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Psychogenic Tremor (psychogenic + tremor)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Dual task interference in psychogenic tremor

MOVEMENT DISORDERS, Issue 14 2007
Hatice Kumru MD
Abstract Psychogenic tremor (PT) is visually indistinguishable from voluntarily mimicked tremor. Healthy volunteers have difficulties with carrying out simultaneously two tasks due to the phenomenon known as dual task interference. Therefore, performing voluntary rhythmic movements would be a burden for carrying out fast ballistic movements with the contralateral hand. We hypothesized that, similarly to healthy volunteers performing rhythmic movements, patients with PT should show the effects of dual task interference, and this may distinguish them from patients with other types of tremor. We studied 6 patients with PT, 9 with Parkinson's disease (PD) and predominantly unilateral tremor, 11 with essential tremor (ET), and 10 normal volunteers (NV) mimicking tremor. They were requested to perform a unilateral simple reaction time task (SRT) to a visual imperative signal in two different conditions: at rest (rSRT) and during contralateral hand tremor (tSRT). Reaction time was significantly longer in tSRT than in rSRT in PT and in NV groups (P < 0.01 for both groups). However, no significant differences were observed between rSRT and tSRT in PD and ET. The delay of unilateral tSRT with respect to rSRT suggests an effect of tremorlike oscillatory movements on reaction time that is consistent with the concept of dual-task interference in NV or PT patients but not in PD or ET. These observations may be useful in the evaluation of psychogenic movement disorders. © 2007 Movement Disorder Society [source]

The pathophysiology of tremor

MUSCLE AND NERVE, Issue 6 2001
Günther Deuschl MD
Abstract Tremor is defined as rhythmic oscillatory activity of body parts. Four physiological basic mechanisms for such oscillatory activity have been described: mechanical oscillations; oscillations based on reflexes; oscillations due to central neuronal pacemakers; and oscillations because of disturbed feedforward or feedback loops. New methodological approaches with animal models, positron emission tomography, and mathematical analysis of electromyographic and electroencephalographic signals have provided new insights into the mechanisms underlying specific forms of tremor. Physiological tremor is due to mechanical and central components. Psychogenic tremor is considered to depend on a clonus mechanism and is thus believed to be mediated by reflex mechanisms. Symptomatic palatal tremor is most likely due to rhythmic activity of the inferior olive, and there is much evidence that essential tremor is also generated within the olivocerebellar circuits. Orthostatic tremor is likely to originate in hitherto unidentified brainstem nuclei. Rest tremor of Parkinson's disease is probably generated in the basal ganglia loop, and dystonic tremor may also originate within the basal ganglia. Cerebellar tremor is at least in part caused by a disturbance of the cerebellar feedforward control of voluntary movements, and Holmes' tremor is due to the combination of the mechanisms producing parkinsonian and cerebellar tremor. Neuropathic tremor is believed to be caused by abnormally functioning reflex pathways and a wide variety of causes underlies toxic and drug-induced tremors. The understanding of the pathophysiology of tremor has made significant progress but many hypotheses are not yet based on sufficient data. Modern neurology needs to develop and test such hypotheses, because this is the only way to develop rational medical and surgical therapies. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 716,735, 2001 [source]

Dual task interference in psychogenic tremor

Identification of psychogenic, dystonic, and other organic tremors by a coherence entrainment test

MOVEMENT DISORDERS, Issue 3 2004
John McAuley MD, MRCP
Abstract The differentiation of psychogenic from organic tremors, particularly those of a dystonic nature, can be difficult on clinical grounds. Entrainment of tremulous movements of different body parts into a single rhythm has been used clinically as a means of distinguishing these tremor forms, based on the inability of a patient with hysterical tremor to generate voluntary tapping oscillations independent of their ongoing tremor oscillation. The coherence entrainment test is a quantified electrophysiological entrainment test performed on accelerometer or surface EMG tremor signals. This test was carried out on 25 patients referred with suspected psychogenic tremor or dystonic tremor and on 10 normal subjects attempting to tap two independent voluntary oscillations. Using established and new clinical diagnostic criteria, patients were assigned the following final clinical diagnoses: 6 cases of clinically definite dystonic tremor, 5 cases of probable dystonic tremor, 2 cases of classic essential tremor, 5 cases of clinically definite psychogenic tremor, 3 cases of probable psychogenic tremor and 4 uncertain cases. On comparing these clinical diagnoses with those reached by a coherence entrainment test subsequently carried out on each patient, there was 100% concordance in both clinically definite and clinically probable patients. In uncertain cases, when later clinical information came to light, this also corroborated with the coherence entrainment diagnosis. No normal subjects were able to "mimic" organic tremor. The coherence entrainment test appears to be a sensitive and specific means of distinguishing psychogenic tremor from dystonic and other organic tremors. © 2003 Movement Disorder Society [source]