Internal tremors and vibrations in long COVID: a cross-sectional study, 2023, Zhou, Iwasaki et al.

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SNT Gatchaman

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Internal tremors and vibrations in long COVID: a cross-sectional study
Tianna Zhou; Mitsuaki Sawano; Adith S. Arun; César Caraballo; Teresa Michelsen; Lindsay McAlpine; Bornali Bhattacharjee; Yuan Lu; Rohan Khera; Chenxi Huang; Frederick Warner; Akiko Iwasaki; Harlan M. Krumholz

Importance: Internal tremors and vibrations symptoms have been described as part of neurologic disorders but not fully described as a part of long COVID.

Objective: To compare demographics, socioeconomic characteristics, pre-pandemic comorbidities, new-onset conditions, and long COVID symptoms between people with internal tremors and vibrations as part of their long COVID symptoms and people with long COVID but without these symptoms.

Design: A cross-sectional study, Listen to Immune, Symptom and Treatment Experiences Now (LISTEN), of adults with and without long COVID and post-vaccination syndrome, defined by self-report.

Setting: Hugo Health Kindred, a decentralized digital research platform hosting a network of English-speaking adults interested in contributing to COVID-related research. No geographic limitation applied.

Participants: The study population included 423 participants who enrolled in LISTEN between May 2022 and June 2023, completed the initial and the conditions and symptoms surveys, reported long COVID, and did not report post-vaccination syndrome.

Exposure: Long COVID symptoms of internal tremors and vibrations.

Main outcomes and Measures: Demographics, pre-pandemic comorbidities, and current conditions, other symptoms, and quality of life at the time of surveys.

Results: Of the 423 participants (median age, 46 years [IQR, 38-56]), 74% were female, 87% were Non-Hispanic White, 92% lived in the United States, 46% were infected before the Delta wave, and 158 (37%) reported “internal tremors, or buzzing/vibration” as a long COVID symptom. Before long COVID, the groups had similar comorbidities. Participants with internal tremors were different from others in having worse health as measured by the Euro-QoL visual analogue scale (median: 40 points [IQR, 30-60] vs. 50 points [IQR, 35-62], P = 0.007), having financial difficulties caused by the pandemic (very much financial difficulties, 22% [95% CI, 1630] vs. 11% [7.3-15], P < 0.001), often feeling socially isolated (43% [95% CI, 35-52] vs. 37% [31-43], P = 0.039), and having higher rates of self-reported new-onset mast cell disorders (11% [95% CI, 7.1-18] vs. 2.6% [1.2-5.6], Bonferroni-adjusted P = 0.008) and neurologic conditions (including but not limited to seizures, dementia, multiple sclerosis, Parkinson's disease, neuropathy, etc.; 22% [95% CI, 16-29] vs. 8.3% [5.4-12], Bonferroni-adjusted P = 0.004).

Conclusions and Relevance: Among people with long COVID, those with internal tremors and vibrations have several other associated symptoms and worse health status, despite having similar pre-pandemic comorbidities, suggesting it may reflect a severe phenotype of long COVID.

Link | PDF (Preprint: MedRxiv)
 
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I have had the internal vibrations in my lower legs since having the first Moderna vaccine. After having the Pfizer vaccine the vibrations are much worse and I also get a burning sensation on the bottom of my feet. Neuropathy is one of the most reported long term adverse reactions to the covid vaccines.
 
Now published as —

Internal tremors and vibrations in long COVID: a cross-sectional study (2024)
Tianna Zhou; Mitsuaki Sawano; Adith S. Arun; César Caraballo; Teresa Michelsen; Lindsay S. McAlpine; Bornali Bhattacharjee; Yuan Lu; Rohan Khera; Chenxi Huang; Frederick Warner; Jeph Herrin; Akiko Iwasaki; Harlan M. Krumholz

BACKGROUND
Internal tremors and vibrations are symptoms previously described as part of neurologic disorders but not fully described as a part of long COVID. This study compared pre-pandemic comorbidities, new-onset conditions, and long COVID symptoms between people with internal tremors and vibrations as part of their long COVID symptoms and people with long COVID but without these symptoms.

