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Bayoumi A, Hasan KM, Patino J, Keser Z, Thomas JA, Gabr RE, Pedroza C, Kamali A. Identifying the white matter pathways involved in multiple sclerosis-related tremor using diffusion tensor imaging. Mult Scler J Exp Transl Clin 2023; 9:20552173231208271. [PMID: 38021452 PMCID: PMC10631316 DOI: 10.1177/20552173231208271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Tremor affects up to 45% of patients with Multiple Sclerosis (PwMS). Current understanding is based on insights from other neurological disorders, thus, not fully addressing the distinctive aspects of MS pathology. Objective To characterize the brain white matter (WM) correlates of MS-related tremor using diffusion tensor imaging (DTI). Methods In a prospective case-control study, PwMS with tremor were assessed for tremor severity and underwent MRI scans including DTI. PwMS without tremor served as matched controls. After tract selection and segmentation, the resulting diffusivity measures were used to calculate group differences and correlations with tremor severity. Results This study included 72 PwMS. The tremor group (n = 36) exhibited significant changes in several pathways, notably in the right inferior longitudinal fasciculus (Cohen's d = 1.53, q < 0.001) and left corticospinal tract (d = 1.32, q < 0.001), compared to controls (n = 36). Furthermore, specific tracts showed a significant correlation with tremor severity, notably in the left medial lemniscus (Spearman's coefficient [rsp] = -0.56, p < 0.001), and forceps minor of corpus callosum (rsp = -0.45, p < 0.01). Conclusion MS-related tremor is associated with widespread diffusivity changes in WM pathways and its severity correlates with commissural and sensory projection pathways, which suggests a role for proprioception or involvement of the dentato-rubro-olivary circuit.
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Affiliation(s)
- Ahmed Bayoumi
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Khader M. Hasan
- Department of Radiology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Jorge Patino
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph A. Thomas
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Refaat E. Gabr
- Department of Radiology, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Arash Kamali
- Department of Radiology, McGovern Medical School at UTHealth, Houston, TX, USA
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Feys P, Duportail M, Kos D, Ilsbroukx S, Lamers I, Van Asch P, Helsen W, Moumdjian L. Effects of Peripheral Cooling on Upper Limb Tremor Severity and Functional Capacity in Persons with MS. J Clin Med 2023; 12:4549. [PMID: 37445583 DOI: 10.3390/jcm12134549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Upper limb intention tremor in persons with multiple sclerosis (pwMS) affects the ability to perform activities of daily life and is difficult to treat. The study investigated the effect of peripheral upper limb cooling on tremor severity and functional performance in MS patients with intention tremor. In experiment 1, 17 patients underwent two 15 min cooling conditions for the forearm (cold pack and cryomanchet) and one control condition. In experiment 2, 22 patients underwent whole arm cooling for 15 min using multiple cold packs. In both experiments, patients were tested at four time points (pre- and post-0, -25 and -50 min cooling) on unilateral tasks of the Test Evaluant les Membres supérieurs des Personnes Agées (TEMPA), Fahn's tremor rating scale (FTRS), Nine Hole Peg Test (NHPT). In experiment 1, the mean FTRS ranged from 13.2 to 14.1 across conditions. A two-way ANOVA showed mainly time effects, showing that cooling the forearm significantly reduced the FTRS, the performance on the NHPT, and three out of four items of the TEMPA, mostly independent of the cooling modality. In experiment 2, the mean FTRS was 13.1. A repeated measures ANOVA showed that cooling the whole arm reduced the FTRS and time needed to execute two out of four items of the TEMPA. These effects occurred immediately after cooling lasting at least 25 min. Cooling the whole upper limb led to a clinically noticeable effect on tremor severity and improved functional performance, which was pronounced during the first half-hour after cooling.
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Affiliation(s)
- Peter Feys
- REVAL Rehabilitation Research Center, Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- University MS Centre Hasselt-Pelt, 3500 Hasselt, Belgium
| | | | - Daphne Kos
- National MS Center Melsbroek, 1820 Steenokkerzeel, Belgium
- Faculty of Kinesiology and Rehabilitation Sciences FABER, Katholieke Universiteit Leuven, 3001 Leuven, Belgium
| | | | - Ilse Lamers
- REVAL Rehabilitation Research Center, Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- University MS Centre Hasselt-Pelt, 3500 Hasselt, Belgium
- Rehabilitation and MS Center Noorderhart, 3900 Pelt, Belgium
| | - Paul Van Asch
- Fitness and Physiotherapy Center, 2550 Kontich, Belgium
| | - Werner Helsen
- Faculty of Kinesiology and Rehabilitation Sciences FABER, Katholieke Universiteit Leuven, 3001 Leuven, Belgium
| | - Lousin Moumdjian
- REVAL Rehabilitation Research Center, Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- University MS Centre Hasselt-Pelt, 3500 Hasselt, Belgium
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3
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Ganzetti M, Graves JS, Holm SP, Dondelinger F, Midaglia L, Gaetano L, Craveiro L, Lipsmeier F, Bernasconi C, Montalban X, Hauser SL, Lindemann M. Neural correlates of digital measures shown by structural MRI: a post-hoc analysis of a smartphone-based remote assessment feasibility study in multiple sclerosis. J Neurol 2023; 270:1624-1636. [PMID: 36469103 PMCID: PMC9970954 DOI: 10.1007/s00415-022-11494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND A study was undertaken to evaluate remote monitoring via smartphone sensor-based tests in people with multiple sclerosis (PwMS). This analysis aimed to explore regional neural correlates of digital measures derived from these tests. METHODS In a 24-week, non-randomized, interventional, feasibility study (NCT02952911), sensor-based tests on the Floodlight Proof-of-Concept app were used to assess cognition (smartphone-based electronic Symbol Digit Modalities Test), upper extremity function (Draw a Shape Test, Pinching Test), and gait and balance (Static Balance Test, Two-Minute Walk Test, U-Turn Test). In this post-hoc analysis, digital measures and standard clinical measures (e.g., Nine-Hole Peg Test [9HPT]) were correlated against regional structural magnetic resonance imaging outcomes. Seventy-six PwMS aged 18-55 years with an Expanded Disability Status Scale score of 0.0-5.5 were enrolled from two different sites (USA and Spain). Sixty-two PwMS were included in this analysis. RESULTS Worse performance on digital and clinical measures was associated with smaller regional brain volumes and larger ventricular volumes. Whereas digital and clinical measures had many neural correlates in common (e.g., putamen, globus pallidus, caudate nucleus, lateral occipital cortex), some were observed only for digital measures. For example, Draw a Shape Test and Pinching Test measures, but not 9HPT score, correlated with volume of the hippocampus (r = 0.37 [drawing accuracy over time on the Draw a Shape Test]/ - 0.45 [touching asynchrony on the Pinching Test]), thalamus (r = 0.38/ - 0.41), and pons (r = 0.35/ - 0.35). CONCLUSIONS Multiple neural correlates were identified for the digital measures in a cohort of people with early MS. Digital measures showed associations with brain regions that clinical measures were unable to demonstrate, thus providing potential novel information on functional ability compared with standard clinical assessments.
