronic period and to control subjects. In chronic stage, there were no inter-hemispheric or group differences in CMC amplitude or frequency.ConclusionsThe changes in CMC parameters in acute stroke could result from a temporary decrease in inhibition, which normalizes in the course of recovery. As all patients showed very good motor recovery, the modulation of CMC amplitude and frequency over time might thus reflect the process of motor recovery.SignificanceWe demonstrate for the first time the dynamical changes of corticomuscular interaction both at acute and chronic stage of stroke.     

Differential effects of changes in mechanical limb properties on physiological and pathological tremor.

The effect of changes in mechanical limb properties on the peak frequency of different tremor forms was analysed. Wrist tremor was recorded by an accelerometer fixed to the dorsum of the hand and demodulated surface EMG was recorded from the wrist extensors, while the extended hand was loaded with successively heavier weights. Physiological tremor was characterised by flat EMG spectra and a gradual decrease in tremor peak frequency with increasing load, as would be expected from the properties of a passive spring-mass-system. Also the peak frequency of activated physiological tremor characterised by increased synchronisation between motor units decreased in frequency with increasing loads. EMG spectra showed clear peaks of activity at the various mechanically determined tremor frequencies. In contrast, in two pathological tremor forms, the postural tremor in Parkinsonian patients and essential tremor, peak frequency tended to remain stable irrespective of changes in load. The method therefore allows a simple distinction between physiological and these two pathological tremors.     

Neurophysiological,behavioural and perceptual differences between wrist flexion and extension related to sensorimotor monitoring as shown by corticomuscular coherence

ObjectiveTo investigate the effects of neurophysiological, behavioural and perceptual differences between wrist flexion and extension movements, on their corticomuscular coherence (CMC) levels.MethodsCMC was calculated between simultaneously recorded electroencephalography (EEG) and electromyography (EMG) measures from fifteen healthy subjects who performed 10 repetitions of alternating isometric wrist flexion and extension tasks at 15% of their maximum voluntary contraction (MVC) torque levels. Task precision was calculated from torque recordings. Subjects rated the perceived difficulty levels for both tasks.ResultsFlexors had significantly lower; peak beta CMC, peak frequency, frequency width, normalised EMG beta power, torque fluctuation (<5 Hz and beta band) and perceived difficulty ratings; but higher MVC and precision compared to extensors. EEG alpha and beta powers were non-different between flexion and extension.ConclusionsAn inverse relationship between CMC and motor precision was found in our inter-muscle study, contrary to the direct relationship found in a prior intra-muscle study. Functional suitability, long term usage adaptation and lower perceived difficulty of wrist flexion may explain the results.SignificanceWe extend the CMC literature to include the clinically different, antagonistic wrist flexors and extensors and add to the debate relating CMC and motor precision by positing the confounding effect of perceived difficulty.     

Effects of surface EMG rectification on power and coherence analyses: an EEG and MEG study

Coherence between electromyography (EMG) and electroencephalography (EEG) or magnetoencephalography (MEG) is frequently examined to gain insights on neuromuscular binding. Commonly, EMG signals are rectified before coherence is computed. However, the appropriateness of EMG rectification in computing EMG-EEG/MEG coherence has never been validated. Since rectification is a non-linear operation and alters the EMG power spectrum, such a validation is important to ensure the accuracy of coherence calculation. In this study we experimentally investigated the effects of EMG rectification on EMG power spectra and its coherence with EEG/MEG signals. Subjects performed sustained isometric index finger abduction at approximately 5-10% maximal voluntary force (in both EEG-EMG and MEG-EMG experiments) and index finger tapping at approximately 2-4Hz (in EEG-EMG experiment only). Bipolar surface EMG data from the first dorsal interosseus (FDI) and EEG/MEG signals from the contralateral primary sensorimotor area (C3) were recorded simultaneously. Power spectra and coherence with the EEG/MEG were calculated before and after EMG rectification. The results show that rectification shifts EMG power to lower frequencies, possibly enhancing peaks of motor unit firing. Coherences with the EEG/MEG signals were not significantly changed by EMG rectification, indicating EMG rectification is overall an appropriate procedure in power and coherence analyses.     

