Head tremor secondary to MS resolved with rituximab
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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.
KeywordsMultiple sclerosis Cerebellar tremor Head tremor Rituximab
Conflict of interest
Dr. Chansakul reports no disclosures. Dr. Moguel-Cobos reports no disclosures. Dr. Bomprezzi has functioned as principal investigator for clinical trials supported by Genzyme Corporation, Novartis, Serono International, Biogen Idec, Genentech Inc, UCB Pharma Inc. He has received honoraria for consulting with Teva Neuroscience, Biogen Idec, Serono International and Genzyme Corporation.
Video Legend. A 33-year-old woman with multiple sclerosis presentting with head tremor. Segment 1. The patient before treatment shows a 2.5-Hz head tremor of the ‘yes-yes’type resolved at full rest. Segment 1. The patient before treatment shows a 2.5-Hz head tremor of the ‘yes-yes’ type resolved at full rest. Supplementary material 1 (WMV 8117 kb)