Mild cerebello-thalamo-cortical impairment in patients with normal dopaminergic scans (SWEDD)

Tommaso Schirinzi, Francesco Di Lorenzo, Viviana Ponzo, Maria Giuseppina Palmieri, Anna Rita Bentivoglio, Orazio Schillaci, Antonio Pisani, Giacomo Koch

Risultato della ricerca: Contributo in rivistaArticolo in rivista

13 Citazioni (Scopus)


INTRODUCTION: Patients with Scans-Without-Evidence-of-Dopaminergic-Deficit (SWEDD) often present asymmetric rest tremor not responsive to levodopa. Although a dystonic origin of this tremor has been proposed, the underlying pathophysiology of such condition is still unclear. An abnormal activity in the Cerebello-Thalamo-Cortical circuit is involved in the pathogenesis of tremor and other movement disorders. Here we used different paradigms of cerebellar transcranial magnetic stimulation to evaluate the Cerebello-Thalamo-Cortical functioning in patients with normal scans. METHODS: Cerebello-Thalamo-Cortical circuit was investigated in 12 patients with normal scans, 8 patients with Parkinson's Disease (PD), 8 patients with adult-onset isolated dystonia and 9 healthy controls. We studied the effects of a single cerebellar magnetic pulse over the excitability of the contralateral primary motor cortex tested with Motor-Evoked-Potentials (Cerebellar-Inhibition) both at rest and during arm extension. Furthermore, we also tested the effects of cerebellar continuous-Theta-Burst-Stimulation on Motor-Evoked-Potentials amplitude. RESULTS:patients with normal scans compared to controls show a deficient Cerebellar-Inhibition at rest but not in arm extension; in both conditions they differ from PD but not from dystonic patients. Cerebellar Continuous-Theta-Burst-Stimulation induced the expected long-lasting cortical inhibition of Motor-Evoked-Potentials amplitude in patients with normal scans differently from PD and dystonic patients. CONCLUSIONS: patients with normal scans show a mild impairment in Cerebello-Thalamo-Cortical circuit that emerges only at rest. Such neurophysiological phenotype differs from the one observed in PD and dystonic patients, suggesting a distinct involvement of this pathway in the pathophysiology of these disorders.
Lingua originaleEnglish
pagine (da-a)23-28
Numero di pagine6
Stato di pubblicazionePubblicato - 2016


  • Cerebello thalamo cortical
  • Dystonia
  • Parkinson's disease
  • Tremor


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