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Affiliation(s)
- Marco Ganzetti
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jennifer S. Graves
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA
| | - Sven P. Holm
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Frank Dondelinger
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland ,grid.419481.10000 0001 1515 9979Present Address: Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luciana Midaglia
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Gaetano
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Licinio Craveiro
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Corrado Bernasconi
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Xavier Montalban
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Stephen L. Hauser
- grid.266102.10000 0001 2297 6811Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Michael Lindemann
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Movement Disorders in Multiple Sclerosis: An Update. Tremor Other Hyperkinet Mov (N Y) 2022; 12:14. [PMID: 35601204 PMCID: PMC9075048 DOI: 10.5334/tohm.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Multiple sclerosis (MS), a subset of chronic primary inflammatory demyelinating disorders of the central nervous system, is closely associated with various movement disorders. These disorders may be due to MS pathophysiology or be coincidental. This review describes the full spectrum of movement disorders in MS with their possible mechanistic pathways and therapeutic modalities. Methods: The authors conducted a narrative literature review by searching for ‘multiple sclerosis’ and the specific movement disorder on PubMed until October 2021. Relevant articles were screened, selected, and included in the review according to groups of movement disorders. Results: The most prevalent movement disorders described in MS include restless leg syndrome, tremor, ataxia, parkinsonism, paroxysmal dyskinesias, chorea and ballism, facial myokymia, including hemifacial spasm and spastic paretic hemifacial contracture, tics, and tourettism. The anatomical basis of some of these disorders is poorly understood; however, the link between them and MS is supported by clinical and neuroimaging evidence. Treatment options are disorder-specific and often multidisciplinary, including pharmacological, surgical, and physical therapies. Discussion: Movements disorders in MS involve multiple pathophysiological processes and anatomical pathways. Since these disorders can be the presenting symptoms, they may aid in early diagnosis and managing the patient, including monitoring disease progression. Treatment of these disorders is a challenge. Further work needs to be done to understand the prevalence and the pathophysiological mechanisms responsible for movement disorders in MS.
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Lipopolysaccharide-Induced Strain-Specific Differences in Neuroinflammation and MHC-I Pathway Regulation in the Brains of Bl6 and 129Sv Mice. Cells 2022; 11:cells11061032. [PMID: 35326484 PMCID: PMC8946912 DOI: 10.3390/cells11061032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
Many studies have demonstrated significant mouse-strain-specific differences in behavior and response to pathogenic and pharmacological agents. This study seeks to characterize possible differences in microglia activation and overall severity of neuroinflammation in two widely used mouse strains, C57BL/6NTac (Bl6) and 129S6/SvEvTac (129Sv), in response to acute lipopolysaccharide (LPS) administration. Locomotor activity within the open field arena revealed similar 24 h motor activity decline in both strains. Both strains also exhibited significant bodyweight loss due to LPS treatment, although it was more severe in the Bl6 strain. Furthermore, LPS induced a hypothermic response in Bl6 mice, which was not seen in 129Sv. We found that 24 h LPS challenge significantly increased the inflammatory status of microglia in 129Sv mice. On the other hand, we observed that, under physiological conditions, microglia of Bl6 seemed to be in a higher immune-alert state. Gene and protein expression analysis revealed that LPS induces a significantly stronger upregulation of MHC-I-pathway-related components in the brain of Bl6 compared to 129Sv mice. The most striking difference was detected in the olfactory bulb, where we observed significant LPS-induced upregulation of MHC-I pathway components in Bl6 mice, whereas no alterations were observed in 129Sv. We observed significant positive correlations between bodyweight decline and expressions of MHC-I components in the olfactory bulbs of Bl6 mice and the frontal cortex of 129Sv, highlighting different brain regions most affected by LPS in these strains. Our findings suggest that the brains of Bl6 mice exist in a more immunocompetent state compared to 129Sv mice.