Clinical and electromyographic examinations of Parkinsonian tremor

Background: The clinical presentations of postural Parkinsonian tremor are variable and different types of tremors have been described. The aim of this study was to re-evaluate the clinical and electromyographic (EMG) pattern of different tremors in Parkinsonian patients.

Methods: One hundred and ten patients with Parkinsonian tremor were included in the study. Patients were subdivided into four groups according to the presence or absence of postural tremor, in addition to a resting tremor and its EMG pattern. The first group consisted of patients without postural tremor. The second group consisted of patients with fast postural tremor (>7 Hz). The third group consisted of patients with slow postural tremor with alternating EMG activity. Patients with slow postural tremor with synchronous EMG activity were included in the fourth group. In each limb position, the tremor of the most involved body part was graded on the Webster Tremor Scale. Surface EMG recordings of the most involved limb in all positions were performed.

Results: Postural tremor in addition to the rest one was found in 84% of the patients. The postural tremor was with lower amplitude than the rest one. The frequencies and EMG patterns of the postural tremors were different and correlated with some specific clinical symptoms. Patients with alternating postural tremor had a kinetic and intention tremor in addition.

Conclusions: Four different subtypes of Parkinsonian tremor were found according to the presence and type of postural tremor. These subtypes had some differing clinical characteristics and probably different relationships to essential tremor.     

Modulation of human corticomuscular beta-range coherence with low-level static forces

Although corticomuscular synchronization in the beta range (15-30 Hz) was shown to occur during weak steady-state contractions, an examination of low-level forces around 10% of the maximum voluntary contraction (MVC) is still missing. We addressed this question by investigating coherence between electroencephalogram (EEG) and electromyogram (EMG) as well as cortical spectral power during a visuomotor task. Eight healthy right-handed subjects compensated isometrically static forces at a level of 4% and 16% of MVC with their right index finger. While 4% MVC was accompanied by low coherence values in the middle to high beta frequency range (25-30 Hz), a significant increase of coherence mainly confined to low beta frequencies (19-20 Hz) was observed with force of 16% MVC. Furthermore, this increase was associated with better performance, as reflected in decreased relative error in force during 16% MVC. We additionally show that periods of good motor performance within each condition were associated with higher values of EEG-EMG coherence and spectral power. In conclusion, our results suggest a role for beta-range corticomuscular coherence in effective sensorimotor integration, thus stabilizing corticospinal communication.     

Amitriptyline enhances the central component of physiological tremor

OBJECTIVES: Postural tremor is a regularly encountered side effect of amitriptyline which can be strong enough to cause discontinuation of therapy. The aim was to characterise amitriptyline induced tremor and to assess if the central or reflex component of physiological tremor was modulated by this drug. METHODS: The postural hand tremor was measured in 15 patients on a clinical rating scale, by power spectral analysis of accelerometer, forearm flexor, and extensor EMG before and after the beginning of amitriptyline treatment for major depression or chronic pain syndrome. A coherence analysis between flexor and extensor muscles on the same side was performed. RESULTS: There was a clinically visible increase in postural tremor in a third of these patients. The tremor amplitude measured by accelerometer total power increased in every patient under amitriptyline. The EMG synchronisation as reflected by significant peaks in the flexor or extensor spectrum generally occurring at higher frequencies (8-18 Hz) than the accelerometric tremor frequencies (6-11 Hz) did not change. The number of patients with a significant flexor-extensor coherence in the 7-15 Hz range increased significantly under amitriptyline, the frequency bands of significant coherence corresponded with the EMG frequencies, and both were independent of changes to the hand's resonant frequency by added inertia. CONCLUSIONS: An enhancement of postural tremor under amitriptyline is a common phenomenon although not always clinically apparent. The increase in EMG-EMG coherence indicates an increased common central drive to the motor units as its frequency is not influenced by peripheral resonance or reflex mechanisms. This is the first account of a drug induced enhancement of the central component of physiological tremor.     

