scholarly journals Is MS Intention Tremor Amplitude Related to Changed Peripheral Reflexes?

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Peter Feys ◽  
Werner Helsen ◽  
Stephan Ilsbroukx ◽  
Tom Meurrens

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.

2010 ◽  
Vol 12 (3) ◽  
pp. 122-132 ◽  
Author(s):  
Frances Hawes ◽  
Carley Billups ◽  
Susan Forwell

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.


2018 ◽  
Vol 20 (5) ◽  
pp. 211-223 ◽  
Author(s):  
J. Keiko McCreary ◽  
James A. Rogers ◽  
Susan J. Forwell

Abstract Background: 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. Methods: 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. Results: 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. Conclusions: 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.


2004 ◽  
Vol 10 (6) ◽  
pp. 708-710 ◽  
Author(s):  
Jean Richard Moringlane ◽  
Jörg Spiegel ◽  
Gerhard Fuss ◽  
Ulrich Dillmann ◽  
Manfred Pützer ◽  
...  

A 34-year-old female patient suffering from multiple sclerosis was treated with thalamic electrostimulation for right dominant brachial ataxia and intention tremor. At the end of the fourth year, the energy of the battery of the impulse generator was depleted. However, the patient was able to use her hands without major impairment with the stimulator OFF, due to a stable reduction of the degree of ataxia and intention tremor. The opposite thalamus received an electrode that was never activated because of a permanent thalamotomy effect. Thus, it can be concluded that restoration of function by means of deep brain stimulation might have been beneficial towards achieving a reorganization and stabilization of subcortico-cortical and cerebellar circuitry, supporting the process of self-repair in this patient with a less aggressive course of multiple sclerosis. However, scientific proof has yet to be found. This exceptional observation emphasizes the need for longterm studies.


2003 ◽  
Vol 9 (5) ◽  
pp. 492-502 ◽  
Author(s):  
P Feys ◽  
W F Helsen ◽  
X Liu ◽  
A Lavrysen ◽  
V Loontjens ◽  
...  

The effect of visual information on step-tracking movements was studied in 18 patients with intention tremor due to multiple sclerosis (MS) and 15 healthy controls. Participants performed a slow wrist step-tracking task with stationary targets under five visual feedback conditions. The display of the target and movement cues was selectively withdrawn to examine the effects of visual information on intention tremor and movement accuracy. Results showed that intentio n tremor was most pronounced when visual display of both target and movement cues was available. Withdrawing visual information of the limb movement reduced tremor more than withdrawing the visual display of the target cues. Both the patient and control group was less accurate when the display of limb movement was occluded. Patients, however, were more dependent on visual information of the limb movement for accurate motor performance than healthy controls. When the visual display of the limb movement was partially occluded between or near to the targets, tremor decreased without deterioration of movement accuracy.


1998 ◽  
Vol 79 (5) ◽  
pp. 2265-2276 ◽  
Author(s):  
Sabine M. P. Verschueren ◽  
Paul J. Cordo ◽  
Stephan P. Swinnen

Verschueren, Sabine M. P., Paul J. Cordo, and Stephan P. Swinnen. Representation of wrist joint kinematics by the ensemble of muscle spindles from synergistic muscles. J. Neurophysiol. 79: 2265–2276, 1998. Proprioceptive information about movement is transmitted to the central nervous system by a variety of receptor types, which are widely distributed among the muscles, joints, and skin. Muscle spindles are known to be an important and reliable source of information for the perception of movement kinematics. Previous studies that focused on the characteristics of single muscle spindle firing patterns have left the impression that each receptor fires in relation to a number of kinematic variables, leaving the following question unanswered: what role is played by the ensemble of muscle spindles within the same muscle or within synergistic muscles? The study described in this paper addressed whether the perception of joint position and velocity is based on the net input of muscle spindles residing in all synergistic muscles crossing a joint. Normal human adults performed a motor coordination task that required perception of joint velocity and dynamic position at the wrist. The task was to open the left hand briskly as the right wrist was passively rotated in the flexion direction through a prescribed target angle. In randomly occurring trials, the tendons to three muscles [extensor carpi radialis (ECR), extensor carpi ulnaris (ECU), and extensor digitorum (ED)] were vibrated either individually or in different combinations during the performance of the motor task. Tendon vibration is known to distort muscle spindle firing patterns, and consequently, kinesthesia. By comparing performance errors with and without tendon vibration, the relative influences of muscle spindles residing in ECR, ECU, and ED were quantified. Vibration of the individual ECR, ECU, or ED tendons produced systematic undershoot errors in performance, consistent with the misperception of wrist velocity and dynamic position. Performance errors were larger when combinations of, rather than individual, muscle tendons were vibrated. The error resulting from simultaneous vibration of ECR and ECU was roughly equal to the sum of the errors produced by vibration of the individual tendons. These effects of vibrating synergistic tendons at the wrist suggest that kinesthesia is derived from the integrated input of muscle spindles from all synergistic muscles.


