Top

Published in:

Open Access 01-02-2007 | REVIEW

Tremor in multiple sclerosis

Authors: Marcus Koch, MD, Jop Mostert, MD, Dorothea Heersema, MD, PhD, Jacques De Keyser, MD, PhD

Published in: Journal of Neurology | Issue 2/2007

Abstract

Tremor is estimated to occur in about 25 to 60 percent of patients with multiple sclerosis (MS). This symptom, which can be severely disabling and embarrassing for patients, is difficult to manage. Isoniazid in high doses, carbamazepine, propranolol and gluthetimide have been reported to provide some relief, but published evidence of effectiveness is very limited. Most trials were of small size and of short duration. Cannabinoids appear ineffective. Tremor reduction can be obtained with stereotactic thalamotomy or thalamic stimulation. However, the studies were small and information on long-term functional outcome is scarce. Physiotherapy, tremor reducing orthoses, and limb cooling can achieve some functional improvement. Tremor in MS remains a significant challenge and unmet need, requiring further basic and clinical research.

Aisen ML, Arnold A, Baiges I, Maxwell S, Rosen M (1993) The effect of mechanical damping loads on disabling action tremor. Neurology 43:1346–1350PubMed

Aisen ML, Holzer M, Rosen M, Dietz M, McDowell F (1991) Glutethimide treatment of disabling action tremor in patients with multiple sclerosis and traumatic brain injury. Arch Neurol 48:513–515PubMed

Albrecht H, Schwecht M, Pollmann W, Parag D, Erasmus LP, Konig N (1998) Lokale Eisapplikation in der Therapie der gliedkinetischen Ataxie. Klinischer Nachweis positiver Behandlungseffekte bei Patienten mit multipler Sklerose. Nervenarzt 69:1066–1073PubMed

Alusi SH, Aziz TZ, Glickman S, Jahanshahi M, Stein JF, Bain PG (2001) Stereotactic lesional surgery for the treatment of tremor in multiple sclerosis: a prospective case-controlled study. Brain 124:1576–1589PubMed

Alusi SH, Glickman S, Aziz TZ, Bain PG (1999) Tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry 66:131–134PubMed

Alusi SH, Worthington J, Glickman S, Bain PG (2001) A study of tremor in multiple sclerosis. Brain 124:720–730PubMed

Alusi SH, Worthington J, Glickman S, Findley LJ, Bain PG (2000) Evaluation of three different ways of assessing tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry 68:756–760PubMed

Andrew J, Rice Edwards JM, Rudolf NM (1974) The placement of stereotaxic lesions for involuntary movements other than in Parkinson’s disease. Acta Neurochir (Wien ) Suppl 21:39–47

Armutlu K, Karabudak R, Nurlu G (2001) Physiotherapy approaches in the treatment of ataxic multiple sclerosis: a pilot study. Neurorehabil Neural Repair 15:203–211PubMed

10.

Arsalo A, Hanninen A, Laitinen L (1973) Functional neurosurgery in the treatment of multiple sclerosis. Ann Clin Res 5:74–79PubMed

11.

Bain PG, Findley LJ, Atchison P, Behari M, Vidailhet M, Gresty M, Rothwell JC, Thompson PD, Marsden CD (1993) Assessing tremor severity. J Neurol Neurosurg Psychiatry 56:868–873PubMed

12.

Baker D, Pryce G, Croxford JL, Brown P, Pertwee RG, Huffman JW, Layward L (2000) Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature 404:84–87PubMed

13.

Benabid AL, Pollak P, Gao D, Hoffmann D, Limousin P, Gay E, Payen I, Benazzouz A (1996) Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 84:203–214PubMedCrossRef

14.

Berk C, Carr J, Sinden M, Martzke J, Honey CR (2002) Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 97:815–820PubMed

15.

Bittar RG, Hyam J, Nandi D, Wang S, Liu X, Joint C, Bain PG, Gregory R, Stein J, Aziz TZ (2005) Thalamotomy versus thalamic stimulation for multiple sclerosis tremor. J Clin Neurosci 12:638–642PubMed

16.

Bozek CB, Kastrukoff LF, Wright JM, Perry TL, Larsen TA (1987) A controlled trial of isoniazid therapy for action tremor in multiple sclerosis. J Neurol 234:36–39PubMed

17.

Brice J, McLellan L (1980) Suppression of intention tremor by contingent deep-brain stimulation. Lancet 315:1221–1222

18.