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6
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Pharmacological treatment of tremor in multiple sclerosis; a systematic review. Mult Scler Relat Disord 2022; 60:103722. [DOI: 10.1016/j.msard.2022.103722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/20/2022]
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Makhoul K, Ahdab R, Riachi N, Chalah MA, Ayache SS. Tremor in Multiple Sclerosis-An Overview and Future Perspectives. Brain Sci 2020; 10:brainsci10100722. [PMID: 33053877 PMCID: PMC7601003 DOI: 10.3390/brainsci10100722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
Tremor is an important and common symptom in patients with multiple sclerosis (MS). It constituted one of the three core features of MS triad described by Charcot in the last century. Tremor could have a drastic impact on patients' quality of life. This paper provides an overview of tremor in MS and future perspectives with a particular emphasis on its epidemiology (prevalence: 25-58%), clinical characteristics (i.e., large amplitude 2.5-7 Hz predominantly postural or intention tremor vs. exaggerated physiological tremor vs. pseudo-rhythmic activity arising from cerebellar dysfunction vs. psychogenic tremor), pathophysiological mechanisms (potential implication of cerebellum, cerebello-thalamo-cortical pathways, basal ganglia, and brainstem), assessment modalities (e.g., tremor rating scales, Stewart-Holmes maneuver, visual tracking, digitized spirography and accelerometric techniques, accelerometry-electromyography coupling), and therapeutic options (i.e., including pharmacological agents, botulinum toxin A injections; deep brain stimulation or thalamotomy reserved for severe, disabling, or pharmaco-resistant tremors). Some suggestions are provided to help overcome the unmet needs and guide future therapeutic and diagnostic studies in this complex disorder.
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Affiliation(s)
- Karim Makhoul
- Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; (K.M.); (R.A.); (N.R.)
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon
| | - Rechdi Ahdab
- Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; (K.M.); (R.A.); (N.R.)
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon
- Hamidy Medical Center, Tripoli 1300, Lebanon
| | - Naji Riachi
- Neurology Division, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; (K.M.); (R.A.); (N.R.)
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon
| | - Moussa A. Chalah
- Service de Physiologie-Explorations Fonctionnelles, Henri Mondor Hospital, AP-HP, 94010 Créteil, France;
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
| | - Samar S. Ayache
- Service de Physiologie-Explorations Fonctionnelles, Henri Mondor Hospital, AP-HP, 94010 Créteil, France;
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
- Correspondence:
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Boonstra FM, Noffs G, Perera T, Jokubaitis VG, Vogel AP, Moffat BA, Butzkueven H, Evans A, van der Walt A, Kolbe SC. Functional neuroplasticity in response to cerebello-thalamic injury underpins the clinical presentation of tremor in multiple sclerosis. Mult Scler 2019; 26:696-705. [PMID: 30907236 DOI: 10.1177/1352458519837706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tremor is present in almost half of multiple sclerosis (MS) patients. The lack of understanding of its pathophysiology is hampering progress in development of treatments. OBJECTIVES To clarify the structural and functional brain changes associated with the clinical phenotype of upper limb tremor in people with MS. METHODS Fifteen healthy controls (46.1 ± 15.4 years), 27 MS participants without tremor (46.7 ± 11.6 years) and 42 with tremor (46.6 ± 11.5 years) were included. Tremor was quantified using the Bain score (0-10) for overall severity, handwriting and Archimedes spiral drawing. Functional magnetic resonance imaging activations were compared between participants groups during performance of a joystick task designed to isolate tremulous movement. Inflammation and atrophy of cerebello-thalamo-cortical brain structures were quantified. RESULTS Tremor participants were found to have atrophy of the cerebellum and thalamus, and higher ipsilateral cerebellar lesion load compared to participants without tremor (p < 0.020). We found higher ipsilateral activation in the inferior parietal lobule, the premotor cortex and supplementary motor area in MS tremor participants compared to MS participants without tremor during the joystick task. Finally, stronger activation in those areas was associated with lower tremor severity. CONCLUSION Subcortical neurodegeneration and inflammation along the cerebello-thalamo-cortical and cortical functional neuroplasticity contribute to the severity of tremor in MS.
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Affiliation(s)
- Frederique Mc Boonstra
- Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia
| | - Gustavo Noffs
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia/Centre for Neuroscience of Speech, University of Melbourne, Parkville, VIC, Australia
| | - Thushara Perera
- The Bionics Institute, East Melbourne, VIC, Australia/Department of Medical Bionics, University of Melbourne, Parkville, VIC, Australia
| | - Vilija G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, VIC, Australia/The Bionics Institute, East Melbourne, VIC, Australia/Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany/Redenlab, Melbourne, VIC, Australia
| | - Bradford A Moffat
- Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia/The Bionics Institute, East Melbourne, VIC, Australia
| | - Anneke van der Walt
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia/The Bionics Institute, East Melbourne, VIC, Australia/Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Scott C Kolbe
- Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia/Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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McCreary JK, Rogers JA, Forwell SJ. Upper Limb Intention Tremor in Multiple Sclerosis: An Evidence-Based Review of Assessment and Treatment. Int J MS Care 2018; 20:211-223. [PMID: 30374251 DOI: 10.7224/1537-2073.2017-024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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.
