Upper Limb Intention Tremor in Multiple Sclerosis

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.

Evaluation of Divers’ Neuropsychometric Effectiveness and High-Pressure Neurological Syndrome via Computerized Test Battery Package and Questionnaires in Operational Setting

“…Both postural and intention tremor in hand and upper limb have previously been reported as the most characteristic symptom related to HPNS (Aarli et al, 1985; Vaernes et al, 1988; Todnem et al, 1989). Postural tremor occurs when the subject is unable to maintain the limb in steady position (Anouti and Koller, 1995), while intention tremor is the “target-directed movements” and occurs at the end of the voluntary movements (McCreary et al, 2018). Several studies have described hand dynamometer as a reliable instrument to measure hand muscle and grip strength; however, the result could vary due to the type of the dynamometer, the distance from the joint, and shoulder/elbow position (Mafi et al, 2012).…”

Personalised profiling to identify clinically relevant changes in tremor due to multiple sclerosis

“…The FTMTRS [8] is the most widely used clinical scale for the assessment of tremor in MS [20]. It consists of three parts, each containing multiple components scored on an integer scale from 0 (least severe) to 4 (most severe).…”

“…Our method is demonstrated in a cohort of people with upper-limb tremor due to MS performing a standardised finger-to-nose task, the most commonly used task in the assessment of this MS symptom [20]. Currently, there are no universally effective treatments for MS tremor [20]. Estimates of the prevalence of tremor in MS vary from approximately 25 to 60 percent [20].…”

“…Currently, there are no universally effective treatments for MS tremor [20]. Estimates of the prevalence of tremor in MS vary from approximately 25 to 60 percent [20]. The prevalence of tremor in the registry of the North American Research Committee on MS (NARCOMS) is estimated to be at least 45 percent [28].…”

“…The assessment of tremor in MS is particularly challenging as it is often concomitant with ataxia or other less well-defined movement disorders, and the relative contribution of each to the observed movement may not be easily distinguished [20]. Intention tremor, defined as arising in target-directed movements [5], is a particularly disabling form that is especially prevalent in MS compared with other aetiologies.…”