Multiple Sclerosis Intention Tremor Research Articles

Upper Limb Intention Tremor in Multiple Sclerosis: An Evidence-Based Review of Assessment and Treatment.

To present the current knowledge on the characteristics, assessment, and treatment of upper limb intention tremor to inform and improve future intervention studies in patients with multiple sclerosis (MS), we conducted a literature review for articles on upper limb intention tremor in patients with MS. Two reviewers conducted searches in PubMed, Web of Science, and MEDLINE (Ovid). Relevant articles, sorted on inclusion criteria, were examined for descriptions and assessments of upper limb intention tremor, and intervention studies were evaluated based on treatment type. Eight descriptive studies were found reporting on the incidence and severity of tremor, impairments, and lesion load. Ten studies focused on measurement of tremor using various assessments. Intervention studies included eight articles using a diverse set of noninvasive techniques mainly showing transient reduction in tremor amplitude and temporary increase in function. Eighteen studies on pharmacologic interventions were found, with most displaying positive outcomes and mediation of tremor; others showed little to no benefit. Surgical interventions included 17 studies on thalamotomy and 20 on deep brain stimulation. Most studies showed tremor improvement after surgery; however, most sample sizes were small, and interventions were highly invasive, with potential adverse effects resulting from surgery. The literature on upper limb intention tremor in MS is relatively sparse. More studies are required to determine mechanism of action and to provide more suitable and sustainable interventions to decrease upper limb intention tremor and improve quality of life of individuals with MS.

Instrumented finger-to-nose test for the quantitative assessment of intention tremor in multiple sclerosis: A Hilbert-Huang-based approach

Instrumented finger-to-nose test for the quantitative assessment of intention tremor in multiple sclerosis: A Hilbert-Huang-based approach

Hilbert–Huang transform based instrumental assessment of intention tremor in multiple sclerosis

Objective. This paper describes a method to extract upper limb intention tremor from gyroscope data, through the Hilbert–Huang transform (HHT), a technique suitable for the study of nonlinear and non-stationary processes. The aims of the study were to: (i) evaluate the method’s ability to discriminate between healthy controls and MS subjects; (ii) validate the proposed procedure against clinical tremor scores assigned using Fahn’s tremor rating scale (FTRS); and (iii) compare the performance of the HHT-based method with that of linear band-pass filters. Approach. HHT was applied on gyroscope data collected on 20 MS subjects and 13 healthy controls (CO) during finger-to-nose tests (FNTs) instrumented with an inertial sensor placed on the hand. The results were compared to those obtained after traditional linear filtering. The tremor amplitude was quantified with instrumental indexes (TIs) and clinical FTRS ratings. Main results. The TIs computed after HHT-based filtering discriminated between CO and MS subjects with clinically-detected intention tremor (MS_T). In particular, TIs were significantly higher in the final part of the movement (TI2) with respect to the first part (TI1), and, for all components (X, Y, Z), MS_T showed a TI2 significantly higher than in CO subjects. Moreover, the HHT detected subtle alterations not visible from clinical ratings, as TI2 (Z-component) was significantly increased in MS subjects without clinically-detected tremor (MS_NT). The method’s validity was demonstrated by significant correlations between clinical FTRS scores and TI2 related to X (rs = 0.587, p = 0.006) and Y (rs = 0.682, p < 0.001) components. Contrarily, fewer differences among the groups and no correlation between instrumental and clinical indexes emerged after traditional filtering. Significance. The present results supported the use of the HHT-based procedure for a fully-automated quantitative and objective measure of intention tremor in MS, which can overcome the limitations of clinical scales and provide supplementary information about this sign.

Is MS Intention Tremor Amplitude Related to Changed Peripheral Reflexes?

Intention tremor is related to lesions in the cerebellum or connected pathways. Intention tremor amplitude decreased after peripheral arm cooling in patients with multiple sclerosis (MS), likely caused by a reduction of muscle spindle afferent inflow, while amplitude increased when muscle spindles were artificially stimulated by tendon vibration. This study investigated the contribution of peripheral reflexes to the generation of MS intention tremor. Tendon reflexes of biceps, triceps, and brachioradialis, muscles were measured, using an electromechanical triggered reflex hammer. MS patients with (n = 17) and without (n = 17) upper limb intention and 18 healthy controls were tested. Latency of brachioradialis, biceps, and triceps tendon reflexes was greater in MS patients with tremor than in healthy controls and MS patients without tremor (except for the triceps reflex). Peak and peak-to-peak amplitude were not different between groups. It is concluded that tendon reflexes were delayed but not enlarged in MS patients with tremor.

Shaking up the Salpêtrière

To analyze Jean-Martin Charcot's studies of mercury-induced tremor. This study examines Charcot's original notes on mercury intoxication from the Bibliothèque Charcot, Paris, and his show-and-tell patient presentations that were hand-transcribed by his students and later published. Using his standard method of presenting multiple patients with a similar disorder side by side, Charcot assembled a series of patients with mercurial intoxication from the clinics of Paris. He emphasized the rest and action components of mercury-induced tremor and stressed the value of using graphical tremor recordings rather than relying only on visual observation. He drew attention to the importance of air ventilation to avoid intoxication and of removal from intoxicating environments. He distinguished the characteristics of mercury-induced tremor from tremor associated with Parkinson disease, multiple sclerosis, and general paresis. Based on the similar intention tremor in multiple sclerosis and mercury intoxication, human pathology studies in multiple sclerosis, and animal experiments with mercury, he suggested that axonal demyelination underlay this form of tremor in both conditions, the former restricted to the CNS and the second to peripheral nerves. These cases illuminate Charcot's diagnostic strategy and his reliance on the clinico-anatomic method to correlate pathology with clinical signs. Whereas much of Charcot's work emphasized hereditary etiologies of neurologic disease, these examples allow an understanding of his views on environmental factors in neurologic disorders as well as treatment strategies.