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Salari M, Mirmosayyeb O, Etemadifar M, Hatamian H, Rahimi Z, Delavar Kasmaei H, Shahidi S, Sabeti F. Prevalence of Tremors in Patients With Multiple Sclerosis: A Cross-Sectional Study in Isfahan, Iran. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2018. [DOI: 10.29252/cjns.4.13.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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11
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Deep Brain Stimulation for Tremor. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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12
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Boonstra F, Florescu G, Evans A, Steward C, Mitchell P, Desmond P, Moffat B, Butzkueven H, Kolbe S, van der Walt A. Tremor in multiple sclerosis is associated with cerebello-thalamic pathology. J Neural Transm (Vienna) 2017; 124:1509-1514. [PMID: 29098451 PMCID: PMC5686246 DOI: 10.1007/s00702-017-1798-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/13/2017] [Indexed: 01/21/2023]
Abstract
Tremor in people with multiple sclerosis (MS) is a frequent and debilitating symptom with a relatively poorly understood pathophysiology. To determine the relationship between clinical tremor severity and structural magnetic resonance imaging parameters. Eleven patients with clinically definite MS and right-sided upper limb tremor were studied. Tremor severity was assessed using the Bain score (overall severity, writing, and Archimedes spiral drawing). Cerebellar dysfunction was assessed using the Scale for the Assessment and Rating of Ataxia. Dystonia was assessed using the Global Dystonia Scale adapted for upper limb. For all subjects, volume was calculated for the thalamus from T1-weighted volumetric scans using Freesurfer. Superior cerebellar peduncle (SCP) cross-sectional areas were measured manually. The presence of lesions was visually determined and the lesion volumes were calculated by the lesion growth algorithm as implemented in the Lesion Segmentation Toolbox. Right thalamic volume negatively correlated with Bain tremor severity score (ρ = - 0.65, p = 0.03). Left thalamic volume negatively correlated with general Bain tremor severity score (ρ = - 0.65, p = 0.03) and the Bain writing score (ρ = - 0.65, p = 0.03). Right SCP area negatively correlated with Bain writing score (ρ = - 0.69, p = 0.02). Finally, Bain Archimedes score was significantly higher in patients with lesions in the contralateral thalamus. Whole brain lesion load showed no relationship with tremor severity. These results implicate degeneration of key structures within the cerebello-thalamic pathway as pathological substrates for tremor in MS patients.
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Affiliation(s)
- Frederique Boonstra
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia
| | - Grace Florescu
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Andrew Evans
- Department of Neurology, The Royal Melbourne Hospital, Level 4 South, 300 Grattan Street, Parkville, VIC, 3052, Australia
| | - Chris Steward
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Brad Moffat
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neurology, The Royal Melbourne Hospital, Level 4 South, 300 Grattan Street, Parkville, VIC, 3052, Australia
- Melbourne Brain Centre at Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia
- Multiple Sclerosis Unit, Box Hill Hospital, Box Hill, Australia
- Department of Neuroscience, Alfred Central Clinical School, Monash University, Melbourne, Australia
| | - Scott Kolbe
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neurology, The Royal Melbourne Hospital, Level 4 South, 300 Grattan Street, Parkville, VIC, 3052, Australia.
- Melbourne Brain Centre at Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia.
- Department of Neuroscience, Alfred Central Clinical School, Monash University, Melbourne, Australia.
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Erdeo F, Armutlu K, Uca AU, Yıldız İ. Multiple Skleroz’lu Hastalarda Üst Ekstremite Ataksisinin Bilgisayar Analizi İle Değerlendirilmesi. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.339015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Ayache SS, Chalah MA, Al-Ani T, Farhat WH, Zouari HG, Créange A, Lefaucheur JP. Tremor in multiple sclerosis: The intriguing role of the cerebellum. J Neurol Sci 2015; 358:351-6. [DOI: 10.1016/j.jns.2015.09.360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
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15
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Khabirov FA, Averianova LA, Babicheva NN, Granatov EV, Khaybullin TI. [Clinical, neurophysiological and neuroimaging study of tremor in multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:21-30. [PMID: 26081333 DOI: 10.17116/jnevro20151152221-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify clinical types of tremor in multiple sclerosis (MS) and clarify their pathophysiological mechanisms. MATERIAL AND METHODS We examined 124 patients with MS, including 58 patients with tremor, using clinical (digital spiralography), neurophysiological (tremor electromyography, visual and sensory evoked potentials, transcranial magnetic stimulation with tremor resetting, long latency reflexes, electroencephalography) and neuroimaging (MRI, morphometry) methods. RESULTS AND CONCLUSION Five main variants of tremor were identified: distal postural and postural-intention (variant 1), distal intention (variant 2), proximal and distal intention and postural-intention (variant 3), Holmes (variant 4), axial (variant 5). Postural tremor (variants 1, 3) and rest tremor (variant 4) are caused by the central oscillators. Intention tremor (variants 2, 3), postural-intention tremor (variant 4), axial (variant 5) are caused by the pathology of cerebellar feedback loops. Clarification of mechanisms for the development of tremor in MS allowed to develop a scheme of differential treatment.
