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Chronic inflammatory demyelinating polyradiculoneuropathy-associated tremor: Phenotype and pathogenesis.
Silsby, Matthew; Fois, Alessandro F; Yiannikas, Con; Ng, Karl; Kiernan, Matthew C; Fung, Victor S C; Vucic, Steve.
  • Silsby M; Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia.
  • Fois AF; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
  • Yiannikas C; Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia.
  • Ng K; Neurology Department, Concord Hospital, Sydney, New South Wales, Australia.
  • Kiernan MC; Neurology Department, Westmead Hospital, Sydney, New South Wales, Australia.
  • Fung VSC; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
  • Vucic S; Neurology Department, Concord Hospital, Sydney, New South Wales, Australia.
Eur J Neurol ; 30(4): 1059-1068, 2023 04.
Article in English | MEDLINE | ID: covidwho-2281435
ABSTRACT
BACKGROUND AND

PURPOSE:

Tremor in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is underrecognized, and the pathophysiology remains incompletely understood. This study evaluated tremor in CIDP and tested the hypothesis, established in other demyelinating neuropathies, that tremor occurs due to mistimed peripheral inputs affecting central motor processing. Additionally, the tremor stability index (TSI) was calculated with the hypothesis that CIDP-related tremor is more variable than other tremor disorders.

METHODS:

Consecutive patients with typical CIDP were prospectively recruited from neuromuscular clinics. Alternative causes of neuropathy and tremor were excluded. Cross-sectional clinical assessment and extensive tremor study recordings were undertaken. Pearson correlation coefficient was used to compare nerve conduction studies and tremor characteristics, and t-test was used for comparisons between groups.

RESULTS:

Twenty-four patients with CIDP were included. Upper limb postural and action tremor was present in 66% and was mild according to the Essential Tremor Rating Assessment Scale. Tremor did not significantly impact disability. Surface electromyography (EMG) found high-frequency spectral peaks in deltoid (13.73 ± 0.66 Hz), biceps brachii (11.82 ± 0.91 Hz), and extensor carpi radialis (11.87 ± 0.91 Hz) muscles, with lower peaks in abductor pollicis brevis EMG (6.07 ± 0.45 Hz) and index finger accelerometry (6.53 ± 0.42 Hz). Tremor was unchanged by weight loading but correlated with ulnar nerve F-wave latency and median nerve sensory amplitude. TSI (2.3 ± 0.1) was significantly higher than essential tremor.

CONCLUSIONS:

Postural tremor is a common feature in CIDP. Tremor was unaffected by weight loading, typical of centrally generated tremors, although there was a correlation with peripheral nerve abnormalities. The high beat-to-beat variability on TSI and gradation of peak frequencies further suggest a complex pathophysiology. These findings may assist clinicians with the diagnosis of neuropathic tremor.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Essential Tremor Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Eur J Neurol Journal subject: Neurology Year: 2023 Document Type: Article Affiliation country: Ene.15693

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Essential Tremor Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Eur J Neurol Journal subject: Neurology Year: 2023 Document Type: Article Affiliation country: Ene.15693