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Case Reports
. 2023 Sep;28(3):415-424.
doi: 10.1111/jns.12574. Epub 2023 Jun 21.

Imbalance and lower limb tremor in chronic inflammatory demyelinating polyradiculoneuropathy

Matthew Silsby  1   2   3 , Con Yiannikas  3   4 , Alessandro F Fois  1 , Karl Ng  4 , Matthew C Kiernan  5 , Victor S C Fung  1 , Steve Vucic  2   3
Affiliations
Case Reports

Imbalance and lower limb tremor in chronic inflammatory demyelinating polyradiculoneuropathy

Matthew Silsby et al. J Peripher Nerv Syst. 2023 Sep.

Abstract

Background and aims: Imbalance is a prominent symptom of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Although upper limb tremor in CIDP is described, lower limb tremor has not been assessed. The aim of this study was to determine whether lower limb tremor was present in CIDP and assess potential relationships with imbalance.

Methods: This was a cross-sectional observational study of prospectively recruited consecutive patients with typical CIDP (N = 25). Clinical phenotyping, lower limb nerve conduction and tremor studies, and posturography analyses were performed. The Berg Balance Scale (BBS) divided CIDP patients into those with "good" and "poor" balance.

Results: Lower limb tremor was evident in 32% of CIDP patients and associated with poor balance (BBSTremor 35 [23-46], BBSNo Tremor 52 [44-55], p = .035). Tremor frequency was 10.2-12.5 Hz with legs outstretched and on standing, apart from four patients with a lower frequency tremor (3.8-4.6 Hz) while standing. Posturography analysis revealed a high-frequency spectral peak in the vertical axis in 44% of CIDP patients (16.0 ± 0.4 Hz). This was more likely in those with "good" balance (40% vs. 4%, p = .013).

Interpretation: Lower limb tremor is present in one third of CIDP patients and is associated with poor balance. A high-frequency peak on posturography is associated with better balance in CIDP. Lower limb tremor and posturography assessments could serve as important biomarkers of balance in a clinical setting.

Keywords: CIDP; balance; posturography; tremor.

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Comment in

  • Vestibular impairment in Guillain-Barré syndrome.
    Akdal G, Koçoğlu K, Ala RT, Tanrıverdizade T, Özçelik P, Şengün İŞ. Akdal G, et al. J Peripher Nerv Syst. 2023 Dec;28(4):677-678. doi: 10.1111/jns.12593. Epub 2023 Sep 4. J Peripher Nerv Syst. 2023. PMID: 37661723 No abstract available.

References

REFERENCES

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