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Affiliation(s)
- F A Khabirov
- Kazan State Medical Academy, Kazan, Republican Clinical and Diagnostic Center for Demyelirating Diseases, Kazan, Tatarstan
| | - L A Averianova
- Kazan State Medical Academy, Kazan, Republican Clinical and Diagnostic Center for Demyelirating Diseases, Kazan, Tatarstan
| | - N N Babicheva
- Kazan State Medical Academy, Kazan, Republican Clinical and Diagnostic Center for Demyelirating Diseases, Kazan, Tatarstan
| | - E V Granatov
- Kazan State Medical Academy, Kazan, Republican Clinical and Diagnostic Center for Demyelirating Diseases, Kazan, Tatarstan
| | - T I Khaybullin
- Kazan State Medical Academy, Kazan, Republican Clinical and Diagnostic Center for Demyelirating Diseases, Kazan, Tatarstan
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Van der Walt A, Buzzard K, Sung S, Spelman T, Kolbe SC, Marriott M, Butzkueven H, Evans A. The occurrence of dystonia in upper-limb multiple sclerosis tremor. Mult Scler 2015; 21:1847-55. [PMID: 26014602 DOI: 10.1177/1352458515577690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pathophysiology of multiple sclerosis (MS) tremor is uncertain with limited phenotypical studies available. OBJECTIVE To investigate whether dystonia contributes to MS tremor and its severity. METHODS MS patients (n = 54) with and without disabling uni- or bilateral upper limb tremor were recruited (39 limbs per group). We rated tremor severity, writing and Archimedes spiral drawing; cerebellar dysfunction (SARA score); the Global Dystonia Scale (GDS) for proximal and distal upper limbs, dystonic posturing, mirror movements, geste antagoniste, and writer's cramp. RESULTS Geste antagoniste, mirror dystonia, and dystonic posturing were more frequent and severe (p < 0.001) and dystonia scores were correlated with tremor severity in tremor compared to non-tremor patients. A 1-unit increase in distal dystonia predicted a 0.52-Bain unit (95% confidence interval (CI) 0.08-0.97), p = 0.022) increase in tremor severity and a 1-unit (95% CI 0.48-1.6, p = 0.001) increase in drawing scores. A 1-unit increase in proximal dystonia predicted 0.93-Bain unit increase (95% CI 0.45-1.41, p < 0.001) in tremor severity and 1.5-units (95% CI 0.62-2.41, p = 0.002) increase in the drawing score. Cerebellar function in the tremor limb and tremor severity was correlated (p < 0.001). CONCLUSIONS Upper limb dystonia is common in MS tremor suggesting that MS tremor pathophysiology involves cerebello-pallido-thalamo-cortical network dysfunction.
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Affiliation(s)
- A Van der Walt
- Department of Neurology, Royal/Melbourne Hospital, Australia Melbourne Brain Centre, Department of Medicine at RMH, University of Melbourne, Australia/Centre for Neuroscience, Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - K Buzzard
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - S Sung
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - T Spelman
- Department of Neurology, Royal Melbourne Hospital, Australia
| | - S C Kolbe
- Centre for Neuroscience, Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - M Marriott
- Department of Neurology, Royal Melbourne Hospital, Australia/Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - H Butzkueven
- Department of Neurology, Royal Melbourne Hospital, Australia/Melbourne Brain Centre, Department of Medicine at RMH, University of Melbourne, Australia
| | - A Evans
- Department of Neurology, Royal Melbourne Hospital, Australia
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Heenan M, Scheidt RA, Woo D, Beardsley SA. Intention tremor and deficits of sensory feedback control in multiple sclerosis: a pilot study. J Neuroeng Rehabil 2014; 11:170. [PMID: 25526770 PMCID: PMC4292988 DOI: 10.1186/1743-0003-11-170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intention tremor and dysmetria are leading causes of upper extremity disability in Multiple Sclerosis (MS). The development of effective therapies to reduce tremor and dysmetria is hampered by insufficient understanding of how the distributed, multi-focal lesions associated with MS impact sensorimotor control in the brain. Here we describe a systems-level approach to characterizing sensorimotor control and use this approach to examine how sensory and motor processes are differentially impacted by MS. METHODS Eight subjects with MS and eight age- and gender-matched healthy control subjects performed visually-guided flexion/extension tasks about the elbow to characterize a sensory feedback control model that includes three sensory feedback pathways (one for vision, another for proprioception and a third providing an internal prediction of the sensory consequences of action). The model allows us to characterize impairments in sensory feedback control that contributed to each MS subject's tremor. RESULTS Models derived from MS subject performance differed from those obtained for control subjects in two ways. First, subjects with MS exhibited markedly increased visual feedback delays, which were uncompensated by internal adaptive mechanisms; stabilization performance in individuals with the longest delays differed most from control subject performance. Second, subjects with MS exhibited misestimates of arm dynamics in a way that was correlated with tremor power. Subject-specific models accurately predicted kinematic performance in a reach and hold task for neurologically-intact control subjects while simulated performance of MS patients had shorter movement intervals and larger endpoint errors than actual subject responses. This difference between simulated and actual performance is consistent with a strategic compensatory trade-off of movement speed for endpoint accuracy. CONCLUSIONS Our results suggest that tremor and dysmetria may be caused by limitations in the brain's ability to adapt sensory feedback mechanisms to compensate for increases in visual information processing time, as well as by errors in compensatory adaptations of internal estimates of arm dynamics.
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Affiliation(s)
| | | | | | - Scott A Beardsley
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA.
