Figure 1
Summary of patients identified and enrolled in this study.
Table 1
Summary of clinical features of patients with Guillain-Barré syndrome.
| n = 18 (%) | |
|---|---|
| Age at onset of GBS (years) | 40.2 ± 13.7 |
| Age at evaluation of tremor (years) | 41.5 ± 14.0 |
| Sex (males) | 13 (72.2) |
| Previous infection | |
| Gastrointestinal | 10 (55.6) |
| Respiratory | 5 (27.8) |
| Time since infection to GBS onset (days) | 10.2 ± 4.8 |
| Features of GBS | |
| Craneal involvement | 14 (77.8) |
| Respiratory impairment | 4 (22.2) |
| Mechanical ventilation | 3 (16.7) |
| Weakness peak severity in upper limbs (MRC) | |
| 1 | 12 (66.7) |
| 2 | 2 (11.1) |
| 3 | 2 (11.1) |
| 4 | 2 (11.1) |
| Weakness peak severity in lower limbs (MRC) | |
| 1 | 12 (66.7) |
| 2 | 3 (16.7) |
| 3 | 2 (11.1) |
| 5 | 1 (5.6) |
| Isolated motor impairment | 13 (72.2) |
| Motor/sensitive impairment | 5 (27.8) |
| Hughes scale (worst) | 4.5 ± 1.1 |
| Management | |
| Plasmapheresis | 4 (22.2) |
| Intravenous immunoglobulin | 13 (72.2) |
| No treatment | 1 (5.6) |
| Residual neurological impairment | |
| mRS at discharge | 3.33 ± 1.13 |
| mRS at tremor evaluation | 1.78 ± 1.0 |
| Residual muscle weakness | |
| Cranial | 0 |
| Upper limbs | 6 (33.3) |
| Lower limbs | 5 (27.7) |
| Residual denervation, distal muscle hypotrophy | 6 (33.3) |
[i] MRC: Medical Research Council Scale score; mRS: modified Rankin Scale.
Table 2
Frequency of tremor according to FTM-TRS Items.
| FTM-TRS | N (%) OF PATIENTS WITH TREMOR/IMPAIRMENT |
|---|---|
| Part A | |
| Tongue tremor (R/P) | 1/18 (5.5) |
| Voice tremor | 1/18 (5.5) |
| Right upper limb tremor | |
| Rest | 1/18 (5.5) |
| Postural | 5/17 (29.4) |
| Kinetic | 4/17 (23.5) |
| Left upper limb tremor | |
| Rest | 1/18 (5.5) |
| Postural | 4/16 (25) |
| Kinetic | 6/16 (37.5) |
| Part B | |
| Writing tremor | 7/17 (41.2) |
| Archimedes spirals drawing | |
| Right hand | 11/16 (68.8) |
| Left hand | 14/16 (87.5) |
| Straight line drawing | |
| Right hand | 8/16 (50) |
| Left hand | 12/16 (75) |
| Liquid pouring (R/L) | 4/15 (26.6) |
| Part C | |
| Speaking | 1/18 (5.5) |
| Feeding other than liquids | 1/16 (6.25) |
| Bringing liquids to mouth | 1/16 (6.25) |
| Hygiene | 1/16 (6.25) |
| Dressing | 2/16 (12.5) |
| Writing | 7/16 (43.8) |
| Working | 7/16 (43.8) |
[i] FTM-TRS: Fahn-Tolosa-Marin tremor rating scale. R/P: rest and postural. Binary data.
Table 3
Summary of tremor features on each patient who suffered Guillain-Barré syndrome.
| CASE | SEX/AGE AT EVALUATION | TREMOR FEATURES | PART A | PART B | PART C | TOTAL | RESIDUAL WEAKNESS/SIGNS OF DENERVATION |
|---|---|---|---|---|---|---|---|
| 1 | M/41 | Arch spirals 1+ (J) | 0 | 2 | 0 | 2 | None |
| 2 | M/37 | Arch spirals 1+ (J) | 0 | 2 | 0 | 2 | None |
| 3 | F/20 | UL postural 2+, kinetic 1+, writing 1+, Arch spirals 1+, finger tremor (J) P > K | 8 | 7 | 2 | 17 | None |
| 4 | M/57 | Arch spirals 1–2+, (J) | 0 | 5 | 0 | 5 | Mild distal upper limb hypotrophy |
| 5 | M/28 | None | 0 | 0 | 0 | 0 | None |
| 6 | F/38 | Arch spirals 1+, straight line 1+ | 2 | 2 | 0 | 4 | None |
| 7 | M/54 | Arch spirals 1–2+, writing 1+, (J) | 0 | 7 | 0 | 7 | None |
| 8 | M/27 | Tongue 1+, voice 3+, UL, rest 2+, postural 2+, kinetic 2+. Writing 4+, wrist tremor. P = K | 17 | 4 | 27 | 48 | Lower limb and N/E due to residual weakness, part B partially evaluated/distal upper limb muscle hypotrophy |
| 9 | M/26 | Arch spirals 1–2+, straight line 1+, liquid pouring 1–2+, (J) | 0 | 11 | 2 | 13 | Mild residual upper limb weakness not interfering with tremor evaluation/distal upper limb muscle hypotrophy |
| 10 | M/49 | Arch spirals 1+ | – | 2 | – | 2 | Left upper limb and lower limbs N/E due to residual weakness/distal upper limb muscle hypotrophy |
| 11 | M/25 | UL postural tremor 1+, Arch spirals 1+, straight line 1+, wrist tremor, P > K (J) | 1 | 5 | 0 | 6 | None |
| 12 | F/61 | Arch spirals 1+, straight line 1+, writing 1+ (J) | 0 | 5 | 1 | 6 | None |
| 13 | F/49 | UL kinetic 2+, Arch spirals 2+, straight line 1+, wrist tremor, K > P (J) | 2 | 6 | 1 | 9 | None |
| 14 | M/48 | UL postural tremor 1+, Arch spirals 1–2+, straight line 1+, liquid pouring 1–2+, writing 2+, wrist tremor, K > P (J) | 2 | 14 | 6 | 22 | Mild distal upper limb muscle hypotrophy |
| 15 | M/54 | UL postural 2+, kinetic 1+, Arch spirals 1–2+, straight line 1+, liquid pouring 1–2+, writing 2+, wrist tremor, P > K (J) | 6 | 11 | 2 | 19 | Mild residual upper and lower limb weakness not interfering with tremor evaluation |
| 16 | F/22 | Arch spirals 1+ | 0 | 3 | 1 | 4 | Distal upper limb muscle hypotrophy |
| 17 | M/50 | Arch spirals 2–3+, straight line 2+, liquid pouring 1–2+, (J) | 2 | 15 | 3 | 20 | None |
| 18 | M/61 | N/A | – | – | – | – | Severe residual upper and lower limb weakness, part B and C N/E |
[i] Arch: Archimedean; F: female; K: kinetic; N/A: not applicable; N/E: not evaluated; M: male; P: postural; UL: upper limbs. (J) jerky tremor. P > K: upper limb postural tremor had greater amplitude than kinetic tremor, K > P: upper limb kinetic tremor had greater amplitude than postural tremor, K = P: upper limb kinetic and postural tremor had similar severity.
Figure 2
Examples of tremor in Archimedes spirals in two patients with Guillain-Barré, tremor has a jerky component without axes (A and B). Patient with essential tremor shows a regular tremor with axes (C).