Effects of peripheral cooling on intention tremor in multiple sclerosis

Abstract

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 extremely difficult to treat. Materials/Methods: Deep (18˚C) and moderate (25˚C) cooling interventions were applied for 15 minutes to 23 and 11 tremor arms of patients with MS, respectively. Deep and moderate cooling reduced skin temperature at the elbow by 13.5˚C and 7˚C, respectively. Evaluations of physiological variables, the finger tapping test, and a wrist step tracking task were performed before and up to 30 minutes after cooling. Results: The heart rate and the central body temperature remained unchanged throughout. Both cooling interventions reduced overall tremor amplitude and frequency proportional to cooling intensity. Tremor reduction persisted during the 30 minute post cooling evaluation period. Nerve conduction velocity was decreased after deep cooling, but this does not fully explain the reduction in tremor amplitude or the effects of moderate cooling. Cooling did not substantially hamper voluntary movement control required for accurate performance of the step tracking task. However, changes in the mechanical properties of muscles may have contributed to the tremor amplitude reduction. Conclusions: Cooling induced tremor reduction is probably caused by a combination of decreased nerve conduction velocity, changed muscle properties, and reduced muscle spindle activity. Tremor reduction is thought to relate to decreased long loop stretch reflexes, because muscle spindle discharge is temperature dependent. These findings are clinically important because applying peripheral cooling might enable patients to perform functional activities more efficiently.

Symptomatic Treatment of Multiple Sclerosis

“…In another comparative study using cooling cuffs (skin temperature 18 vs. 25°C) a temperature-correlated effect on postural tremor could be demonstrated (class III evidence [152]). Local cooling may be used by the patients themselves whenever necessary, e.g.…”

System identification for FES-based tremor suppression

“…For example, limb cooling can reduce the amplitude and frequency of tremor but this effect is temporary, and is accompanied by a decrease in the nerve conduction velocity and muscle spindle activity. Moreover, deep cooling causes changes in muscle properties which mean that maximum voluntary forces will decrease [6]. Another technique comprises adding weights to tremulous limbs, however this causes fatigue and slowness in performing tasks.…”

Effects of cryotherapy on joint position sense and intraarticular blood flow volume in healthy knee joints

“…In their study, the mean surface temperature after 15 min cooling and temperature difference were 23.2°C and 3.5°C, which is similar to our results of 26.1°C and 4.1°C. Thus, the authors hypothesize that impaired knee JPS may occur due to decreased NCV, which may also occur due to other factors such as changed muscle properties and reduced muscle spindle activity 16,17) . Various modalities, including hot and cold therapies, are often used in sports medicine to treat symptoms associated with local inflammation, which is a response to tissue trauma.…”