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For this reason, we used a combination of structural neuroimaging to measure cortical thickness and neurophysiological studies to analyze whether PD tremor was associated with cortex integrity. Magnetic resonance imaging and neurophysiological assessment were performed in 13 nondemented PD patients (9 women, 69.2%) with a clearly tremor\u2010dominant phenotype. Cortical reconstruction and volumetric segmentation were performed with the Freesurfer image analysis software. Assessment of tremor was performed by means of high\u2010density surface electromyography (hdEMG) and inertial measurement units (IMUs). Individual motor unit discharge patterns were identified from surface hdEMG and tremor metrics quantifying motor unit synchronization from IMUs. Increased motor unit synchronization (i.e., more severe tremor) was associated with cortical changes (i.e., atrophy) in wide\u2010spread cortical areas, including caudal middle frontal regions bilaterally (dorsal premotor cortices), left inferior parietal lobe (posterior parietal cortex), left lateral orbitofrontal cortex, cingulate cortex bilaterally, left posterior and transverse temporal cortex, and left occipital lobe, as well as reduced left middle temporal volume. Given that the majority of these areas are involved in controlling movement sequencing, our results support Albert's classic hypothesis that PD tremor may be the result of an involuntary activation of a program of motor behavior used in the genesis of rapid voluntary alternating movements.<\/jats:p>","DOI":"10.1002\/jnr.24248","type":"journal-article","created":{"date-parts":[[2018,4,16]],"date-time":"2018-04-16T23:39:07Z","timestamp":1523921947000},"page":"1341-1352","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Tremor severity in Parkinson's disease and cortical changes of areas controlling movement sequencing: A preliminary study"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1769-4809","authenticated-orcid":false,"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)  Spain"},{"name":"Department of Medicine, Faculty of Medicine Complutense University Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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