METHODS
The Yale Listen to Immune, Symptom and Treatment Experiences Now (LISTEN) Study surveyed 423 adults who had long COVID between May 12, 2022 and June 1, 2023. The exposure variable was long COVID symptoms of internal tremors and vibrations. The outcome variables were demographic characteristics, pre-pandemic comorbidities, new-onset conditions, other symptoms, and quality of life.

RESULTS
Among study participants with long COVID, median age was 46 years [IQR, 38-56]), 74% were female, 87% were Non-Hispanic White, and 158 (37%) reported “internal tremors, or buzzing/vibration” as a long COVID symptom. The 2 groups reported similar pre-pandemic comorbidities, but people with internal tremors reported worse health as measured by the Euro-QoL visual analogue scale (median: 40 points [IQR, 30-60] vs. 50 points [IQR, 35-62], P = 0.007) and had higher rates of new-onset mast cell disorders (11% [95% CI, 7.1-18] vs. 2.6% [1.2-5.6], P = 0.008) and neurologic conditions (22% [95% CI, 16-29] vs. 8.3% [5.4-12], P = 0.004).

CONCLUSIONS
Among people with long COVID, those with internal tremors and vibrations had different conditions and symptoms and worse health status compared with others who had long COVID without these symptoms.

Link | PDF (The American Journal of Medicine)
 
More basic biomechanical studies please, at all scales, micro to macro.

For a disease featuring difficulty in movement it is surprising and more than a little disappointing that so little attention has been paid to how the body is behaving biomechanically, how it is handling both internally and externally sourced mechanical forces, passive and active, static and dynamic.

I think we are potentially missing a big chunk of critical data from this angle.
 
I’m going to say what I always say about internal tremors they are a common side effect for pregabalin so hopefully people using that medication were excluded.

I only had the one experience and it was definitely linked to pregabalin because I wasn’t taking a daily (low) dose as prescribed I didn’t like the sedation so only took them when the burning neurpathic pain was high. This time I had taken them two days running and woke up with pretty vigorous internal tremor. It was scary because I had never had anything like that before I had no idea. I had to google and luckily quickly discovered it was such a common side effect of pregabalin.

Because I was only on low dose that I’d been taking occasionally I was able to simply stop taking them and have never experienced tremors again.
 
I've had internal tremors when really unwell, even though I wasn't on any medication. I can't remember now where I saw it, but about 30 years ago I read a description someone had posted about a grinding sensation travelling down her spine that felt like an old pedal-operated dentist's drill.

I'd recently had my first experience of the same thing, and it was a good description. It's only happened to me a handful of times, it was really odd, and it usually preceded intense hallucinations and spinal muscle contractions that made me arch up in bed like someone with tetanus. It sounds a lot more unpleasant than it actually was; the contractions were painful, but the hallucinations were among the most exhilarating things I've ever experienced.

I only ever tried to describe it to a doctor once...you can probably imagine how well it went.
 
I've had internal tremors in the past. I have found out that, in my case, it is connected with my cortisol level. When I first tested my cortisol some years ago with a four-part saliva test (which measures unbound cortisol) my results were over the range. I have improved matters by optimising some vitamins and minerals, and also improving my thyroid hormones levels (Free T4 and Free T3 - I don't worry about TSH). I also take a supplement which seems to have a temporary suppressing effect on my cortisol and allows me to sleep better than I would without it.

I have read on thyroid forums that people with low levels of cortisol can also suffer from internal tremors.
 
Kitty said:
a grinding sensation travelling down her spine that felt like an old pedal-operated dentist's drill.
...
spinal muscle contractions that made me arch up in bed like someone with tetanus.
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Oh!! I experienced the same thing when I was first becoming bedbound, for about 3 months (until I stopped sitting up or getting out of bed even to toilet). And since then I've had constant (except for a window of a few weeks once) shaking of some muscle group for 2.5 years. When it's "mild" it's just my tongue or lips, when it's "bad" it's every muscle in my back and legs and scalp shaking, and a grinding sensation (or sound? it's hard to tell the difference sometimes) in the vertebrae of my neck.

Cortisol has always showed up normal, and I don't take any medications with tremors as a side effect. Though benzodiazapines and similar medications stop or reduce the shaking and grinding.
 