Interventions for Upper-Limb Intention Tremor in Multiple Sclerosis

Approximately 25% of people with multiple sclerosis (MS) experience upper-limb intention tremor (ULIT), which limits their ability to participate in daily activities. Little research has been conducted on the effectiveness of available treatments for ULIT. The objectives of this study were to investigate the use of occupational therapy interventions to improve eating and handwriting performance in adults with MS and ULIT and, based on these findings, to provide recommendations for the development of a treatment protocol for ULIT. Six adults with MS and ULIT were recruited from an MS clinic. Participants rated their pre- and post-intervention functional performance using the Multi-Dimensional Assessment of Tremor. Interventions included education about tremor, proximal stabilization, hand-over-hand technique, weighted tool, weighted wrist, and splinting. Participants evaluated the techniques using visual analogue scales (VASs). One month after the intervention, participants were interviewed to assess sustainability of the techniques. Pre- and post-intervention functional scores, VAS scores, and qualitative reports were used to evaluate the success of the techniques in improving participants' abilities in eating and handwriting. Preliminary evidence demonstrates the usefulness and sustainability of the behavioral strategies and the use of multiple techniques simultaneously in the treatment of ULIT. Further investigation is needed to support the use of weights and splints. Recommendations for the further development of a ULIT treatment protocol were provided.

Digitised spirography as an evaluation tool for intention tremor in multiple sclerosis

This study investigated validity and reliability of digitised circle and square spiral drawing for quantifying intention tremor severity and related disability in patients with multiple sclerosis (MS). The tremor amplitude was measured as the standard deviation of the drawing velocity of the arm in the radial and tangential direction for circle spiral drawing, and in the horizontal and vertical direction for square spiral drawing. Results were compared with those of MS patients without tremor and healthy controls, and correlated with clinical assessments of tremor severity and arm functionality including Fahn's tremor rating scale, Test d’Evaluation des Membres supérieurs des Personnes Agées (TEMPA) and the nine-hole-peg test to examine validity. Comparison of patient's performance between four repeated trials examined short-term test-retest reliability.All digitised spirography variables discriminated between the MS-tremor and both MS-no-tremor and healthy control groups. Validity was also shown by high spearman correlation coefficients between spirography variables and clinical ratings. Tremor appeared to be most profound in the radial and vertical direction during circle and square spiral drawing, respectively. The consistency and high correlations between four repeated executions indicated short-term test-retest reliability.We conclude that the digitised spirography provide a useful instrumentation for quantifying MS intention tremor.

The effect of changed visual feedback on intention tremor in multiple sclerosis

In patients with multiple sclerosis (MS), intention tremor amplitude is enhanced during the visually guided compared to the memory guided motor tasks. In the present study, the effect of visual feedback on intention tremor was investigated during visually guided wrist step-tracking tasks. Specifically, visual feedback of the hand was provided either instantly or averaged over different time windows. Thirteen MS patients with intention tremor and 14 healthy controls performed the wrist step-tracking task, while the visual representation of the actual hand position was displayed instantly or averaged over time windows of 150, 250 and 350 ms. It has been found in the patient group that, in association with a decreased initial error and decreased tremor amplitude on the screen, the amplitude of the actual performed tremor also decreased when visual feedback was changed. The tremor reduction was not different between conditions with manipulated feedback, although delays in presenting visual feedback of the hand position increased when the time window was larger. The reduction in overall tremor amplitude was unlikely related to other factors, such as eye fixation deficits or the speed of the primary hand movement. These results suggest that hand tremor severity is dependent on the visual feedback of position and movement errors.

Effects of peripheral cooling on intention tremor in multiple sclerosis

Objective: To investigate the effect of peripheral sustained cooling on intention tremor in patients with multiple sclerosis (MS). MS induced upper limb intention tremor affects many functional activities and is...

Thalamotomy for the relief of intention tremor in multiple sclerosis.

Acta Neurologica ScandinavicaVolume 38, Issue s3 p. 153-156 THALAMOTOMY FOR THE RELIEF OF INTENTION TREMOR IN MULTIPLE SCLEROSIS B. Broager, B. BroagerSearch for more papers by this authorT. Fog, T. FogSearch for more papers by this author B. Broager, B. BroagerSearch for more papers by this authorT. Fog, T. FogSearch for more papers by this author First published: October 1962 https://doi.org/10.1111/j.1600-0404.1962.tb01135.xCitations: 9 From the Neurosurgical Department, Bispebjerg Hospital, and the Neurological Department, Kommunehospitalet, Copenhagen. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume38, Issues3October 1962Pages 153-156 RelatedInformation