Objective Purkinje cell loss has been documented in some although not all postmortem studies of essential tremor. Hence, there is considerable controversy concerning the presence of Purkinje cell loss in this disease. To date, few studies have been performed. Methods Over the past eight years, we have assembled 50 prospectively-studied cases and 25 age-matched controls; none were reported in our prior large series of 33 essential tremor and 21 controls. In addition to methods used in prior studies, the current study used a random sampling approach to quantify Purkinje cells along the Purkinje cell layer with a mean of 217 sites examined in each specimen, allowing for extensive sampling of the Purkinje cell layer within the section. For the first time, we also quantified the distance between Purkinje cell bodies - a nearest neighbor analysis. Results In the Purkinje cell count data collected from fifteen 100x-fields, cases had lower counts than controls in all three counting criteria (cell bodies, nuclei, nucleoli, all p<0.001). Purkinje cell linear density was also lower in cases than controls (all p<0.001). Purkinje cell linear density obtained by random sampling was similarly lower in cases than controls in all three counting criteria (cell bodies, nuclei, nucleoli, all p≤0.005). In agreement with the quantitative Purkinje cell counts, the mean distance from one Purkinje cell body to another Purkinje cell body along the Purkinje cell layer was greater in cases than controls (p=0.002). Conclusions These data provide support for the neurodegeneration of cerebellar Purkinje cells in essential tremor.

Objective Postmortem studies have reported Purkinje cell loss in essential tremor (ET), and we recently demonstrated a significant increase in the mean distance between Purkinje cell bodies (i.e., a larger gap length distance) in ET cases vs. controls, likely reflecting a disease-associated reduction in Purkinje cells. We now analyze the regularity of distribution of Purkinje cells along the Purkinje cell layer to determine whether there is greater disorganization in ET cases than age-matched controls. Methods A standard parasagittal, formalin-fixed, tissue block was harvested from the neocerebellum of 50 ET cases and 25 age-matched controls. The gap length distance (μm) between Purkinje cells was quantified using a nearest neighbor analysis in which the distance between each Purkinje cell body was measured in Open Lab software, version 5 (Improvision, Waltham, MA) by drawing a freehand line between adjacent Purkinje cell bodies along the entirety of the Purkinje cell layer within a given image. We analyzed the subject-specific variation in the organization of Purkinje cells along the Purkinje cell layer. Results The 50 ET cases and 25 controls were similar in age at death, gender and brain weight. Overall, greater variation in gap length distance (i.e., more disorganization) was associated with greater gap length distance (p <0.001) and younger age (p = 0.020). However, the variation in the Purkinje cell gap length distance (i.e., Purkinje cell organization) did not differ in ET cases and controls (p = 0.330). Interpretation We observed that the regularity of the distribution of Purkinje cells along the Purkinje cell layer did not differ between ET cases and controls. Several alternative biological interpretations for this finding are discussed.