Internal Tremor in Long COVID May Be a Symptom of Dysautonomia and Small Fiber Neuropathy, 2024

Abstract
Background/Objectives: Internal tremor (IT) is often reported by patients with post-acute sequelae of SARS-CoV-2, also known as Long COVID, as a distressing and disabling symptom. Similarly, physicians are typically perplexed by the nature and etiology of IT and find it extremely challenging to manage.

Methods: We describe a patient with Long COVID who experienced IT as part of post-COVID postural orthostatic tachycardia syndrome (POTS) and small fiber neuropathy (SFN) and review the limited literature available on this topic.

Results: Our patient’s IT improved significantly after intravenous saline infusions, but there was no effect on IT with oral hydration, increased oral sodium chloride intake, neuropathic pain medications, muscle relaxants, or medications used for the treatment of POTS. Conclusions: Based on this case, our clinical experience, and the limited literature available to date, we believe IT is a manifestation of POTS and SFN, which may be driven by hypovolemia, cerebral hypoperfusion, sympathetic overactivity, neuropathic pain, and mast cell hyperactivation. Subjective description, objective findings, and diagnostic and therapeutic considerations in patients with IT and Long COVID are discussed.
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LINK
 
Mij said:
Internal Tremor in Long COVID May Be a Symptom of Dysautonomia and Small Fiber Neuropathy, 2024

.....................physicians are typically perplexed by the nature and etiology of IT and find it extremely challenging to manage..

.... a patient with Long COVID who experienced IT as part of post-COVID postural orthostatic tachycardia syndrome (POTS) and small fiber neuropathy (SFN) ......limited literature...

Our patient’s IT improved significantly after intravenous saline infusions,

- but there was no effect on IT with

oral hydration
increased oral sodium chloride intake
neuropathic pain medications
muscle relaxants, or
medications used for the treatment of POTS.

Conclusions: Based on this case, our clinical experience, and the limited literature available to date, we believe IT is a manifestation of POTS and SFN,

which may be driven by

hypovolemia,
cerebral hypoperfusion,
sympathetic overactivity,
neuropathic pain, and
mast cell hyperactivation.

Subjective description, objective findings, and diagnostic and therapeutic considerations in patients with IT and Long COVID are discussed.
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I am sorry I thought I could keep this one short, but it doesn't work like that, so I added spoilers again to keep the scrolling short - um - shorter instead and - memo to myself - I must remember to take these CNS obs over to the thread started by @Creekside who was wondering

Creekside said:
I was wondering if ME symptoms could be mapped to specific brain regions, which could then be checked for commonalities.

Some ME symptoms might be downstream of other failure modes, so not all would have a direct link.

Others might be unmapped.

Where does the symptom of lethargy or brainfog originate?

Some might, such as hypersensitivity or short-term memory.

I was just imagining a map of affected brain regions and finding a common abnormality, such as those regions having a specific type of astrocyte or neuron...
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in forum: General and other signs and symptoms

Research idea: Mapping symptoms to brain areas

Who said IT was part of POTS and SFN in the first place ?

Can they say everyone with an IT has POTS and / or SFN that they can treat ?

I don't appear to have either, but I might have an orthostatic intolerance (OI)

I can get what could be called a tremor - I call it a jitter - a signal jitter. My working theory is it is in the neural networks and stems from a shortfall in signal transmission. It comes and goes, and with the usual correlations.

It much interferes with my neurology, thought processes and comms (maybe also coincident with cns flickers and fades, or the bladder buzzing the brain, or - upon brain overload - the small warning signs developed in series: the cricket-clicking in one ear else twitch of an eye else grinding sensation around the ears else echoing of silence else reverb of sound else overcontraction of all facial muscle: before all that the trip of the heart with a variable delay soon after altering the dilution, volume, density, flow, pressure, viscosity, salinity of bloodstreams by input/output of liquids, and then the same trip could result from something pressing around a vein)

I would be extremely cautious with salines. I understand that they are expensive if intravenous and require a clinic to administer at least to start with (so might be safe enough) but here's another IT-coincidental thing, my thing: there is something up with my salt loads (another long obs) and so I have - more recently - had to avoid foods rich in mineral salts eg kale powder eg seaweeds (upsets loadbearing leg-muscle tone)

Over-contraction of muscle can become fixed in slight contractures, maybe like in Parkinsonism or some auto-immune attacks on particular parts of the brain with bruxism etc. An overcontracted diaphragm can reduce lung capacity - once muscles can relax the lungs spontaneously open for deeper breaths (I guess thats acetylcholine). Once released the other muscles also flex spontaneously.