2021 ◽  
pp. 92-99
Author(s):  
Salvatore Facciorusso ◽  
Stefania Spina ◽  
Luigi Santoro ◽  
Nicoletta Cinone ◽  
Alessio Baricich ◽  
...  

Upper limb intention tremor is a common cause of disability in multiple sclerosis (MS). Transcranial direct current stimulation (tDCS) is an emerging form of brain stimulation used to improve sensorimotor impairments in many neurological disorders. Here, we describe a combined therapeutic approach with botulinum neurotoxin type A (BoNT-A) and tDCS for the treatment of upper limb tremor in a patient with MS. We administered a cathodal tDCS 15 days after the injections of BoNT-A. Both post-injection and post-stimulation evaluation revealed a considerable improvement of the tremor. This approach positively affected the patient’s activities of daily living. Our case report shows a safe and beneficial effect of tDCS in the treatment of action tremor in MS especially as a possible adjunctive synergic treatment with BoNT-A injections.


Author(s):  
Laurence P. Ketteringham ◽  
Simon A. Neild ◽  
Rick A. Hyde ◽  
Rosie J. S. Jones ◽  
Angela Davies Smith

This paper reports on a project to measure and control tremor in individuals with multiple sclerosis (MS). It discusses systems for measuring and modelling upper limb movements and intention tremor, together with initial movement measurement and torque modelling data. The system uses microelectromechanical systems (MEMS) sensors to measure movements of the upper limb representative of everyday tasks. Surface electromyogram (EMG) measurements are taken simultaneously to provide gross muscle activity data. A dynamic model is used to simulate the movements, allowing particular sites to be studied in detail. Initial movement data is presented, comparing analysed EMG data and torque estimated by the dynamic model around the elbow joint. Despite the simple analysis, a good fit was obtained. The dynamic model includes a neuromuscular modelling system which will be used in future work to simulate the interactions between measured movements containing intention tremor and the intention behind them, allowing better understanding of the tremor and creating better descriptions of the tremor. Future work will use measured data and modelling to develop methods of attenuating intention tremor, by providing real-time feedback control of tremor reduction devices, without adversely affecting the underlying intended movement.


2021 ◽  
pp. 088307382199988
Author(s):  
Giuseppina Pilloni ◽  
Martin Malik ◽  
Raghav Malik ◽  
Lauren Krupp ◽  
Leigh Charvet

Aim: To adopt a computer-based protocol to assess grip fatigability in patients with pediatric-onset multiple sclerosis to provide detection of subtle motor involvement identifying those patients most at risk for future decline. Method: Pediatric-onset multiple sclerosis patients were recruited during routine outpatient visits to complete a grip assessment and compared to a group of healthy age- and sex-matched controls. All participants completed a computer-based measurement of standard maximal grip strength and repetitive and sustained grip performance measured by dynamic and static fatigue indices. Results: A total of 38 patients with pediatric-onset multiple sclerosis and 24 healthy controls completed the grip protocol (right-hand dominant). There were no significant group differences in maximal grip strength bilaterally (right: 21.8 vs 19.9 kg, P = .25; left: 20.4 vs 18.7 kg, P = .33), although males with pediatric-onset multiple sclerosis were significantly less strong than healthy controls (right: 26.53 vs 21.23 kg, P = .009; left; 25.13 vs 19.63 kg, P = .003). Both dynamic and static fatigue indices were significantly higher bilaterally in pediatric-onset multiple sclerosis compared with healthy control participants (left-hand dynamic fatigue index: 18.6% vs 26.7%, P = .003; right-hand static fatigue index: 28.3% vs 41.3%, P < .001; left-hand static fatigue index: 31.9% vs 42.6%, P < .001). Conclusion: Brief repeatable grip assessment including measures of dynamic and sustained static output can be a sensitive indicator of upper extremity motor involvement in pediatric-onset multiple sclerosis, potentially identifying those in need of intervention to prevent future disability.


Sign in / Sign up

Export Citation Format

Share Document