title: Head tremor secondary to MS resolved with rituximab.
abstract: We describe the case of a 33-year-old woman who presented with a 2-month history of worsening head tremor. The medical evaluation led to the new diagnosis of MS and the MRI of brain demonstrated prominently active disease. Intravenous rituximab was started according to the HERMES trial, and significant improvement was noted. She has received additional rituximab dosing approximately every 6 months, and at the 2-year follow-up the tremor has not recurred. The resolution of head tremor likely resulted from the complete suppression of MS disease activity, which must have allowed restoration of normal neural circuitry. In agreement with a growing body of evidence that supports early control of MS disease activity to prevent accumulation of fixed disability, this case advocates for aggressive immunological therapy at the onset of tremor in MS patients.
authors.affiliation: Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 300, Phoenix, AZ 85013, USA. Chakorn.Chansakul@gmail.com
authors.forename: Chakorn
authors.initials: C
authors.lastname: Chansakul
authors.forename: Guillermo
authors.initials: G
authors.lastname: Moguel-Cobos
authors.forename: Roberto
authors.initials: R
authors.lastname: Bomprezzi
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D005260:Female; D006257:Head; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy; D000069283:Rituximab; D014202:Tremor / Q000188:drug therapy* / Q000209:etiology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab