Peripheral Neuropathy Tremors

Yet again, there may be faulty motor output from the oscillatory neurons of the motor cortex of the brain which causes the muscles of the limb to respond with a postural tremor in the case of NT.

The fact that deep brain stimulation (DBS) at a high frequency suppresses the tremor has led many scientists to conclude that the processing of motor neuron outputs in the deep thalamic nuclei of the brain is faulty in NT. Such tremors are more likely to be refractory to treatment.

Diagnosis

Postural or kinetic tremor of minimal amplitude is typically a presenting or chief sign in NT. The diagnosis is suggested by the presence of other signs of neuropathy. Confirmation may require serum electrophoresis for abnormal serum proteins, electrophysiological studies such as electromyography (EMG), cerebrospinal fluid (CSF) examination for signs of infection, inflammation, or tumor, and in some cases, nerve biopsy.

It is important to diagnose the condition early so that timely treatment can be provided. This can help reverse some underlying medical causes.

Management

Medical treatment of NT has focused on the use of a beta-blocker and a anticonvulsant. However, their use has not met expectations.

Other more successful therapies include deep brain stimulation of the nucleus ventralis intermedius of the thalamus, with benefit being reported in the form of 30-50% reduction in tremor intensity. Side effects at higher charges include increasing gait ataxia. However, at the right levels, marked improvement has been reported in activities of daily living and in the amplitude of the tremor. Especially significant is the fact that the corticomuscular coherence of the contralateral motor cortex and the tremulous limb muscle disappears completely with DBS. More study is required in this area.
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