Broager B, Fog T (1962) Thalamotomy for the relief of intention tremor in multiple sclerosis. Acta Neurol Scand 38(Suppl 3):153–156

19.

Carpenter MB (1956) Anatomic degenerations and physiologic effects resulting from localized lesions of the red nucleus. J Comp Neurol 105:195–239PubMed

20.

Carpenter MB, Hanna GR (1962) Effects of thalamic lesions upon cerebellar dyskinesia in the rhesus monkey. J Comp Neurol 119:127–147PubMed

21.

Clifford DB (1983) Tetrahydrocannabinol for tremor in multiple sclerosis. Ann Neurol 13:669–671PubMed

22.

Conrad B, Brooks VB (1975) Cerebellare Bewegungsstörungen im Tierversuch. Vergleich rascher Alternativbewegungen und langsamerer Zielbewegungen während reversibler Dentatusausschaltung. J Neurol 209:165–179PubMed

23.

Consroe P, Musty R, Rein J, Tillery W, Pertwee R (1997) The perceived effects of smoked cannabis on patients with multiple sclerosis. Eur Neurol 38:44–48PubMed

24.

Cooper IS (1960) Neurosurgical alleviation of intention tremor of multiple sclerosis and cerebellar disease. N Engl J Med 263:441–444PubMedCrossRef

25.

Cooper IS (1960) Neurosurgical relief of intention tremor due to cerebellar disease and multiple sclerosis. Arch Phys Med Rehabil 41:1–4PubMed

26.

Cooper IS (1967) Relief of intention tremor of multiple sclerosis by thalamic surgery. JAMA 199:689–694PubMed

27.

Critchley GR, Richardson PL (1998) Vim thalamotomy for the relief of the intention tremor of multiple sclerosis. Br J Neurosurg 12:559–562PubMed

28.

Dahlin-Webb SR (1986) A weighted wrist cuff. Am J Occup Ther 40:363–364PubMed

29.

Deuschl G, Bain P, Brin M (1998) Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord 13(Suppl 3):2–23

30.

Deuschl G, Raethjen J, Lindemann M, Krack P (2001) The pathophysiology of tremor. Muscle Nerve 24:716–735PubMed

31.

Dow RS, Moruzzi G (1958) The Physiology and Pathophysiology of the Cerebellum.

32.

Duquette P, Pleines J, du SP (1985) Isoniazid for tremor in multiple sclerosis: a controlled trial. Neurology 35:1772–1775PubMed

33.

Fahn S, Tolosa E, Marin C (1988) Clinical rating scale for tremor. 225–234

34.

Ferraro A, Barrera SE (1936) The effects of lesions of the superior cerebellar peduncle in the Macacus rhesus monkey. Bull Neur Inst NY 5:165–179

35.

Feys P, Helsen W, Liu X, Mooren D, Albrecht H, Nuttin B, Ketelaer P (2005) Effects of peripheral cooling on intention tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry 76:373–379PubMed

36.

Feys P, Romberg A, Ruutiainen J, Davies-Smith A, Jones R, Avizzano CA, Bergamasco M, Ketelaer P (2001) Assistive technology to improve PC interaction for people with intention tremor. J Rehabil Res Dev 38:235–243PubMed

37.

Fox P, Bain PG, Glickman S, Carroll C, Zajicek J (2004) The effect of cannabis on tremor in patients with multiple sclerosis. Neurology 62:1105–1109PubMed

38.

Francis DA, Grundy D, Heron JR (1986) The response to isoniazid of action tremor in multiple sclerosis and its assessment using polarised light goniometry. J Neurol Neurosurg Psychiatry 49:87–89PubMed

39.

Gbadamosi J, Buhmann C, Moench A, Heesen C (2001) Failure of ondansetron in treating cerebellar tremor in MS patients-an open-label pilot study. Acta Neurol Scand 104:308–311PubMed

40.

Gemba H, Sasaki K, Yoneda Y, Hashimoto S, Mizuno N (1980) Tremor in the monkey with a cerebellar lesion. Exp Neurol 69:173–182PubMed

41.

Geny C, Nguyen JP, Pollin B, Feve A, Ricolfi F, Cesaro P, Degos JD (1996) Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation. Mov Disord 11:489–494PubMed

42.

Gilman S, Carr D, Hollenberg J (1976) Kinematic effects of deafferentation and cerebellar ablation. Brain 99:311–330PubMed

43.

Goldman MS, Kelly PJ (1992) Symptomatic and functional outcome of stereotactic ventralis lateralis thalamotomy for intention tremor. J Neurosurg 77:223–229PubMed

44.

Hallett M, Lindsey JW, Adelstein BD, Riley PO (1985) Controlled trial of isoniazid therapy for severe postural cerebellar tremor in multiple sclerosis. Neurology 35:1374–1377PubMed

45.

Hauptvogel H, Poser S, Orthner H, Roeder F (1975) Indikationen zur stereotaktischen Operation bei Patienten mit Multipler Sklerose. J Neurol 210:239–251PubMed

46.

Hay OD (1999) Thalamic deep brain stimulation for treatment of visual symptoms in multiple sclerosis. Clinical Eye and Vision Care 11:121–131

47.

Henkin Y, Herishanu YO (1989) Primidone as a treatment for cerebellar tremor in multiple sclerosis–two case reports. Isr J Med Sci 25:720–721PubMed

48.

Hitchcock E, Flint GA, Gutowski NJ (1987) Thalamotomy for movement disorders: a critical appraisal. Acta Neurochir Suppl (Wien) 39:61–65

49.

Hooper J, Taylor R, Pentland B, Whittle IR (2002) A prospective study of thalamic deep brain stimulation for the treatment of movement disorders in multiple sclerosis. Br J Neurosurg 16:102–109PubMed

50.

Hooper J, Whittle IR (1998) Long-term outcome after thalamotomy for movement disorders in multiple sclerosis. Lancet 352:1984PubMed

51.

Kandel EI, Hondcarian OA (1985) Surgical treatment of the hyperkinetic form of multiple sclerosis. Acta Neurol (Napoli) 7:345–347

52.

Koller WC (1984) Pharmacologic trials in the treatment of cerebellar tremor. Arch Neurol 41:280–281PubMed

53.

Krauss JK, Simpson RK, Jr, Ondo WG, Pohle T, Burgunder JM, Jankovic J (2001) Concepts and methods in chronic thalamic stimulation for treatment of tremor: technique and application. Neurosurgery 48:535–541PubMed

54.

Krayenbuhl H, Yasargil MG (1962) Relief of Intention Tremor Due to Multiple Sclerosis by Stereotaxic Thalamotomy. Confinia Neurologica 22:368

55.

Kurtzke JF (1955) A new scale for evaluating disability in multiple sclerosis. Neurology 5:580–583PubMed

56.

Lee HJ, DeLisa JA, Bach JR (1993) The effect of temperature on antidromic median sensory conduction. Electromyogr Clin Neurophysiol 33:125–128PubMed

57.

Lenz FA, Dostrovsky JO, Tasker RR, Yamashiro K, Kwan HC, Murphy JT (1988) Single-unit analysis of the human ventral thalamic nuclear group: somatosensory responses. J Neurophysiol 59:299–316PubMed

58.

Lenz FA, Normand SL, Kwan HC, Andrews D, Rowland LH, Jones MW, Seike M, Lin YC, Tasker RR, Dostrovsky JO (1995) Statistical prediction of the optimal site for thalamotomy in parkinsonian tremor. Mov Disord 10:318–328PubMed

59.

Lenz FA, Tasker RR, Kwan HC, Schider S, Kwong R, Dostrovsky JO, Murphy JT (1987) Selection of the optimal lesion site for the relief of parkinsonian tremor on the basis of spectral analysis of neuronal firing patterns. Appl Neurophysiol 50:338–343PubMed

60.

Liu X, Aziz TZ, Miall RC, Rowe J, Alusi SH, Bain PG, Stein JF (2000) Frequency analysis of involuntary movements during wrist tracking: a way to identify ms patients with tremor who benefit from thalamotomy. Stereotact Funct Neurosurg 74:53–62PubMed

61.

Loher TJ, Gutbrod K, Fravi NL, Pohle T, Burgunder JM, Krauss JK (2003) Thalamic stimulation for tremor. Subtle changes in episodic memory are related to stimulation per se and not to a microthalamotomy effect. J Neurol 250:707–713PubMed

62.

Matsumoto J, Morrow D, Kaufman K, Davis D, Ahlskog JE, Walker A, Sneve D, Noseworthy J, Rodriguez M (2001) Surgical therapy for tremor in multiple sclerosis: an evaluation of outcome measures. Neurology 57:1876–1882PubMed

63.

