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A hypothesis is that a defective control in the preexisting cerebellar\u2010motor loop drives cortical tremor. Meanwhile, the basal ganglia system might also participate in BAFME. This study aimed to discover the structural basis of cortical tremor\/myoclonus in BAFME.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nineteen patients with BAFME type 1 (BAFME1) and 30 matched healthy controls underwent T1\u2010weighted and diffusion tensor imaging scans. FreeSurfer and spatially unbiased infratentorial template (SUIT) toolboxes were utilized to assess the motor cortex and the cerebellum. Probabilistic tractography was generated for two fibers to test the hypothesis: the dentato\u2010thalamo\u2010(M1) (primary motor cortex) and globus pallidus internus (GPi)\u2010thalamic projections. Average fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) of each tract were extracted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cerebellar atrophy and dentate nucleus alteration were observed in the patients. In addition, patients with BAFME1 exhibited reduced AD and FA in the left and right dentato\u2010thalamo\u2010M1 nondecussating fibers, respectively false discovery rate (FDR) correction <jats:italic>q<\/jats:italic>\u2009&lt;\u2009.05. Cerebellar projections showed negative correlations with somatosensory\u2010evoked potential P25\u2010N33 amplitude and were independent of disease duration and medication. BAFME1 patients also had increased FA and decreased MD in the left GPi\u2010thalamic projection. Higher FA and lower RD in the right GPi\u2010thalamic projection were also observed (FDR <jats:italic>q<\/jats:italic>\u2009&lt;\u2009.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The present findings support the hypothesis that the cerebello\u2010thalamo\u2010M1 loop might be the structural basis of cortical tremor in BAFME1. The basal ganglia system also participates in BAFME1 and probably serves a regulatory role.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17430","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T09:38:38Z","timestamp":1664962718000},"page":"3192-3203","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Altered cerebellar\u2010motor loop in benign adult familial myoclonic epilepsy type 1: The structural basis of cortical tremor"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2132-9652","authenticated-orcid":false,"given":"Ge","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology Xiangya Hospital, Central South University  Changsha China"},{"name":"National Clinical Research Center for Geriatric Disorders Xiangya Hospital, Central South University  Changsha China"},{"name":"Clinical Research Center for Epileptic Disease 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