Although essential tremor is the most common movement disorder, there is little 
knowledge about the pathophysiological mechanisms of this disease. Therefore, we 
explored brain connectivity based on slow spontaneous fluctuations of blood 
oxygenation level dependent (BOLD) signal in patients with essential tremor 
(ET). A cohort of 19 ET patients and 23 healthy individuals were scanned in 
resting condition using functional magnetic resonance imaging (fMRI). General 
connectivity was assessed by eigenvector centrality (EC) mapping. Selective 
connectivity was analyzed by correlations of the BOLD signal between the 
preselected seed regions and all the other brain areas. These measures were then 
correlated with the tremor severity evaluated by the Fahn-Tolosa-Marin Tremor 
Rating Scale (FTMTS). Compared to healthy subjects, ET patients were found to 
have lower EC in the cerebellar hemispheres and higher EC in the anterior 
cingulate and in the primary motor cortices bilaterally. In patients, the FTMTS 
score correlated positively with the EC in the putamen. In addition, the FTMTS 
score correlated positively with selective connectivity between the thalamus and 
other structures (putamen, pre-supplementary motor area (pre-SMA), parietal 
cortex), and between the pre-SMA and the putamen. We observed a selective 
coupling between a number of areas in the sensorimotor network including the 
basal ganglia and the ventral intermediate nucleus of thalamus, which is widely 
used as neurosurgical target for tremor treatment. Finally, ET was marked by 
suppression of general connectivity in the cerebellum, which is in agreement 
with the concept of ET as a disorder with cerebellar damage.