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19
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Oakes PK, Srivatsal SR, Davis MY, Samii A. Movement Disorders in Multiple Sclerosis. Phys Med Rehabil Clin N Am 2013; 24:639-51. [DOI: 10.1016/j.pmr.2013.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Habek M. Evaluation of brainstem involvement in multiple sclerosis. Expert Rev Neurother 2013; 13:299-311. [DOI: 10.1586/ern.13.18] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Karmon Y, Morrow SA, Weinstock A, Hojnacki D, Weinstock-Guttman B. Limb ataxia originating from peri-central sulcus demyelinating lesion in multiple sclerosis. J Neurol Sci 2012; 320:136-40. [DOI: 10.1016/j.jns.2012.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
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22
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Carpinella I, Cattaneo D, Bertoni R, Ferrarin M. Robot Training of Upper Limb in Multiple Sclerosis: Comparing Protocols With or WithoutManipulative Task Components. IEEE Trans Neural Syst Rehabil Eng 2012; 20:351-60. [DOI: 10.1109/tnsre.2012.2187462] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Schiefer TK, Matsumoto JY, Lee KH. Moving forward: advances in the treatment of movement disorders with deep brain stimulation. Front Integr Neurosci 2011; 5:69. [PMID: 22084629 PMCID: PMC3211039 DOI: 10.3389/fnint.2011.00069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/07/2011] [Indexed: 11/13/2022] Open
Abstract
The modern era of stereotactic and functional neurosurgery has ushered in state of the art technologies for the treatment of movement disorders, particularly Parkinson's disease (PD), tremor, and dystonia. After years of experience with various surgical therapies, the eventual shortcomings of both medical and surgical treatments, and several serendipitous discoveries, deep brain stimulation (DBS) has risen to the forefront as a highly effective, safe, and reversible treatment for these conditions. Idiopathic advanced PD can be treated with thalamic, globus pallidus internus (GPi), or subthalamic nucleus (STN) DBS. Thalamic DBS primarily relieves tremor while GPi and STN DBS alleviate a wide range of Parkinsonian symptoms. Thalamic DBS is also used in the treatment of other types of tremor, particularly essential tremor, with excellent results. Both primary and various types of secondary dystonia can be treated very effectively with GPi DBS. The variety of anatomical targets for these movement disorders is indicative of the network-level dysfunction mediating these movement disturbances. Despite an increasing understanding of the clinical benefits of DBS, little is known about how DBS can create such wide sweeping neuromodulatory effects. The key to improving this therapeutic modality and discovering new ways to treat these and other neurologic conditions lies in better understanding the intricacies of DBS. Here we review the history and pertinent clinical data for DBS treatment of PD, tremor, and dystonia. While multiple regions of the brain have been targeted for DBS in the treatment of these movement disorders, this review article focuses on those that are most commonly used in current clinical practice. Our search criteria for PubMed included combinations of the following terms: DBS, neuromodulation, movement disorders, PD, tremor, dystonia, and history. Dates were not restricted.
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Affiliation(s)
| | | | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
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Feys P, Helsen W, Ilsbroukx S, Meurrens T. Is MS Intention Tremor Amplitude Related to Changed Peripheral Reflexes? ISRN NEUROLOGY 2011; 2011:192414. [PMID: 22389808 PMCID: PMC3263540 DOI: 10.5402/2011/192414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/26/2011] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Peter Feys
- Departments of Biomedical Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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25
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de Sa JCC, Airas L, Bartholome E, Grigoriadis N, Mattle H, Oreja-Guevara C, O'Riordan J, Sellebjerg F, Stankoff B, Vass K, Walczak A, Wiendl H, Kieseier BC. Symptomatic therapy in multiple sclerosis: a review for a multimodal approach in clinical practice. Ther Adv Neurol Disord 2011; 4:139-68. [PMID: 21694816 DOI: 10.1177/1756285611403646] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As more investigations into factors affecting the quality of life of patients with multiple sclerosis (MS) are undertaken, it is becoming increasingly apparent that certain comorbidities and associated symptoms commonly found in these patients differ in incidence, pathophysiology and other factors compared with the general population. Many of these MS-related symptoms are frequently ignored in assessments of disease status and are often not considered to be associated with the disease. Research into how such comorbidities and symptoms can be diagnosed and treated within the MS population is lacking. This information gap adds further complexity to disease management and represents an unmet need in MS, particularly as early recognition and treatment of these conditions can improve patient outcomes. In this manuscript, we sought to review the literature on the comorbidities and symptoms of MS and to summarize the evidence for treatments that have been or may be used to alleviate them.
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Quattrocchi CC, Cherubini A, Luccichenti G, Grasso MG, Nocentini U, Beomonte Zobel B, Sabatini U. Infratentorial lesion volume correlates with sensory functional system in multiple sclerosis patients: a 3.0-Tesla MRI study. Radiol Med 2009; 115:115-24. [PMID: 20017006 DOI: 10.1007/s11547-009-0477-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 11/05/2008] [Indexed: 12/20/2022]
Abstract
PURPOSE This study sought to correlate lesion volume in infratentorial areas using 3.0-T proton-density (PD)-weighted images with disability scales and appropriate functional system scores in patients with multiple sclerosis (MS). MATERIALS AND METHODS We examined 20 consecutive patients (13 women and 7 men) with a median age of 47 years (range 26-70). Neurological examination included the Expanded Disability Status Scale and its functional systems, the Barthel Index (BI) and the Rivermead Mobility Index (RMI). MRI scans were performed on a system operating at 3.0 T using a quadrature birdcage head coil. Acquired images imported as Digital Imaging and Communication in Medicine (DICOM) files, and the region of interest (ROI) files were converted to Neuroimaging Informatics Technology Initiative (NIfTI) format and normalised to the Montreal Neurological Institute (MNI) standard template. An automated segmentation algorithm was used to distinguish between supratentorial and infratentorial areas. Normalisation to the magnetisation-prepared rapid acquisition with gradient echo (MPRAGE) T1-weighted sequence allowed lesion volume estimation in the different anatomical areas. RESULTS A significant correlation was found between infratentorial lesion volume and the sensory functional system score (rho=0.76, p=0.002). No significant correlation was found between supratentorial lesion volume and Expanded Disability Status Scale (EDSS), RMI and BI scores. CONCLUSIONS The described method, by means of anatomical assignment of MS lesions, allows detection of significant correlation coefficients between clinical and MRI lesion burden in MS patients at the infratentorial level.
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Affiliation(s)
- C C Quattrocchi
- Department of Radiology, IRCCS Fondazione Santa Lucia, Rome, Italy.
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Lin HC, Chen CH, Khor GT, Huang P. Upper limbs dysmetria caused by cervical spinal cord injury: a case report. BMC Neurol 2009; 9:50. [PMID: 19775477 PMCID: PMC2759899 DOI: 10.1186/1471-2377-9-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 09/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Upper limbs dysmetria caused by spinal cord injury is very rare. We will discuss the associated mechanism in our articles. CASE PRESENTATION A 51-year-old male had sudden onset of weakness, dysmetria over bilateral upper limbs and ataxia after he fell accidentally. Brain magnetic resonance imaging (MRI) revealed no specific findings. C-spine MRI revealed C1 myelopathy and C4-6 spinal cord compression by bulged disc. The symptoms subsided after surgical intervention. CONCLUSION Sudden onset of upper limbs dysmetria is a sign of dysfunction in cerebellum and its associated pathway. However, lesion in spinal cord can also cause cerebellar signs such as dysmetria.
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Affiliation(s)
- Hsun-Chang Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
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28
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Ayache SS, Ahdab R, Neves DO, Nguyen JP, Lefaucheur JP. Thalamic stimulation restores defective cerebellocortical inhibition in multiple sclerosis tremor. Mov Disord 2009; 24:467-9. [PMID: 19097183 DOI: 10.1002/mds.22416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Feys P, D'hooghe MB, Nagels G, Helsen WF. The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis. Mult Scler 2009; 15:371-8. [PMID: 19168602 DOI: 10.1177/1352458508099142] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) intention tremor is a disabling symptom, which is difficult to treat. OBJECTIVES To investigate the effects of levetiracetam, an antiepileptic drug, on tremor severity and related functionality in MS. METHODS A randomized, double-blind, placebo-controlled, cross-over study examined the effects of 6 weeks of oral levetiracetam administration (starting dose=250 mg/day, maximal dose=2000 mg/day) in 18 MS patients with disabling intention tremor. Primary outcome was Fahn's Tremor Rating Scale (FTRS) A&B. Secondary outcome measures were the nine-hole peg test, patient's opinion rated with the visual analog scale, FTRS C, and an activities of daily life questionnaire and validated tremor indexes derived during the performance of a digitized spiral drawing task and a wrist step-tracking task. Repeated measures analysis of variance and Friedman tests were applied. RESULTS In all, 14 patients completed the trial. Maximal dose intake ranged from 1000 to most commonly 2000 mg, depending on patients' tolerance level. No significant effects of levetiracetam were found for any outcome measure. Further analyses on subgroups with different tremor severity showed no differential effects. Eight patients reported adverse events such as fatigue and stomach ache. CONCLUSIONS Levetiracetam intake of 2000 mg/day did not affect tremor severity or functionality in patients with MS.
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Affiliation(s)
- P Feys
- Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
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30
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Burdick AP, Okun MS, Foote KD. Deep Brain Stimulation for Tremor. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Herzog J, Hamel W, Wenzelburger R, Pötter M, Pinsker MO, Bartussek J, Morsnowski A, Steigerwald F, Deuschl G, Volkmann J. Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor. ACTA ACUST UNITED AC 2007; 130:1608-25. [PMID: 17439979 DOI: 10.1093/brain/awm077] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Deep brain stimulation of the thalamus (thalamic DBS) is an established therapy for medically intractable essential tremor and tremor caused by multiple sclerosis. In both disorders, motor disability results from complex interaction between kinetic tremor and accompanying ataxia with voluntary movements. In clinical studies, the efficacy of thalamic DBS has been thoroughly assessed. However, the optimal anatomical target structure for neurostimulation is still debated and has never been analysed in conjunction with objective measurements of the different aspects of motor impairment. In 10 essential tremor and 11 multiple sclerosis patients, we analysed the effect of thalamic DBS through each contact of the quadripolar electrode on the contralateral tremor rating scale, accelerometry and kinematic measures of reach-to-grasp-movements. These measures were correlated with the anatomical position of the stimulating electrode in stereotactic space and in relation to nuclear boundaries derived from intraoperative microrecording. We found a significant impact of the stereotactic z-coordinate of stimulation contacts on the TRS, accelerometry total power and spatial deviation in the deceleration and target period of reach-to-grasp-movements. Most effective contacts clustered within the subthalamic area (STA) covering the posterior Zona incerta and prelemniscal radiation. Stimulation within this region led to a mean reduction of the lateralized tremor rating scale by 15.8 points which was significantly superior to stimulation within the thalamus (P < 0.05, student's t-test). STA stimulation resulted in reduction of the accelerometry total power by 99%, whereas stimulation at the ventral thalamic border (68%) or within the thalamus proper (2.5%) was significantly less effective (P < 0.01). Concomitantly, STA stimulation led to a significantly higher increase of tremor frequency and decrease in EMG synchronization compared to stimulation within the thalamus proper (P < 0.001). In reach-to-grasp movements, STA stimulation reduced the spatial variability of the movement path in the deceleration period by 28.9% and in the target period by 58.4%, whereas stimulation within the thalamus was again significantly less effective (P < 0.05), with a reduction in the deceleration period between 6.5 and 21.8% and in the target period between 1.2 and 11.3%. An analysis of the nuclear boundaries from intraoperative microrecording confirmed the anatomical impression that most effective electrodes were located within the STA. Our data demonstrate a profound effect of deep brain stimulation of the thalamic region on tremor and ataxia in essential tremor and tremor caused by multiple sclerosis. The better efficacy of stimulation within the STA compared to thalamus proper favours the concept of a modulation of cerebello-thalamic projections underlying the improvement of these symptoms.
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Affiliation(s)
- Jan Herzog
- Department of Neurology, Christian Albrechts University Kiel, Germany
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Feys P, Helsen WF, Verschueren S, Swinnen SP, Klok I, Lavrysen A, Nuttin B, Ketelaer P, Liu X. Online movement control in multiple sclerosis patients with tremor: effects of tendon vibration. Mov Disord 2007; 21:1148-53. [PMID: 16700031 DOI: 10.1002/mds.20938] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patients with intention tremor due to multiple sclerosis (MS) exhibit an increased reliance on visual feedback in the sensorimotor control of slow goal-directed movements. In the present study, the use of proprioceptive information was investigated in MS patients with intention tremor compared to MS patients without tremor and healthy controls. Tendon vibration was applied to the wrist extensor muscles during a memory-guided slow wrist step-tracking task to investigate the use of muscle spindle afferent information in online movement control. A significant reduction of movement amplitude was induced by tendon vibration in all three groups, but the effect was found to be smaller in MS patients with tremor (28%) than in subjects without tremor (50%). Vibration also induced an increase of overall tremor amplitude in the MS tremor group; however, its effect on movement amplitude was not directly related to (changes in) tremor severity. The results suggest that the decreased online use of proprioceptive information in MS patients with tremor reflects an adaptation over time to cope with a tremor-related noisy background. Abnormalities in proprioceptive processing may explain why MS patients with tremor show an increased reliance on visual feedback for online motor control.
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Affiliation(s)
- Peter Feys
- Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium.
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Longstaff MG, Heath RA. Spiral drawing performance as an indicator of fine motor function in people with multiple sclerosis. Hum Mov Sci 2006; 25:474-91. [PMID: 16859790 DOI: 10.1016/j.humov.2006.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigated spiral drawing performance as an indicator of fine motor function, as well as to gain insight into adaptive movement strategies used by people with multiple sclerosis (MS). Seven people with MS, nine younger controls (mean age of 20) and eight older controls (mean age of 40) drew spirals on a graphics tablet at a comfortable speed and size. Spirography (i.e., a subjective visual assessment of the static trace) revealed indications of reduced control of the pen for people with MS. Analysis of the movements showed that people with MS tended to draw the spirals slower and with less pen pressure than controls. All groups increased their speed and pressure along with spiral size, but this increase was much steeper for the controls. MS participants drew spirals with more variability around an ideal trajectory, highlighting fine motor control degradation. MS patients tended to use a smaller scaling ratio, resulting in smaller spirals for a given number of revolutions. The younger and older control groups drew the spirals in a similar manner, and age was not a significant factor in any of the analyses. It is argued that the relatively lower pressure used, and slower, smaller movements (particularly during the more difficult outer sections of the spiral) are in part an adaptive strategy used to reduce movement variability. These results demonstrate the utility of the analysis of spiral movements as an objective technique for assessing motor control degradation, which can compliment the subjective rating based on the static pen trace. As such, it can provide further insight into the biomechanical strategies used when performing fine movements.
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Affiliation(s)
- M G Longstaff
- Department of Psychology and Counselling, University of Greenwich, Avery Hill Campus, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, United Kingdom.
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Silwedel C, Förster C. Differential susceptibility of cerebral and cerebellar murine brain microvascular endothelial cells to loss of barrier properties in response to inflammatory stimuli. J Neuroimmunol 2006; 179:37-45. [PMID: 16884785 DOI: 10.1016/j.jneuroim.2006.06.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 06/14/2006] [Accepted: 06/21/2006] [Indexed: 01/28/2023]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease whose symptoms are caused by an inflammatory invasion of the central nervous system (CNS). The molecular pathogenesis of MS includes an increased permeability of the blood brain barrier (BBB) along with an inability of the BBB to fulfill its normal function of protecting the CNS. The cerebellar BBB seems to be especially vulnerable, as the development of experimental autoimmune encephalomyelitis (EAE) as an animal model of MS often takes its beginning in the cerebellum. Inflammatory lesion development seems to correlate with increased permeability of the local BBB. Responsible for the BBB are cerebral and cerebellar capillary endothelial cells. We therefore generated an in vitro model of the cerebellar BBB (cerebEND) and compared its response to inflammatory stimuli (TNFalpha administration) with a cerebral BBB in vitro model (cEND) characterised previously [Förster, C., Silwedel, C., Golenhofen, N., Burek, M., Kietz, S., Mankertz, J., Drenckhahn, D., 2005. Occludin as direct target for glucocorticoid-induced improvement of blood brain-barrier properties in a murine in vitro system. J. Physiol. 565(Pt 2), 475-486]. We could demonstrate a faster and more pronounced increase in permeability in the cerebellar BBB manifested by reduced transendothelial electrical resistance and reduced tight junction protein expression. This cell line cerebEND could thus be valuable to identify genes differently expressed within the BBB in the future and therefore be helpful in finding new ways of treatment of MS.
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Affiliation(s)
- Christine Silwedel
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstrasse 6, Würzburg, Germany
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Feys P, Helsen W, Buekers M, Ceux T, Heremans E, Nuttin B, Ketelaer P, Liu X. The effect of changed visual feedback on intention tremor in multiple sclerosis. Neurosci Lett 2006; 394:17-21. [PMID: 16257487 DOI: 10.1016/j.neulet.2005.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 09/07/2005] [Accepted: 10/02/2005] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Peter Feys
- Katholieke Universiteit Leuven, Department of Biomedical Kinesiology, Motor Learning Laboratory, Tervuursevest 101, 3001 Leuven, Belgium.
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