Abstract

Pathological tremor is a common but highly complex movement disorder, affecting ~5% of population older than 65 years. Different methodologies have been proposed for its quantification. Nevertheless, the discrimination between Parkinson’s disease tremor and essential tremor remains a daunting clinical challenge, greatly impacting patient treatment and basic research. Here, we propose and compare several movement-based and electromyography-based tremor quantification metrics. For the latter, we identified individual motor unit discharge patterns from high-density surface electromyograms and characterized the neural drive to a single muscle and how it relates to other affected muscles in 27 Parkinson’s disease and 27 essential tremor patients. We also computed several metrics from the literature. The most discriminative metrics were the symmetry of the neural drive to muscles, motor unit synchronization, and the mean log power of the tremor harmonics in movement recordings. Noteworthily, the first two most discriminative metrics were proposed in this study. We then used decision tree modelling to find the most discriminative combinations of individual metrics, which increased the accuracy of tremor type discrimination to 94%. In summary, the proposed neural drive-based metrics were the most accurate at discriminating and characterizing the two most common pathological tremor types.