Neuropathic Tremor in Guillain‐Barré Syndrome

Abstract

BackgroundNeuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein‐associated and hereditary neuropathies.ObjectivesTo describe the clinical and electrophysiological features of NT in a previously underrecognized setting‐ during recovery from Guillain‐Barré Syndrome (GBS).MethodsPatients with a documented diagnosis of GBS in the past, presenting with tremor were identified from review of clinical records. Participants underwent structured, videotaped neurological examination, and electrophysiological analysis using tri‐axial accelerometry‐surface electromyography. Tremor severity was assessed using the Fahn‐Tolosa‐Marin Tremor Rating Scale.ResultsWe describe the clinical and electrophysiological features of 5 patients with GBS associated NT. Our cohort had a fine, fast, and slightly jerky postural tremor of frequency ranging from 8 to 10 Hz. Dystonic posturing and overflow movements were noted in 4/5 patients. Tremor appeared 3 months–5 years after the onset of GBS, when patients had regained near normal muscle strength and deep tendon jerks were well elicitable. Electrophysiological analysis of tremor strongly suggested the presence of a central oscillator in all patients.ConclusionNT is not limited to chronic inflammatory or hereditary neuropathies and may occur in the recovery phase of GBS. The tremor is characterized by a high frequency, jerky postural tremor with dystonic posturing. Electrophysiological evaluation suggests the presence of a central oscillator, hypothetically the cerebellum driven by impaired sensorimotor feedback.

Pregabalin Responsive Tongue and Arm Tremor after Guillain Barré Syndrome

“…There are few reports of neuropathic tremor after Guillain Barr e syndrome (GBS). 1 We describe a patient with tremor after an axonal motor form of GBS who responded to pregabalin treatment.…”

“…2 NT is seen more frequently with demyelinating neuropathies, such as chronic inflammatory demyelinating neuropathy (CIDP), especially those with anti-nodal/paranodal IgG4 antibodies. 1 The characteristics of NT are similar to essential tremor (predominantly postural kinetic tremor affecting both hands) and frequency has varied in reports between 3.3 and 10 Hz. 3 No relationship has been established between tremor severity and motor or sensory loss.…”

Reply to: Pregabalin Responsive Tongue and Arm Tremor after Guillain Barré Syndrome

“…2 The clinical course and characteristics of tremor in their report are strikingly similar to our series of patients with neuropathic tremor after Guillain Barr e Syndrome-being a fine, fast and jerky tremor predominantly in the upper limb. 1 While the majority of our patients had dystonic posturing in the upper limb, the patient reported by N obrega et al, had prominent tongue tremor.…”

“…We thank N obrega et al for their interest in our article "Neuropathic tremor in Guillain Barr e Syndrome". 1 In their letter, N obrega et al highlight an important treatment option for neuropathic tremor following Guillain Barr e Syndrome. 2 The clinical course and characteristics of tremor in their report are strikingly similar to our series of patients with neuropathic tremor after Guillain Barr e Syndrome-being a fine, fast and jerky tremor predominantly in the upper limb.…”

Recurrent CNTN1 antibody-positive nodopathy: a case report and literature review

“…The speculated mechanism involves central compensation by the cerebellum for delays induced by peripheral neuropathy ( 29 ). Moreover, tremor can manifest as a rare symptom of GBS, particularly in specific variants like Miller–Fisher syndrome, where the mechanism is linked to cerebellar function and impaired sensorimotor feedback ( 30 ). In the case discussed, the patient did not exhibit tremors during the initial episode nor were ganglioside or paranodal antibodies tested.…”