I can get what could be called a tremor - I call it a jitter - a signal jitter. My working theory is it is in the neural networks and stems from a shortfall in signal transmission. It comes and goes, and with the usual correlations.

It much interferes with my neurology (inludes the cns flickers and fades)

It does not shake muscle so maybe its not in the motor nerves but it can coincide with eg:

- problems of manual dexterity, of sequencing and co-ordination of tasks in time amd space (tasks as in tasks in mind and tasks in environment), of the 1% error in location of points in space, of some loss in depth of field, and of the perception of spatial relationships vanishing i.e offline

In one extremity the interference with visual perception spread (temporarily) to interfere also with aural perception so i know it can get much worse.

The consequences then to hearing can only resemble a stroke when coupled with a flickering of current-speech-related thought also impacting on communication and while unable to describe the hearing problem - stroke cannot affect hearing in this way (said a TIA neurologist)

I can even suffer it without detecting it (except in retrospect by comparison when it stops). Its invisible but once, in extremity, it could have been what spread enough to shake vision.

I don't appear to have POTS or SFN. I might have an orthostatic intolerance (OI).

There is one medicine that seemed to steady this tremulous neural transmission remarkably but the dosage has a sweet spot thats easily exceeded and then it reverses and causes the symptoms it had corrected, also it pre-occupies some UB40 sorry P40 enzyme family so its not safe to take unless monitoring blood levels of some extremely important medications if also taken. The NHS does not reccommend it unless for some form of epilepsy

Not sure how come they believe POTS can manifest as an invisible tremor since the medications they use to treat their POTS patients made no difference, so maybe it was a foregone conclusion with a confirmation bias

Or maybe they know their meds only work on IT co-morbid with POTS if not also co-morbid with SFN

Actually being an amateur I don't even know if a symptom can be classed as a co-morbidity, and there is still some discussion on which is a symptom

Or maybe they know its the SFN producing the IT irrrespective of the POTS, but have no meds to treat their SFN patients ands see if it helps or hinders an IT

But I can't now read the whole paper and see what objective findings were specified but got omitted from the abstract.

Maybe they found a way to measure the tremor to confirm the subjective description that so confounds them but I doubt that since they don't know or don't say where to look for it

They cite 5 possible drivers for this mystery. Do they derive this from the cited literature on diagnostic and therapeutic considerations ? Or is it their own catch all working theory in clinic and does the paper say which as its not in the abstract.

But in the abstract it sounds like it derives from a wider review, assuming the Neuorology International Journal sorted that one out for us, it being so atttractive to see an advert by clinicans who know what they are doing
 
Jonathan Edwards said:
I really wouldn't bother with this mumbo-jumbo.
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Ok, phew, gobbledy-gook mangles the brain

Mij said:
Ilene S. Ruhoy and Svetlana Blitshteyn say so because every single diagnosis fits into their theories. Don't try to challenge their views or you will be "blocked".
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Yes it could be bad for business, I gathered Blitsheyn had a name for brash petty infamy, I didn't realise it knew no bounds, that is a bigger gamble, I guess too many clients came a cropper already, got discredited and blocked too. Rabidly

By some cross-sectional comparison the previous paper had noted that these inner shakes tend to mark the iller cases (which also have a different presentation), so this consequent? paper is targeting those most in need of clinical care

"Among people with long COVID, those with internal tremors and vibrations had different conditions and symptoms and worse health status compared with others who had long COVID without these symptoms"

Sad to say there was some limited global immunity for medical trial and error and all the posing of evidence-based medicine could not conceal the reckless experimental nature of clinical convention.

And there I was not daring to say to a doctor that something buzzed my brain and something else jittered my signal transmission, and since covid sound can grind on my brain

The buzzing of the central nervous system was instant upon its local trigger and stopped with the trigger, so it had to be conveyed through the neurons, and it developed before covid.

