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Research paper
Tremor in inflammatory neuropathies
  1. Tabish Aziz Saifee1,
  2. Petra Schwingenschuh1,2,
  3. Mary M Reilly3,
  4. Michael P T Lunn3,
  5. Petra Katschnig1,2,
  6. Panagiotis Kassavetis1,
  7. Isabel Pareés1,
  8. Hadi Manji3,
  9. Kailash Bhatia1,
  10. John C Rothwell1,
  11. Mark J Edwards1
  1. 1Sobell Department, UCL Institute of Neurology, London, UK
  2. 2Department of Neurology, Medical University of Graz, Graz, Austria
  3. 3MRC Centre for Neuromuscular Diseases, Department of Molecular Neurosciences, UCL Institute of Neurology, London, UK
  1. Correspondence to Dr T A Saifee, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; t.saifee{at}ucl.ac.uk

Abstract

Background Tremor is known to occur in patients with neuropathies although its reported prevalence varies widely. Tremor has been shown to cause disability in children with Charcot–Marie–Tooth disease but no data exit about the disability caused by tremor in inflammatory neuropathies. Little is known about the response of neuropathic tremor to treatment and why it selectively occurs in some people and not others.

Methods This case control study investigates the presence and severity of tremor in 43 consecutively recruited patients with inflammatory neuropathies at the National Hospital for Neurology and Neurosurgery, London. Clinical assessment, including Fahn–Tolosa–Marin Scale for tremor, sensory scores, power scores and Overall Neuropathy Limitations Scale, were recorded. Results of nerve conduction studies were retrieved and assessed. Nine patients' tremors were recorded with accelerometry.

Results Tremor was most common in IgM paraproteinaemic neuropathies, as previously reported, but also occurred in 58% of those with chronic inflammatory demyelinating polyradiculoneuropathy and 56% of those with multifocal motor neuropathy with conduction block. We describe, for the first time, tremor in the majority of patients with multifocal motor neuropathy with conduction block. Tremor in all of these patients seems generally refractory to treatment except in a small number of cases where tremor improves with treatment of the underlying neuropathy. We provide evidence that tremor may add to disability in patients with inflammatory neuropathy. Mean tremor frequency was 6 Hz and did not vary with weight loading. We demonstrate for the first time that although tremor severity correlates with F wave latency, it is not sufficient to distinguish those with, from those without, tremor.

Conclusion Tremor in inflammatory neuropathies is common, adds to disability and yet does not often respond to treatment of the underlying neuropathy. When present, tremor severity is associated with F wave latency.

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Footnotes

  • Funding This work was supported by the National Institute for Health Research, award reference No DRF-2009-02-121.

  • Competing interests TAS received financial support for the submitted work from the National Institute for Health Research (as noted in the funding statement); IP has received research grants from the Anglo-Spanish Society Santander Scholarship (Fundacion Alfonso Martin Escudero); JCR received research grants from Dystonia Medical Research Foundation and been paid for developing and delivering educational presentations for the Movement disorders Society; and MJE has received research grants from the National Institute for Health Research.

  • Ethics approval Ethics approval was provided by the National Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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