Multiple Sclerosis Tremor

Isolating the cerebellar component of MS motor dysfunction

Intention tremor and dysmetria in multiple sclerosis are disabling and poorly captured by the EDSS or the 9-Hole Peg Test, which records time but not movement quality. NeuroQuantix measures the cerebellar component of MS upper-limb dysfunction continuously from a brief spiral drawing.

Published evidence on digitized spiral analysis supports continuous, rater-independent motor measurement; the strength of that evidence for this condition is stated on this page. NeuroQuantix standardizes this evidence into a pre-specified endpoint for your program. Learn more about multiple sclerosis tremor from the NINDS/NIH overview.

Discuss Your Program View Technical Data

Spectral

Intention Tremor

Frequency and amplitude from pen velocity

Continuous

Dysmetria

Spatial error and spiral width variability

Captured

Movement Quality

Smoothness and velocity profile, not completion time

Emerging

Evidence Status

Scoping review, Wang et al., 2025

Limitations of 9HPT

The The 9-Hole Peg Test (9HPT) is the current gold standard for multiple sclerosis tremor assessment in clinical trials. These are its documented limitations.

The 9HPT and the EDSS cerebellar functional system score carry the regulatory precedent in MS and remain the anchors

The 9HPT records completion time only; two patients with the same time can have very different tremor and coordination profiles

EDSS cerebellar scores are ordinal and rater-assigned, with known inter-rater variability

Neither isolates intention tremor amplitude or frequency, which are the targets of tremor-directed therapies

Published smartphone spiral tracing studies in MS support feasibility; the platform is positioned for exploratory endpoint use

The MS Upper-Limb Measurement Challenge

MS trials measure upper-limb function with a stopwatch. The 9HPT is reliable for what it measures, but it cannot see the intention tremor and dysmetria that disable patients and that tremor-directed and remyelination programs aim to change. A continuous kinematic measure isolates the cerebellar component and sits beside the 9HPT and EDSS as a pre-specified exploratory endpoint.

Clinical Applications

Tremor-directed therapy trials in MS as an exploratory endpoint beside the 9HPT

Remyelination and neuroprotection programs measuring upper-limb function

Decentralized MS studies where a tablet assessment replaces a site visit

Published Evidence

Evidence from peer-reviewed publications supporting digital kinematic endpoints for multiple sclerosis tremor assessment. View the full evidence base.

Spiral Tracing in MS

Tablet and smartphone spiral tracing has been used to quantify cerebellar dysfunction in multiple sclerosis, establishing feasibility of the task in this population.

Scoping review: Wang S, et al. Movement Disorders Clinical Practice, 2025

Statistical Power Advantage

Higher measurement precision translates directly into smaller enrollment requirements. See the full interactive power curve comparison on the NeuroQuantix platform page.

View Power Visualization

Frequently Asked Questions

What are the limitations of the 9-Hole Peg Test for MS trials?

The 9HPT measures completion time and nothing about movement quality. Tremor amplitude, dysmetria, and smoothness are invisible to it, so a therapy that improves coordination without changing speed shows no effect. It remains the accepted upper-limb anchor; a kinematic measure beside it captures what the stopwatch cannot.

How does NeuroQuantix measure MS tremor and upper-limb function?

A brief spiral drawing yields intention tremor frequency and amplitude, spatial error, velocity, and smoothness at 240 Hz. These isolate the cerebellar component of MS upper-limb dysfunction as continuous, rater-independent variables that can be pre-specified as an exploratory endpoint beside the 9HPT and EDSS.

Is spiral analysis validated in multiple sclerosis?

Published studies have used spiral tracing on tablets and smartphones in MS and report feasibility and sensitivity to cerebellar dysfunction. The scoping review classes MS among conditions with emerging evidence. The appropriate use today is an exploratory endpoint that generates within-program evidence.