Objective: To report three cases of patients developing tremor in the course of Guillain-Barré Syndrome (GBS).

Background: GBS is a monophasic neuropathy causing weakness and/or impaired sensation and sometimes pain. Tremor is known to be a manifestation of chronic inflammatory demyelinating neuropathy (CIDP),[1,2] but has rarely been reported in GBS.[3–5]

Method: We describe three male patients at the age of 25, 29 and 39 years, who were seen on the movement disorder outpatient clinlic of the Amsterdam University Medical Center because of tremor that developed during the course of GBS.

Results: The three patients had developed GBS symptoms 12 months, 13 months and 13 years earlier. Two patients had sensory and motor involvement, one patient had a pure motor GBS. In all patients, tremor had developed several days after debut of the GBS symptoms. Two patients were treated with intravenous immunoglobulins. Tremor persisted despite full recovery of strength and sensory impairment. On examination, a postural and intention tremor was observed in the hands in all patients. In two patients, tremor was also present in the feet and tremor was present in the tongue in one patient. Besides high frequency rythmic movements with small amplitude, irregular jerky movements were seen. Tremor analysis in one patient showed a 8-9 Hz tremor in action. Results of the tremor analysis of the other patients follow and will be described. In all patients the tremor had remained stable over time. In one patient, tremor caused  impairment in daily life for which propranolol was tried but not tolerated.

Conclusion: Tremor may develop early in the course of GBS and may persist up to years after recovery of motor and sensory symptoms.

References: 1. Cao Y, Menon P, Ching-Fen Chang, et al, Postural tremor and chronic inflammatory demyelinating polyneuropathy, Muscle Nerve. 2017;55(3):338-343 2. Saifee TA, Schwingenschuh P, Reilly MM, et al. Tremor in inflammatory neuropathies. J Neurol Neurosurg Psychiatry. 2013;84(11):1282-1287 3. Rossi LN, Mumenthaler M et al. Guillain-barré syndrome in children with special reference to the natural history of 38 personal cases. Neuropadiatrie 1976 Feb;7(1):45-51 4. Coltamai L, Magezi DA, Croquelois A. Pregabalin in the treatment of neuropathic tremor following a motor axonal form of Guillain-Barre syndrome. Mov Disord. 2010;25(4):517-519 5. Doppler K, Stengler H, et al. Neurofascin-155 IgM autoantibodies in patients with inflammatory neuropathies J Neurol Neurosurg Psychiatry. 2018;0:1–7

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MDS Abstracts - https://www.mdsabstracts.org/abstract/three-cases-of-early-tremor-in-the-course-of-guillain-barre-syndrome/