A longitudinal study of tremor frequencies in Parkinson’s disease and essential tremor

ObjectiveThere is evidence that the tremor frequency in essential tremor (ET) decreases with time. Longitudinal studies on the evolution of tremor frequencies in Parkinson’s disease (PD) have so far not been published. Here, we present a longitudinal analysis of tremor frequencies in PD and ET.MethodsWe analyzed the standardized accelerometric and electromyographic tremor recordings of 53 patients with PD and 38 patients with ET who underwent repeated routine tremor recordings between 1991 and 2002.ResultsIn an average follow-up period of 44.9 months in PD and 50.6 months in ET, the average number of tremor recordings was 3.3 in PD and 3.7 in ET. In both disorders, tremor frequencies tended to decrease with time. The average annual decrease of the tremor frequency was 0.09 Hz/year in Parkinsonian rest tremor, 0.08 Hz/year in Parkinsonian postural tremor and 0.12 Hz/year in ET.ConclusionsThe tremor frequency decreases with time in both PD and ET. The similarity of this decrease in PD and ET may point to a common underlying pathophysiological mechanism.SignificanceDecreasing tremor frequencies with time may be functionally important by inducing larger tremor amplitudes due to the low-pass filtering properties of muscles and limbs.     

Postural tremor in Wilson's disease: a magnetoencephalographic study.

The following study included 5 Wilson's disease (WD) patients showing a right-sided postural forearm tremor (4-6 Hz) and addressed the question of whether the primary motor cortex (M1) is involved in tremor generation. Using a 122-channel whole-head neuromagnetometer and surface electromyogram (EMG), we investigated cerebromuscular coupling. Postural tremor was observed in a sustained 45-degree posture of the right-sided forearm. Data were analyzed using dynamic imaging of coherent sources (DICS), revealing cerebromuscular coupling between EMG and cerebral activity. Coherent sources were superimposed on individual high-resolution T1-weighted magnetic resonance images (MRI). Phase lags between EMG and cerebral areas showing strongest coherence were determined by means of a Hilbert transform of both signals. In all patients, postural tremor was associated with strong coherence between tremor EMG and activity in contralateral primary sensorimotor cortex (S1/M1) at tremor or double tremor frequency. Phase lag values between S1/M1 activity and EMG revealed efferent and afferent components in the corticomuscular coupling. Taken together, our results indicate that postural tremor in WD is mediated through a pathological oscillatory drive from the primary motor cortex.     

Single unit analysis of the human ventral thalamic nuclear group: correlation of thalamic "tremor cells" with the 3-6 Hz component of parkinsonian tremor

Although cells firing at tremor frequency, called "tremor cells" (Guiot et al., 1962), have often been recorded in the thalamus of parkinsonian patients, the extent of correlation between these spike trains and tremor has rarely been assessed quantitatively. This paper describes spectral cross-correlation functions calculated between the activity of "tremor cells" and electromyogram (EMG) signals recorded from several muscles in the contralateral arm. The power occurring in the spike train at tremor frequency was described in absolute terms by the spike autopower, and in relation to the average for all spectral components by the spike autopower signal-to-noise ratio (spike autopower SNR). The probability of significant cross-correlation between the thalamic spike train and EMG at tremor frequency was assessed by the coherence at tremor frequency. Autopower spectra of the activity of many of these cells exhibited a concentration of power at tremor frequency, indicated by spike autopower SNRs as high as 18. Of the EMG signals studied, signals recorded from finger flexors were most often significantly correlated at tremor frequency. Significant correlation between the thalamic spike train and finger flexor EMG activity was found in 34% of cells analyzed. Tremor frequency coherence was significantly correlated with tremor frequency spike autopower (r = 0.46, p less than 0.0001) and spike autopower SNR (r = 0.533, p less than 0.0001). The proportion of cells with a spike autopower SNR greater than 2 that were significantly correlated with finger flexor EMG activity was greater than that of cells with a spike autopower SNR of less than 2 (p less than 0.001; chi-square). Therefore, cells exhibiting a large amount of power at tremor frequency were those best correlated with EMG activity during tremor. Some of these cells may be involved in the generation of tremor.     

