title: Multiple sclerosis tremor and the Stewart-Holmes manoeuvre.
abstract: The objective of this study is to define tremor and cerebellar dysfunction and determine whether kinetic and postural tremor correlate with cerebellar dysfunction in patients with multiple sclerosis (MS). Cerebellar symptoms such as dysmetria often interfere with tremor evaluation in MS. The Stewart-Holmes (SH) manoeuvre, which has been recently quantified, may offer a selective evaluation of cerebellar dysfunction in such patients. Thirty-two patients with definite MS and arm tremor were evaluated (simplified Fahn tremor scale for kinetic and postural tremor, finger-to-nose test, clinical SH manoeuvre, quantitative study of the SH manoeuvre). Median severity of kinetic and postural tremor on the most disabled side was, respectively, 2 (range 0-4) and 1.5 (range 0-4). Clinical SH scores were moderately correlated to quantified SH measures (r = 0.36, P < 0.05). Kinetic and postural tremors were strongly correlated (r = 0.73, P < 0.0001) but did not correlate with clinical or quantified SH scores. Patients with bilateral tremor had higher scores for quantified SH, and a trend to higher clinical SH and finger-to-nose scores than patients with unilateral tremor. Although clinically associated, cerebellar dysfunction and tremor may be partly independent symptoms, suggesting they may relate to dysfunction of different neuronal systems. The SH manoeuvre should be part of the evaluation of MS patients considered for surgery of tremor.
authors.affiliation: Federation de Neurologie, CHU Pitié Salpêtrière, Paris, France. waubant@itsa.ucsf.edu
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Waubant
authors.forename: Sophie
authors.initials: S
authors.lastname: Tezenas du Montcel
authors.forename: Charles
authors.initials: C
authors.lastname: Jedynak
authors.forename: Michael
authors.initials: M
authors.lastname: Obadia
authors.forename: Hassan
authors.initials: H
authors.lastname: Hosseini
authors.forename: Philippe
authors.initials: P
authors.lastname: Damier
authors.forename: Catherine
authors.initials: C
authors.lastname: Lubetzki
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
authors.forename: Jean-Denis
authors.initials: JD
authors.lastname: Degos
mesh_terms: D000328:Adult; D002526:Cerebellar Diseases / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011187:Posture / Q000502:physiology; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology