title: Effects of peripheral cooling on intention tremor in multiple sclerosis.
abstract: OBJECTIVE
  To investigate the effect of peripheral sustained cooling on intention tremor in patients with multiple sclerosis (MS). MS induced upper limb intention tremor affects many functional activities and is extremely difficult to treat.Materials/
  
  
  METHODS
  Deep (18 degrees C) and moderate (25 degrees C) cooling interventions were applied for 15 minutes to 23 and 11 tremor arms of patients with MS, respectively. Deep and moderate cooling reduced skin temperature at the elbow by 13.5 degrees C and 7 degrees C, respectively. Evaluations of physiological variables, the finger tapping test, and a wrist step tracking task were performed before and up to 30 minutes after cooling.
  
  
  RESULTS
  The heart rate and the central body temperature remained unchanged throughout. Both cooling interventions reduced overall tremor amplitude and frequency proportional to cooling intensity. Tremor reduction persisted during the 30 minute post cooling evaluation period. Nerve conduction velocity was decreased after deep cooling, but this does not fully explain the reduction in tremor amplitude or the effects of moderate cooling. Cooling did not substantially hamper voluntary movement control required for accurate performance of the step tracking task. However, changes in the mechanical properties of muscles may have contributed to the tremor amplitude reduction.
  
  
  CONCLUSIONS
  Cooling induced tremor reduction is probably caused by a combination of decreased nerve conduction velocity, changed muscle properties, and reduced muscle spindle activity. Tremor reduction is thought to relate to decreased long loop stretch reflexes, because muscle spindle discharge is temperature dependent. These findings are clinically important because applying peripheral cooling might enable patients to perform functional activities more efficiently.
authors.affiliation: FABER, Tervuursevest 101, 3001 Leuven, Belgium. Peter.Feys@faber.kuleuven.be
authors.forename: P
authors.initials: P
authors.lastname: Feys
authors.forename: W
authors.initials: W
authors.lastname: Helsen
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: D
authors.initials: D
authors.lastname: Mooren
authors.forename: H
authors.initials: H
authors.lastname: Albrecht
authors.forename: B
authors.initials: B
authors.lastname: Nuttin
authors.forename: P
authors.initials: P
authors.lastname: Ketelaer
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001831:Body Temperature; D005260:Female; D006339:Heart Rate; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000502:physiology; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology* / Q000628:therapy*
references.citation: J Neurol Neurosurg Psychiatry. 2001 Dec;71 Suppl 2:ii22-7
references.pmid: 11701781
references.citation: Arch Phys Med Rehabil. 2003 Jan;84(1):79-82
references.pmid: 12589625
references.citation: Arch Phys Med Rehabil. 2003 Jan;84(1):131-5
references.pmid: 12589634
references.citation: Mult Scler. 2003 Feb;9(1):44-54
references.pmid: 12617268
references.citation: Mult Scler. 2003 Oct;9(5):492-502
references.pmid: 14582776
references.citation: J Neurophysiol. 1977 Sep;40(5):1214-24
references.pmid: 409809
references.citation: Pflugers Arch. 1978 May 18;374(2):159-66
references.pmid: 566425
references.citation: Ann Neurol. 1983 Mar;13(3):227-31
references.pmid: 6847134
references.citation: Arch Phys Med Rehabil. 1983 Sep;64(9):412-6
references.pmid: 6615178
references.citation: Exp Neurol. 1984 May;84(2):314-25
references.pmid: 6714345
references.citation: J Neurophysiol. 1986 Jul;56(1):123-36
references.pmid: 3746391
references.citation: J Neurol Neurosurg Psychiatry. 1987 Jan;50(1):71-7
references.pmid: 3819758
references.citation: Arch Phys Med Rehabil. 1987 Aug;68(8):490-3
references.pmid: 3619611
references.citation: J Physiol. 1987 Sep;390:383-95
references.pmid: 3443940
references.citation: Am J Physiol. 1990 Aug;259(2 Pt 2):R197-203
references.pmid: 2201213
references.citation: Arch Phys Med Rehabil. 1990 Sep;71(10):745-8
references.pmid: 2403281
references.citation: Electromyogr Clin Neurophysiol. 1993 Mar;33(2):125-8
references.pmid: 8449169
references.citation: J Neurophysiol. 1993 Nov;70(5):1853-62
references.pmid: 8294959
references.citation: J Neurol Neurosurg Psychiatry. 1994 Jan;57(1):35-42
references.pmid: 8301303
references.citation: Mov Disord. 1995 Sep;10(5):622-9
references.pmid: 8552115
references.citation: Neurosci Lett. 1997 Oct 3;234(2-3):99-102
references.pmid: 9364507
references.citation: Mov Disord. 1997 Nov;12(6):992-9
references.pmid: 9399226
references.citation: Arch Phys Med Rehabil. 1998 Sep;79(9):1076-9
references.pmid: 9749687
references.citation: Mov Disord. 1998;13 Suppl 3:2-23
references.pmid: 9827589
references.citation: Mov Disord. 1998;13 Suppl 3:24-8
references.pmid: 9827590
references.citation: J Neurol Neurosurg Psychiatry. 1999 Jan;66(1):43-7
references.pmid: 9886449
references.citation: Nervenarzt. 1998 Dec;69(12):1066-73
references.pmid: 9888143
references.citation: J Neurol Sci. 1999 Feb 1;163(1):61-9
references.pmid: 10223413
references.citation: Brain Res. 1999 Sep 4;840(1-2):1-15
references.pmid: 10517947
references.citation: J Neurol Neurosurg Psychiatry. 2000 Jun;68(6):756-60
references.pmid: 10811700
references.citation: Brain. 2000 Aug;123 ( Pt 8):1568-80
references.pmid: 10908187
references.citation: J Hand Ther. 2000 Oct-Dec;13(4):276-88
references.pmid: 11129253
references.citation: Brain. 2001 Apr;124(Pt 4):720-30
references.pmid: 11287372
references.citation: Muscle Nerve. 2001 Jun;24(6):716-35
references.pmid: 11360255
references.citation: Arch Phys Med Rehabil. 2001 Jun;82(6):845-50
references.pmid: 11387593