Internal Tremor in Long COVID Could Be Linked to Dysautonomia and Small Fiber Neuropathy
Nikhil Prasad Fact checked by:Thailand Medical News Team Dec 26, 2024 12 hours, 50 minutes ago
Medical News: As the global community continues to grapple with the long-term effects of COVID-19, researchers are shedding light on an array of post-viral symptoms, including the less understood internal tremor (IT). For many individuals suffering from Long COVID, internal tremor manifests as a persistent and debilitating symptom, significantly impacting daily life. This peculiar sensation, often described as vibrations or internal shaking, is invisible to others, making it a challenging phenomenon for medical professionals to diagnose and treat.
Internal Tremor in Long COVID Could Be Linked to Dysautonomia and Small Fiber Neuropathy
A recent case study conducted by American researchers from the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Mount Sinai South Nassau, the Icahn School of Medicine at Mount Sinai, and the University of Arizona College of Medicine, delves into the connection between internal tremor, dysautonomia, and small fiber neuropathy (SFN). This
Medical News report explores these findings and their implications for Long COVID patients.
A Closer Look at Internal Tremor
Internal tremor is a sensation that many Long COVID patients describe as a vibration, trembling, or shaking within their body. Unlike the visible tremors associated with conditions such as Parkinson's disease, internal tremor is purely subjective, making it a symptom rather than a sign. Recent studies estimate that internal tremor affects approximately 37% of Long COVID patients, often alongside other conditions such as postural orthostatic tachycardia syndrome (POTS) and mast cell activation syndrome (MCAS).
The researchers presented a case study involving a middle-aged woman who experienced internal tremor following a mild SARS-CoV-2 infection. The patient reported symptoms including rapid heart rate, dizziness, body pain, fatigue, and brain fog, which persisted for 10 months. Her internal tremor, primarily affecting her legs and torso, severely impaired her ability to work and carry out everyday tasks.
Diagnostic Pathways and Challenges
The patient underwent a series of diagnostic tests, including a 10-minute stand test, which revealed a significant increase in heart rate consistent with POTS. A skin biopsy confirmed reduced epidermal nerve fiber density, indicating SFN. Despite these findings, other diagnostic measures, such as brain imaging and blood tests, showed no abnormalities.
The patient’s case underscores the diagnostic challenges associated with internal tremor and Long COVID. Misdiagnoses, such as attributing symptoms to anxiety or functional neurological disorders, are common due to the absence of visible signs. However, researchers emphasize the importance of thorough evaluations to identify underlying conditions like POTS and SFN.
Exploring Treatment Options
Treatment for internal tremor in Long COVID patients often involves managing associated conditions such as dysautonomia and neuropathy. In this case, the patie
nt’s symptoms improved significantly with intravenous saline infusions, which alleviated her internal tremor more effectively than oral hydration, neuropathic pain medications, or muscle relaxants.
Researchers hypothesize that intravenous saline’s efficacy may be linked to its ability to counteract hypovolemia and improve cerebral perfusion. While the exact mechanisms remain unclear, these findings highlight the potential of intravenous therapy as a treatment option for internal tremor.
Broader Implications and Future Directions
The case study aligns with existing research suggesting a strong correlation between internal tremor, POTS, and SFN. These conditions are characterized by autonomic dysfunction, which may involve a hyperadrenergic state, mast cell hyperactivation, or neuropathic processes affecting small nerve fibers. Understanding these mechanisms could pave the way for more targeted treatments and improved patient outcomes.
Key Findings from the Study
-Prevalence and Characteristics of Internal Tremor: Internal tremor is reported by 37% of Long COVID patients, often in conjunction with other symptoms like fatigue, brain fog, and dizziness.
-Diagnostic Insights: The study highlights the importance of tests such as the 10-minute stand test and skin biopsies in diagnosing underlying conditions like POTS and SFN.
-Treatment Outcomes: Intravenous saline proved to be an effective treatment for internal tremor, offering relief that was not achieved with oral hydration or conventional medications.
-Pathophysiological Mechanisms: Internal tremor may result from a combination of factors, including hypovolemia, cerebral hypoperfusion, and sympathetic overactivity, warranting further investigation.
Conclusions and Patient Impact
The findings from this case study and related research highlight the need for greater awareness and understanding of internal tremor as a symptom of Long COVID. Clinicians are encouraged to evaluate patients for autonomic dysfunction and small fiber neuropathy, avoiding misdiagnoses that could delay appropriate treatment.
For patients, the recognition of internal tremor as a valid and treatable symptom offers hope. The success of intravenous saline therapy in this case underscores the potential for tailored interventions to alleviate suffering and improve quality of life.
In conclusion, internal tremor represents a complex interplay of neurological and autonomic factors in Long COVID. Addressing this symptom requires a multidisciplinary approach, combining thorough diagnostics with individualized treatment plans. As research continues to evolve, the medical community must prioritize the needs of Long COVID patients, ensuring that emerging therapies are accessible and effective.
The study findings were published in the peer-reviewed journal: Neurology International.
https://www.mdpi.com/2035-8377/17/1/2
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https://www.thailandmedical.news/news/nk-cell-genes-and-the-mystery-of-long-covid-small-fiber-neuropathy
https://www.thailandmedical.news/news/long-covid-news-postural-orthostatic-tachycardia-syndrome-pots-and-dysautonomia-are-common-occurrences-in-long-covid
https://www.thailandmedical.news/articles/long-covid
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