Objective: Study of the effect of tremor on the quality of life of patients with multifocal motor neuropathy and its dynamics in response to therapy of the underlying disease.

Background: Tremor in MMN is often resistant to standard therapy, with only a limited number of cases showing marked reduction. This makes it difficult to provide effective symptomatic treatment and in some cases exacerbates the level of functional disability of patients, limiting their ability to perform fine motor and activities of daily living.

Method: The present study presents a clinical case of a female patient, born in 2003, hospitalized with complaints of tremor in the right arm, restriction of movements in the right limbs, difficulty in performing fine hand movements, and a feeling of heaviness in the right leg when walking.

Results: The patient had considered herself ill since May 2024, when she first noticed a limitation of movement in her right arm. At the same time, a tremor developed in this limb, which made it difficult to perform everyday activities. About five months later, weakness in the right leg developed.

Neurological examination revealed hypotenar atrophy of the right hand, and restriction of active movements in the distal parts of the right hand and in the distal and proximal parts of the right leg. Muscle strength was 5 points in the left arm, 4 points in the right arm, 5 points in the left leg, and 3.5 points in the right leg on a five-point scale. Tendon reflexes were enlivened and muscle tone was unchanged. Postural and intensional tremor was noted.

Neuroimaging (MRI of the brain and cervical spinal cord) revealed no pathological changes. Electroneuromyography (ENMG) showed increased terminal latency and decreased M-response area with preserved sensory conduction.

The patient was diagnosed with multifocal motor neuropathy and was treated with intravenous immunoglobulin. One month later, there was a decrease in the severity of muscle weakness, and at a follow-up examination two months later, there was an improvement in movements and a decrease in tremor amplitude.

Conclusion: The clinical case demonstrates the features of multifocal motor neuropathy with asymmetric motor impairment and tremor, requiring differential diagnosis. Tremor exacerbated functional limitations, reducing quality of life. Administration of intravenous immunoglobulin improved motor function and reduced weakness, but the tremor was not significantly reduced.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tremor-in-multifocal-motor-neuropathy/