Postural tremor and chronic inflammatory demyelinating polyneuropathy

Cao, Yijun; Menon, Parvathi; Chang, Florence; Mahant, Neil; Geevasinga, Nimeshan; Fung, Victor S.C.; Vucic, Steve

doi:10.1002/mus.25253

Cited by 17 publications

(24 citation statements)

References 30 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…None of our patients showed an evident tremor of the lower extremities, similar to another study using the FTM and TETRAS 3 . However, one patient in our study reported that their tremor affected their leg disability on the INCAT‐DS.…”

Section: Discussionsupporting

confidence: 89%

“…Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) symptoms and signs typically include muscle weakness and sensory deficits 1 . Tremor in CIDP is underrecognized but is reported to be present in 58% to 80% of CIDP patients 2,3 …”

Section: Introductionmentioning

confidence: 99%

“…There is also evidence supporting a peripheral origin of tremor, such as associations between tremor severity and nerve conduction study parameters, such as F wave latencies, as well as median and ulnar motor velocities and amplitudes 2,3,10 . However, no substantial consistent associations between tremor and muscle strength or sensory deficit have been reported 2,3,11 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of tremor on disability assessment in chronic inflammatory demyelinating polyradiculoneuropathy

Veen

Pallada

Holter

et al. 2023

J Peripheral Nervous Sys

View full text Add to dashboard Cite

Tremor in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is common, often unresponsive to treatment, and may contribute to disability. We aim to investigate whether tremor is associated with disability as measured in daily practice and clinical trials, independent of other impairments. We included 76 CIDP patients in this cross-sectional study. We assessed tremor with the Tremor Research Group essential tremor rating assessment scale (TETRAS) and the Fahn-Tolosa-Marin clinical rating scale (FTM). Disability was measured with the inflammatory Rasch-built overall disability scale (I-RODS) and the adjusted Inflammatory Neuropathy Cause and Treatment disability scale (INCAT-DS, categorized separately in arm score, or total score). Impairments including strength, sensory impairment, and fatigue were measured using specific impairment scales. We tested whether "the presence of a clinically relevant tremor" (based on TETRAS and FTM) or "tremor severity" (FTM part B sum score) was associated with disability scores (I-RODS, INCAT-DS total score, and INCAT-DS arm score), independent of the impairment scores, using multivariate regression. Both "the presence of a clinically relevant tremor" and "tremor severity" were significantly associated with disability measured by the INCAT-DS (arm score and total score), but not the I-RODS, independent of strength, sensory impairment, and fatigue. The explained variances were low. Clinically relevant tremor can (partly) explain disability in CIDP, as measured with the INCAT-DS, independent of muscle strength, sensory deficits, and fatigue. To assess disease activity in CIDP patients with tremor, both impairment and disability outcomes should be assessed, as disability is caused partly by tremor while the effect of immunotherapy on tremor seems limited.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of tremor on disability assessment in chronic inflammatory demyelinating polyradiculoneuropathy

Veen

Pallada

Holter

et al. 2023

J Peripheral Nervous Sys

View full text Add to dashboard Cite

show abstract

“…Among those with inflammatory demyelinating polyneuropathies, postural or action tremor is found in 60%-80% of patients [5][6][7][8]. CIDP-associated tremor is found at similar rates, although the tremor is usually less severe [5,7].…”

Section: Introductionmentioning

confidence: 99%

Chronic inflammatory demyelinating polyradiculoneuropathy‐associated tremor: Phenotype and pathogenesis