I got the grinding sensation around the ears not the brainstem (but there once was a smidgin of hypoperfusion at the brainstem) and this only developed after covid in series with a number of other odd things, all minor but intensely alerting and triggered by overload

The jitter is something else but could produce a grind maybe
 
If Internal Tremor and Vibrations in Long-COVID Cannot Be Confirmed by Abnormal Instrumental Examinations, Psychiatrists are Required, Josef Finsterer, MD, PhD

To the Editor,

We were interested to read the article by Zhou et al on a retrospective observational study comparing demographic and socioeconomic characteristics, prepandemic comorbidities and new-onset disease between patients with internal tremor and vibration as symptoms of Long COVID and patients with Long COVID but without internal tremor or vibration.1 It was found that 37% of patients with long-COVID reported internal tremor or vibration, that patients with internal tremor had lower quality of life (QoL) scores than patients without tremor, and had a higher rate of new-onset mast cell dysfunction.1 The study concluded that patients with long-term COVID who manifest with internal tremor and vibration have different conditions and symptoms and poorer health than patients without these symptoms.1 The study is excellent, but some points should be discussed.

...

To summarize, this interesting study has limitations that put the results and their interpretation into perspective. Addressing these limitations could strengthen the conclusions and corroborate the study's message. Patients with prolonged COVID manifesting with internal tremor and vibrations need a thorough and comprehensive diagnostic workup to avoid overlooking a CNS/PNS or psychiatric disorder as the cause of these symptoms.

Open access
 
If Internal Tremor and Vibrations in Long-COVID Cannot Be Confirmed by Abnormal Instrumental Examinations, Psychiatrists are Required
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Sympathetic Neural Overdrive, Vascular Dysfunction and Diminished Exercise Capacity in Long COVID-19 Patients: A Long-Term Study of Cardiovascular Sequelae (2025, American Journal of Physiology-Regulatory, Integrative and Comparative Physiology) —

Fig 1: Sympathetic neural overdrive in Long COVID patients. (A) Original recordings of muscle sympathetic [nerve] activity (MSNA) in one control and one COVID-19 survivor. (B) MSNA burst frequency and (C) incidence in controls and COVID-19 survivors.
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Screenshot 2025-05-21 at 9.21.19 PM copy.jpg
 
The second point is that the symptoms of internal tremor and vibration were not clearly defined. Therefore, one patient may understand these terms differently from another patient. Did internal tremor and vibration also include anxiety, fear, depressed mood, impulsivity, panic, uncertainty and hopelessness?
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I have no idea why anyone would take «internal tremors» to mean those things.
The third point is that none of the included patients underwent a systematic examination for neurological diseases. Since internal tremor and vibration can be a clinical manifestation of a central nervous system (CNS) or peripheral nervous system (PNS) disease, it would have been mandatory to systematically screen all included patients for cerebrovascular diseases, epilepsy, movement disorders, cerebellar diseases, or neuropathies by means of cerebral MRI, EEG, nerve conduction studies (NCS), and cerebrospinal fluid (CSF) examinations, if applicable.
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Is that a reasonable thing to do in the context of this study?
The fourth point is that the included patients were not systematically subjected to a psychiatric examination. In particular, in the cases where all applied tests were negative, a psychiatric evaluation should have been performed, as it cannot be excluded that at least in some cases these symptoms had no organic correlate, but were rather a long-term psychosomatic reaction to the SARS-CoV-2 infection.
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I’m curious about how they would suggest that one can determine of the symptoms are a «psychosomatic reaction». Apparently, the reasoning from point three gets thrown out the window for the BPS stuff.
The fifth point is that therapeutic interventions to treat internal tremor and vibration were not reported. We should know whether these patients received specific treatment and whether tranquilizers, antidepressants, neuroleptics, hypnotics, antiepileptics, or beta-blockers had a positive effect.
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I have no idea why this is something «we should know» in the context of this study.
The sixth point is that it was not systematically assessed whether internal tremor and vibration were intermittent or permanent and how long these symptoms persisted until full recovery.
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Again, they show that they have no idea about these symptoms. My internal tremors are still not gone after three years. They are on and off, but always return.

It seems like the aim of this letter was to be contrary. An LLM could probably have saved them the effort.
 
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I've had internal tremors. I discovered that they were related to my cortisol level. My cortisol is high, but I have seen other people with low cortisol saying that it gives them tremors too.

Edit : I've just realised I've given the same information in two different replies to this thread. My apologies! :( :banghead:
 
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