Meinck HM, Schonle PW, Conrad B (1989) Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. J Neurol 236:120–122PubMed

64.

Mense S (1978) Effects of temperature on the discharges of muscle spindles and tendon organs. Pflugers Arch 374:159–166PubMed

65.

Monaca-Charley C, Stojkovic T, Duhamel A, De Seze J, Ferriby D, Vermersch P (2003) Double-blind crossover study with dolasetron mesilate, a 5-HT3 receptor antagonist in cerebellar syndrome secondary to multiple sclerosis. J Neurol 250:1190–1194PubMed

66.

Montgomery EB, Jr, Baker KB, Kinkel RP, Barnett G (1999) Chronic thalamic stimulation for the tremor of multiple sclerosis. Neurology 53:625–628PubMed

67.

Morrow J, McDowell H, Ritchie C, Patterson V (1985) Isoniazid and action tremor in multiple sclerosis. J Neurol Neurosurg Psychiatry 48:282–283PubMed

68.

Mundinger F, Kuhn I (1982) Postoperative and long-term results after stereotactic operations for action myoclonia in cases of encephalomyelitis disseminata. Appl Neurophysiol 45:299–305PubMed

69.

Nandi D, Aziz TZ (2004) Deep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor. J Clin Neurophysiol 21:31–39PubMed

70.

Nandi D, Chir M, Liu X, Bain P, Parkin S, Joint C, Winter J, Stein J, Scott R, Gregory R, Aziz T (2002) Electrophysiological confirmation of the zona incerta as a target for surgical treatment of disabling involuntary arm movements in multiple sclerosis: use of local field potentials. J Clin Neurosci 9:64–68PubMed

71.

Nguyen JP, Degos JD (1993) Thalamic stimulation and proximal tremor. A specific target in the nucleus ventrointermedius thalami. Arch Neurol 50:498–500PubMed

72.

Niranjan A, Kondziolka D, Baser S, Heyman R, Lunsford LD (2000) Functional outcomes after gamma knife thalamotomy for essential tremor and MS-related tremor. Neurology 55:443–446PubMed

73.

Ohye C (2000) Use of selective thalamotomy for various kinds of movement disorder, based on basic studies. Stereotact Funct Neurosurg 75:54–65PubMed

74.

Pittock SJ, McClelland RL, Mayr WT, Rodriguez M, Matsumoto JY (2004) Prevalence of tremor in multiple sclerosis and associated disability in the Olmsted County population. Mov Disord 19:1482–1485PubMed

75.

Poirier LJ, Lafleur J, de Lean J, Guiot G, Larochelle L, Boucher R (1974) Physiopathology of the cerebellum in the monkey. 2. Motor disturbances associated with partial and complete destruction of cerebellar structures. J Neurol Sci 22:491–509PubMed

76.

77.

Quintern J, Immisch I, Albrecht H, Pollmann W, Glasauer S, Straube A (1999) Influence of visual and proprioceptive afferences on upper limb ataxia in patients with multiple sclerosis. J Neurol Sci 163:61–69PubMed

78.

Rice GP, Lesaux J, Vandervoort P, Macewan L, Ebers GC (1997) Ondansetron, a 5-HT3 antagonist, improves cerebellar tremor. J Neurol Neurosurg Psychiatry 62:282–284PubMed

79.

Riechert T, Richter D (1972) Stereotaktische Operationen zur Behandlung des Tremors der Multiplen Sklerose. Schweiz Arch Neurol Neurochir Psychiatr 111:411–416PubMed

80.

Sabra AF, Hallett M, Sudarsky L, Mullally W (1982) Treatment of action tremor in multiple sclerosis with isoniazid. Neurology 32:912–913PubMed

81.

Samra K, Waltz JM, Riklan M, Koslow M, Cooper IS (1970) Relief of intention tremor by thalamic surgery. J Neurol Neurosurg Psychiatry 33:7–15PubMed

82.

Sandyk R, Dann LC (1994) Weak electromagnetic fields attenuate tremor in multiple sclerosis. Int J Neurosci 79:199–212PubMedCrossRef

83.

Schulder M, Sernas T, Mahalick D, Adler R, Cook S (1999) Thalamic stimulation in patients with multiple sclerosis. Stereotact Funct Neurosurg 72:196–201PubMed

84.

Schulder M, Sernas TJ, Karimi R (2003) Thalamic stimulation in patients with multiple sclerosis: long-term follow-up. Stereotact Funct Neurosurg 80:48–55PubMed

85.

