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Moving toward "laboratory-supported" criteria for psychogenic tremor.

Schwingenschuh, P; Katschnig, P; Seiler, S; Saifee, TA; Aguirregomozcorta, M; Cordivari, C; Schmidt, R; Rothwell, JC; Bhatia, KP; Edwards, MJ (2011) Moving toward "laboratory-supported" criteria for psychogenic tremor. Mov Disord, 26 (14). pp. 2509-2515. ISSN 1531-8257
SGUL Authors: Edwards, Mark John James

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A confident clinical diagnosis of psychogenic tremor is often possible, but, in some cases, a "laboratory-supported" level of certainty would aid in early positive diagnosis. Various electrophysiological tests have been suggested to identify patients with psychogenic tremor, but their diagnostic reliability has never been assessed "head to head" nor compared to forms of organic tremor other than essential tremor or PD. We compared baseline tremor characteristics (e.g., frequency and amplitude) as well as electrophysiological tests previously reported to distinguish psychogenic and organic tremor in a cohort of 13 patients with psychogenic tremor and 25 patients with organic tremor, the latter including PD, essential-, dystonic-, and neuropathic tremors. We assessed between-group differences and calculated sensitivity and specificity for each test. A number of tests, including entrainment or frequency changes with tapping, pause of tremor during contralateral ballistic movements, increase in tremor amplitude with loading, presence of coherence, and tonic coactivation at tremor onset, revealed significant differences on a group level, but there was no single test with adequate sensitivity and specificity for separating the groups (33%-77% and 84%-100%, respectively). However, a combination of electrophysiological tests was able to distinguish psychogenic and organic tremor with excellent sensitivity and specificity. A laboratory-supported level of diagnostic certainty in psychogenic tremor is likely to require a battery of electrophysiological tests to provide sufficient specificity and sensitivity. Our data suggest such a battery that, if supported in a prospective study, may form the basis of laboratory-supported criteria for the diagnosis of psychogenic tremor.

Item Type: Article
Additional Information: Copyright © 2011 Movement Disorder Society This article: Schwingenschuh, P., Katschnig, P., Seiler, S., Saifee, T. A., Aguirregomozcorta, M., Cordivari, C., Schmidt, R., Rothwell, J. C., Bhatia, K. P. and Edwards, M. J. (2011), Moving toward “laboratory-supported” criteria for psychogenic tremor. Mov. Disord., 26: 2509–2515. was published at
Keywords: Adult, Diagnosis, Differential, Diagnostic Techniques, Neurological, Electromyography, Evidence-Based Medicine, Female, Humans, Male, Middle Aged, Movement, Neurologic Examination, Psychophysiologic Disorders, Reproducibility of Results, Sensitivity and Specificity, Tremor, Humans, Tremor, Psychophysiologic Disorders, Diagnosis, Differential, Diagnostic Techniques, Neurological, Neurologic Examination, Electromyography, Sensitivity and Specificity, Reproducibility of Results, Evidence-Based Medicine, Movement, Adult, Middle Aged, Female, Male, psychogenic tremor, tremor analysis, electrophysiology, diagnostic criteria, Neurology & Neurosurgery, 1103 Clinical Sciences, 1106 Human Movement And Sports Science, 1702 Cognitive Science
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Neuroscience (INCCNS)
Journal or Publication Title: Mov Disord
ISSN: 1531-8257
Language: eng
14 December 2011Published
28 September 2011Published Online
25 July 2011Accepted
Project IDFunderFunder ID
089698Wellcome Trust
MC_G1000735Medical Research Council
PubMed ID: 21956485
Web of Science ID: WOS:000298086700017
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