Silsby

Fois

Yiannikas

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

Background and purpose Tremor in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is underrecognized, and the pathophysiology remains incompletely understood. This study evaluated tremor in CIDP and tested the hypothesis, established in other demyelinating neuropathies, that tremor occurs due to mistimed peripheral inputs affecting central motor processing. Additionally, the tremor stability index (TSI) was calculated with the hypothesis that CIDP‐related tremor is more variable than other tremor disorders. Methods Consecutive patients with typical CIDP were prospectively recruited from neuromuscular clinics. Alternative causes of neuropathy and tremor were excluded. Cross‐sectional clinical assessment and extensive tremor study recordings were undertaken. Pearson correlation coefficient was used to compare nerve conduction studies and tremor characteristics, and t‐test was used for comparisons between groups. Results Twenty‐four patients with CIDP were included. Upper limb postural and action tremor was present in 66% and was mild according to the Essential Tremor Rating Assessment Scale. Tremor did not significantly impact disability. Surface electromyography (EMG) found high‐frequency spectral peaks in deltoid (13.73 ± 0.66 Hz), biceps brachii (11.82 ± 0.91 Hz), and extensor carpi radialis (11.87 ± 0.91 Hz) muscles, with lower peaks in abductor pollicis brevis EMG (6.07 ± 0.45 Hz) and index finger accelerometry (6.53 ± 0.42 Hz). Tremor was unchanged by weight loading but correlated with ulnar nerve F‐wave latency and median nerve sensory amplitude. TSI (2.3 ± 0.1) was significantly higher than essential tremor. Conclusions Postural tremor is a common feature in CIDP. Tremor was unaffected by weight loading, typical of centrally generated tremors, although there was a correlation with peripheral nerve abnormalities. The high beat‐to‐beat variability on TSI and gradation of peak frequencies further suggest a complex pathophysiology. These findings may assist clinicians with the diagnosis of neuropathic tremor.

show abstract

“…Cao et al (2017) foi investigado se o tremor é uma característica clínica comum em pacientes com CIDP, outro tipo de polineuropatia inflamatória desmielinizante. Nesse estudo o tremor não foi observado em membros inferiores durante uma tarefa postural, enquanto foi presente nos membros superiores, principalmente nos músculos flexor radial do carpo e extensor radial do carpo, músculos do antebraço.…”

unclassified

Efeitos de neuropatias periféricas desmielinizantes em tarefas de controle motor estudados por meio de um modelo neuromuscular multiescala.

Oliveira¹

View full text Add to dashboard Cite

Multiscale computational models of the neuromuscular system provide a better understanding of the phenomena involved in motor control, as they are based on well-known biophysical, neurophysiological, and biomechanical mechanisms, whose quantifiers are available for analysis. The use of these models for the study of peripheral neuropathies can be useful to obtain a better understanding of the impacts of these neuropathies, as well as serving as a basis for suggesting new proposals for early diagnosis and follow-up. Despite that, multiscale models of the neuromuscular system have not been widely used to study these types of diseases. In the present work, a phenomenological model of motor and sensory axons is proposed, capable of representing axons of subjects with peripheral neuropathies. These axonal representations were inserted into an existing multiscale model of the neuromuscular system, which was elaborated and validated for healthy subjects by previous researchers. As the starting model represents leg muscles, the initial focus was on neuropathies that mainly affect the lower limbs, especially acute inflammatory demyelinating polyneuropathy, a variant of Guillain-Barré syndrome. The existing axon delay model was modified so that it would be possible to represent the axonal conduction velocity of motor and sensory axons, as well as the number of functional motor units. To obtain a representative model of subjects affected by the neuropathy, the model parameters were strongly based on electrophysiological findings of patients available in the literature. Different neuropathy scenarios were simulated in two motor control tasks (force task and position task). The results suggested that it is possible to detect changes in quantitative features of both torque and surface electromyography signals, in force and position tasks, in patients with the studied polyneuropathy. These findings can complement qualitative and quantitative assessments classically used in clinical neurology, aiding early diagnosis and follow-up of the disease. In addition, the developed model allows straightforward adaptation for other conditions not covered in the present research, being only necessary to make the appropriate changes in the model parameters.

show abstract

Postural tremor and chronic inflammatory demyelinating polyneuropathy

Abstract: Tremor appears to be a common clinical feature of CIDP that results in significant disability. Sensory and motor impairment may be associated with development of tremor in CIDP. Muscle Nerve 55: 338-343, 2017.

Cited by 17 publications

References 30 publications

The effect of tremor on disability assessment in chronic inflammatory demyelinating polyradiculoneuropathy

The effect of tremor on disability assessment in chronic inflammatory demyelinating polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy‐associated tremor: Phenotype and pathogenesis

Efeitos de neuropatias periféricas desmielinizantes em tarefas de controle motor estudados por meio de um modelo neuromuscular multiescala.

Contact Info

Product

Resources

About