Validation of “laboratory‐supported” criteria for functional (psychogenic) tremor

Schwingenschuh, Petra; Saifee, Tabish A.; Katschnig‐Winter, Petra; Macerollo, Antonella; Koegl-Wallner, Mariella; Culea, Valeriu; Ghadery, Christine; Hofer, Edith; Pendl, Tamara; Seiler, Stephan; Werner, Ulrike; Franthal, Sebastian; Maurits, Natasha M.; Tijssen, Marina A. J.; Schmidt, Reinhold; Rothwell, John C.; Bhatia, Kailash P.; Edwards, Mark J.

doi:10.1002/mds.26525

Cited by 89 publications

(81 citation statements)

References 20 publications

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“…Although there are often psychiatric features like depression in patients with functional disorders, their pathophysiological relationship with the functional tremor is often unclear. Test batteries have been proposed . There are probably multiple etiologies.…”

Section: Resultsmentioning

confidence: 99%

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Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society

et al. 2017

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Background Consensus criteria for classifying tremor disorders were published by the International Parkinson and Movement Disorder Society in 1998. Subsequent advances with regard to essential tremor, tremor associated with dystonia, and other monosymptomatic and indeterminate tremors make a significant revision necessary. Objectives Convene an international panel of experienced investigators to review the definition and classification of tremor. Methods Computerized MEDLINE searches in January 2013 and 2015 were conducted using a combination of text words and MeSH terms: “tremor”, “tremor disorders”, “essential tremor”, “dystonic tremor”, and “classification” limited to human studies. Agreement was obtained using consensus development methodology during four in‐person meetings, two teleconferences, and numerous manuscript reviews. Results Tremor is defined as an involuntary, rhythmic, oscillatory movement of a body part and is classified along two axes: Axis 1—clinical characteristics, including historical features (age at onset, family history, and temporal evolution), tremor characteristics (body distribution, activation condition), associated signs (systemic, neurological), and laboratory tests (electrophysiology, imaging); and Axis 2—etiology (acquired, genetic, or idiopathic). Tremor syndromes, consisting of either isolated tremor or tremor combined with other clinical features, are defined within Axis 1. This classification scheme retains the currently accepted tremor syndromes, including essential tremor, and provides a framework for defining new syndromes. Conclusions This approach should be particularly useful in elucidating isolated tremor syndromes and syndromes consisting of tremor and other signs of uncertain significance. Consistently defined Axis 1 syndromes are needed to facilitate the elucidation of specific etiologies in Axis 2. © 2017 International Parkinson and Movement Disorder Society

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Section: Resultsmentioning

confidence: 99%

“…Test batteries have been proposed. 88 There are probably multiple etiologies. A search for underlying psychiatric disorders is required in all cases.…”

Section: Functional Tremor Syndromementioning

confidence: 99%

Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society

et al. 2017

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“…The usefulness of this test battery was recently validated in a prospective study including 40 patients with FT and 72 patients with organic tremors [30].…”

Section: • Electrophysiologic Testingmentioning

confidence: 99%

An Update on Functional (Psychogenic) Tremor

Koegl-Wallner

Schwingenschuh

2015

Future Neurol.