Central oscillators in a patient with neuropathic tremor: Evidence from intraoperative local field potential recordings

Present pathophysiological concepts of neuropathic tremor assume mistimed and defective afferent input resulting in deregulation of cerebello‐thalamo‐cortical motor networks. Here, we provide direct evidence of central tremor processing in a 76‐year‐old female who underwent bilateral deep brain stimulation of the ventral intermedial nucleus of the thalamus (Vim‐DBS) because of neuropathic tremor associated with IgM paraproteinemia. Electrophysiological recordings of EEG and EMG were performed in three perioperative sessions: (1) preoperatively, (2) intraoperatively, and (3) 4 days after surgery in both rest and postural tremor conditions. Tremor‐related synchronization (coherence) between motor cortex (M1) and muscles (M. extensor digitorum, M. flexor digitorum) was assessed, and additional intraoperative local field potential (LFP) recordings from Vim allowed comprehensive coherence mapping in thalamo‐cortico‐muscular networks. Directionality of information flow was determined by directed transfer function (DTF) and phase analyses. Stimulation effects on tremor and corticomuscular coherence were assessed and the patient was followed for 12 months on clinical outcome measures (Tremor Rating Scale, CADET‐Score). Vim‐DBS reduced tremor (59%) and improved motor functionality in daily activities (31%, CADET‐A) after 12 months. Intraoperative recordings demonstrated significant coherence in the tremor frequency (4 Hz) between M1 and contralateral muscle, Vim and ipsilateral M1, Vim and contralateral muscle, but not between Vim and contralateral M1. Information flow was directed from M1 to Vim and bidirectional between M1 and muscle and between Vim and muscle, respectively. Corticomuscular coherence at tremor frequency was completely suppressed by Vim‐DBS. Our case study demonstrates central oscillators underlying neuropathic tremor and implies a strong pathophysiological rationale for Vim‐DBS. © 2010 Movement Disorder Society     

Rest tremor correlates with reduced contralateral striatal dopamine transporter binding in Parkinson's disease

IntroductionIn vivo dopamine transporter imaging is a useful tool for distinguishing nigrostriatal pathologies (e.g. Parkinson's disease) from other causes of tremor. However, while many of the motoric features of Parkinson's disease (e.g. bradykinesia, rigidity, hypomimia) correlate well with reduced striatal dopamine transporter binding, the same relationship has not been demonstrated for tremor. We investigated the relationship between striatal dopamine transporter binding and quantitative measures of tremor.Methods23 participants with Parkinson's disease underwent standardised clinical assessment including structured, videotaped clinical examination, tremor neurophysiology study of both upper limbs using accelerometry and surface EMG, and Technitium-99 m TRODAT-1 brain SPECT imaging. Normalised striatal uptake values were calculated. Tremor EMG and accelerometry time series were processed with Fourier transformation to identify peak tremor power within a window of 3–10Hz and to calculate the tremor stability index (TSI).ResultsSpearman correlation analyses revealed an association between tremor power and contralaterally reduced striatal uptake in a number of recording conditions. This association was strongest for rest tremor, followed by postural tremor, with the weakest association observed for kinetic tremor. Lower TSI was also associated with lower contralateral striatal uptake in a number of rest and postural conditions.ConclusionThese data suggest a relationship between Parkinsonian rest tremor and contralateral reduction in striatal dopamine binding. Use of quantitative neurophysiology techniques may allow the demonstration of clinico-pathophysiological relationships in tremor that have remained occult to previous studies.