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We used a combination of cortical thickness imaging and neurophysiological studies to analyze whether the severity of tremor was associated with anatomical changes in the brain in <jats:styled-content style=\"fixed-case\">ET<\/jats:styled-content> patients<jats:bold>.<\/jats:bold><\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) and a neurophysiological assessment were performed in 13 nondemented <jats:styled-content style=\"fixed-case\">ET<\/jats:styled-content> patients. High field structural brain <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> images acquired in a 3T scanner and analyses of cortical thickness and surface were carried out. Cortical reconstruction and volumetric segmentation was performed with the FreeSurfer image analysis software. We used high\u2010density surface electromyography (hd<jats:styled-content style=\"fixed-case\">EMG<\/jats:styled-content>) and inertial measurement units (<jats:styled-content style=\"fixed-case\">IMU<\/jats:styled-content>s) to quantify the tremor severity in upper extrimities of patients. In particular, advanced computer tool was used to reliably identify discharge patterns of individual motor units from surface hd<jats:styled-content style=\"fixed-case\">EMG<\/jats:styled-content> and quantify motor unit synchronization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found significant association between increased motor unit synchronization (i.e., more severe tremor) and cortical changes (i.e., atrophy) in widespread cerebral cortical areas, including the left medial orbitofrontal cortex, left isthmus of the cingulate gyrus, right paracentral lobule, right lingual gyrus, as well as reduced left supramarginal gyrus (inferior parietal cortex), right isthmus of the cingulate gyrus, left thalamus, and left amygdala volumes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Given that most of these brain areas are involved in controlling movement sequencing, <jats:styled-content style=\"fixed-case\">ET<\/jats:styled-content> tremor could be the result of an involuntary activation of a program of motor behavior used in the genesis of voluntary repetitive movements.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.681","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T14:01:03Z","timestamp":1541685663000},"page":"83-97","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Essential tremor severity and anatomical changes in brain areas controlling movement sequencing"],"prefix":"10.1002","volume":"6","author":[{"given":"Juli\u00e1n","family":"Benito\u2010Le\u00f3n","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital 12 de Octubre Madrid Spain"},{"name":"Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED) Madrid Spain"},{"name":"Department of Medicine Faculty of Medicine Complutense University Madrid 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