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Functional tremor accounts for at least 50% of patients with functional movement disorders. The diagnostic work-up of these patients can be challenging. It is a multistep process based on patients' history and clinical criteria finally providing a 'positive' diagnosis. Variability of the tremor over the disease course and during clinical examination is characteristic. Patients often show increased attention toward the tremulous body part and distractability of the tremor once attention is drawn away. Sometimes distractability becomes obvious during history taking or neurological examination, in others certain distraction tasks are needed. If uncertainty remains, ancillary investigations such as electrophysiological tests may be helpful. Recent studies suggested that a loss of sense of control of ones actions may help to explain why patients with functional tremor report that they do not experience the abnormal movement as voluntary. Treatment has to be placed in a multidisciplinary team involving neurologists, psychiatrists, physiotherapists and psychologists. KEYWORDSFunctional (or psychogenic) movement disorders (FMD) are part of a wide spectrum of functional neurological disorders and account for 2-20% of movement disorders in specialized clinics [1,2].FMD can resemble all organic involuntary movements, affect gait and speech or present as unusual undifferentiated movements that do not fit into a known category [3]. Historically, FMD were thought to be caused by emotional trauma and were diagnosed by excluding organic disorders. There has been an ongoing debate concerning the preferable terminology [1]. Descriptive terms such as psychogenic, conversion or somatization disorders were proposed, other experts suggested nonorganic or medically unexplained disorders, hysteria or functional disorders.Recent epidemiological studies questioned the relevance of psychological triggering factors [4] and most movement disorder neurologists do not consider them mandatory for a diagnosis of FMD [5]. This paradigm shift has also found acceptance among psychiatrists and the DSM5 criteria for conversion disorder (functional neurological symptom disorder) have been modified to emphasize the essential importance of the neurological examination, and in recognition that relevant psychological factors may not be demonstrable at the time of diagnosis [6].Over the last decades the diagnosis of an FMD has shifted from excluding an organic movement disorder to providing a 'positive' diagnosis. A modified definition for FMD was recently proposed as "a movement disorder that is significantly altered by distraction or nonphysiological manoeurvres (including dramatic placebo response) and that is clinically incongruent with movement disorders known to be caused by neurological disease [1]".Among patients the term 'functional' has been shown to be most acceptable and subsequently many movement disorder specialists now prefer this term because it does not presuppose a cause for For reprint orders, please contact: reprints@futuremedicine.com

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“…The key clinical features that help to differentiate psychogenic from organic tremor are a sudden tremor onset, unusual disease course, often with fluctuations or remissions, distractibility of the tremor if attention is removed from the affected body part, tremor entrainment, tremor variability, and a coactivation sign [48]. In cases where the clinical diagnosis remains challenging, providing a “laboratory-supported” level of certainty aids an early positive diagnosis [49]. Due to the inability of a patient with PT to generate voluntary tapping oscillations independent of their ongoing tremor oscillation, coherence entrainment test (CET) was used as a sensitive and specific means to distinguish PT from dystonic and other organic tremors, with nearly 100% concordance with clinical diagnosis [50].…”

Section: Ancillary Tests For Tremor Differential Diagnosesmentioning

confidence: 99%

Rest tremor revisited: Parkinson’s disease and other disorders

Chen

Hopfner

Becktepe

et al. 2017

Transl Neurodegener

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Tremor is the most common movement disorder characterized by a rhythmical, involuntary oscillatory movement of a body part. Since distinct diseases can cause similar tremor manifestations and vice-versa, it is challenging to make an accurate diagnosis. This applies particularly for tremor at rest. This entity was only rarely studied in the past, although a multitude of clinical studies on prevalence and clinical features of tremor in Parkinson’s disease (PD), essential tremor and dystonia, have been carried out. Monosymptomatic rest tremor has been further separated from tremor-dominated PD. Rest tremor is also found in dystonic tremor, essential tremor with a rest component, Holmes tremor and a few even rarer conditions. Dopamine transporter imaging and several electrophysiological methods provide additional clues for tremor differential diagnosis. New evidence from neuroimaging and electrophysiological studies has broadened our knowledge on the pathophysiology of Parkinsonian and non-Parkinsonian tremor. Large cohort studies are warranted in future to explore the nature course and biological basis of tremor in common tremor related disorders.

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Validation of “laboratory‐supported” criteria for functional (psychogenic) tremor

Abstract: We now propose this test battery as the basis of laboratory-supported criteria for the diagnosis of functional tremor, and we encourage its use in clinical and research practice.

Cited by 89 publications

References 20 publications

Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society

Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society

An Update on Functional (Psychogenic) Tremor

Rest tremor revisited: Parkinson’s disease and other disorders

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