Schuurman PR, Bosch DA, Bossuyt PM, Bonsel GJ, van Someren EJ, de Bie RM, Merkus MP, Speelman JD (2000) A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 342:461–468PubMed

86.

Sechi GP, Zuddas M, Piredda M, Agnetti V, Sau G, Piras ML, Tanca S, Rosati G (1989) Treatment of cerebellar tremors with carbamazepine: a controlled trial with long-term follow-up. Neurology 39:1113–1115PubMed

87.

Shahzadi S, Tasker RR, Lozano A (1995) Thalamotomy for essential and cerebellar tremor. Stereotact Funct Neurosurg 65:11–17PubMed

88.

Siegfried J, Lippitz B (1994) Chronic electrical stimulation of the VL-VPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982. Stereotact Funct Neurosurg 62:71–75PubMed

89.

Speelman JD, Van Manen J (1984) Stereotactic thalamotomy for the relief of intention tremor of multiple sclerosis. J Neurol Neurosurg Psychiatry 47:596–599PubMedCrossRef

90.

Taha JM, Janszen MA, Favre J (1999) Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor. J Neurosurg 91:68–72PubMedCrossRef

91.

Van Manen J (1974) Stereotaxic operations in cases of hereditary and intention tremor. Acta Neurochir (Wien) Suppl 21:49–55

92.

Wade DT, Makela P, Robson P, House H, Bateman C (2004) Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 10:434–441PubMed

93.

Walker AE, Botterell EH (1937) The syndrome of the superior cerebellar peduncle in the monkey. Brain 60:327–341

94.

Weinshenker BG, Issa M, Baskerville J (1996) Long-term and short-term outcome of multiple sclerosis: a 3-year follow-up study. Arch Neurol 53:353–358PubMed

95.

Weinshenker BG, Rice GP, Noseworthy JH, Carriere W, Baskerville J, Ebers GC (1991) The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. Brain 114:1045–1056PubMed

96.

Weiss N, North RB, Ohara S, Lenz FA (2003) Attenuation of cerebellar tremor with implantation of an intrathecal baclofen pump: the role of gamma-aminobutyric acidergic pathways. Case report. J Neurosurg 99:768–771

97.

Wester K, Hauglie-Hanssen E (1990) Stereotaxic thalamotomy–experiences from the levodopa era. J Neurol Neurosurg Psychiatry 53:427–430PubMed

98.

Whittle IR, Haddow LJ (1995) CT guided thalamotomy for movement disorders in multiple sclerosis: problems and paradoxes. Acta Neurochir Suppl (Wien) 64:13–16

99.

Whittle IR, Hooper J, Pentland B (1998) Thalamic deep-brain stimulation for movement disorders due to multiple sclerosis. Lancet 351:109–110PubMed

100.

Whittle IR, Yau YH, Hooper J (2004) Mesodiencephalic targeting of stimulating electrodes in patients with tremor caused by multiple sclerosis. J Neurol Neurosurg Psychiatry 75:1210PubMed

101.

Wilms H, Sievers J, Deuschl G (1999) Animal models of tremor. Mov Disord 14:557–571PubMed

102.

Wishart HA, Roberts DW, Roth RM, McDonald BC, Coffey DJ, amourian AC, Hartley C, Flashman LA, Fadul CE, Saykin AJ (2003) Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports. J Neurol Neurosurg Psychiatry 74:1392–1397PubMed

103.

Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A (2003) Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 362:1517–1526PubMed

Title: Tremor in multiple sclerosis
Authors: Marcus Koch, MD
Jop Mostert, MD
Dorothea Heersema, MD, PhD
Jacques De Keyser, MD, PhD
Publication date: 01-02-2007
Publisher: Steinkopff-Verlag
Published in: Journal of Neurology / Issue 2/2007
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-006-0296-7

At a glance: The STEP trials

Springer Medicine

Tremor in multiple sclerosis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2007

Nasal meningoencephalocele, an unusual cause for recurrent meningitis

Characterization of a familial case with primary erythromelalgia from Taiwan

Mikhail B. Kroll (1879–1939)

Motor evoked potentials in multiple sclerosis patients without walking limitation: amplitude vs. conduction time abnormalities

A prospective study of physiotherapist prescribed community based exercise in inflammatory peripheral neuropathy

Dissection of the internal carotid artery mimicking episodic cluster headache