Brain, Vol. 119, No. 3, 789-799, 1996
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Tremor associated with benign IgM paraproteinaemic neuropathy
1MRC Human Movement and Balance Unit, The Institute of Neurology London UK 2The Institute of Neurology London UK 3MRC Cyclotron Unit, Hammersmith Hospital London UK
Correspondence to:
Correspondence to:Dr P. G. Bain, Acadmic Unit of Neuroscience, Charing Cross Hospital. Fulham Palace Road, London W6 8RF, UK
The clinical and neurophysiological features of six patients with action tremor of the upper limbs associated with IgM paraproteinaemic neuropathy are described. Symptomatic tremor was confined to the upper limbs and was broadly symmetrical. The frequency of associated rhythmic muscle activity ranged from 2.8 to 5.5 Hz in abductor pollicis brevis and from 3.7 to 5.5 Hz in the forearm flexor muscles. Magnetic brain stimulation, somatosensory evoked potentials (SEPs) and stretch reflex studies did not provide evidence for delayed conduction within central pathways. There was marked slowing of the maximum motor conduction velocities in peripheral nerves. Forearm stretch reflexes were present but their latencies were prolonged. Somatosensory evoked potentials were obtained in the majority of patients, but were delayed. Wrist tremor could be modulated by mechanical perturbations or median nerve electrical shocks. Simple voluntary wrist movements were of normal duration and peak velocity, but the kinematic profile was asymmetric. Each movement was associated with a triphasic EMG pattern in agonist-antagonist-agonist muscles but the durations of the bursts were prolonged and the onset of the second agonist was delayed. These results support the hypothesis that distorted, mistimed peripheral inputs reach a central processor (probably the cerebellum) which although intact is misled into producing tremor in certain parts of the body.
tremor; paraprotein; neuropathy
Received September 14, 1995. Revised January 20, 1996. Accepted January 31, 1996.
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