Distal versus proximal arm tremor in multiple sclerosis assessed by visually guided tracking tasks
a University
Laboratory of Physiology, Parks Road, Oxford OX1 3PT, UK, b Department of Neurosurgery, c University
Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2
6HE, UK
Correspondence to: Dr Xuguang Liu, University Laboratory of Physiology, Parks Road, Oxford OX1 3PT, UK. Telephone 0044 1865 272116; fax 0044 1865 272469; email xuguang.liu{at}physiol.ox.ac.uk
Received 5 March 1998 and in revised form 26 June 1998;
Accepted 3 August 1998
OBJECTIVES
To compare
action tremor (AT) during manual tracking in normal subjects and
patients with multiple sclerosis with tremor (MS-tremor group) and
without tremor (MS-no tremor group), and to differentiate tremor
occurring predominantly around the distal joint from that involving the
proximal joints of the arm.
METHODSSubjects
performed both a visually guided ramp tracking task using wrist
flexion/extension and a whole arm circle tracking task using shoulder
movement. Action tremor at the wrist or shoulder was computed as the SD
of the tracking velocity. The ratio of wrist:arm tremor was then
calculated to differentiate distal from proximal tremor in the tested
arm. Frequency spectra of the records were also examined.
RESULTSDuring wrist
tracking, AT in patients with multiple sclerosis contained a major
frequency component at 4-5 Hz; the frequency was slightly lower during
whole arm tracking. The ratio of wrist:arm tremor was significantly
higher in the MS-tremor group. Of 12 tested arms, eight had tremor
significantly weighted towards the distal joint, only one towards the
proximal joint, and three had a ratio inside the control range.
CONCLUSIONSAT in the
arms of patients with multiple sclerosis can be effectively
differentiated into proximal or distal using these two different
tracking tasks. Despite the variability of the effects of multiple
sclerosis, most of the AT was distal rather than proximal in this group
of patients. Possibly conduction block along the corticocerebellocortical pathways caused this distal tremor.
© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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