Tremor may also be entrainable, i.e., brought into a specific rhythm. CNS Spectr 11: 501–508. The use of such drugs, however, must be made on an individual basis, taking into consideration all aspects of the patient's medical, neurological and psychological condition. Tremor and Other Hyperkinetic Movements, vol. 'Orthopedic Surgeon'. Showing patients with functional (psychogenic) motor symptoms their physical signs. When testing postural instability they may have an exaggerated loss of balance to a minimal pull without an actual fall. Trick or treat? [PubMed], Edwards, MJ and Schrag, A (2011). The examiner should take time to elicit these additional signs as they collectively support the diagnosis of PT. Almost 30 per cent of parkinsonian patients relate the onset of tremor to emotional trauma, most frequently citing the sudden death of a loved one as the precipitant. Prognosis is considered poor when the movement disorder continues for many years. It has worsened over the past few years. [PubMed], Shill, H and Gerber, P (2006). As the patient recites the months backwards, the tremor of the right hand varies in direction, amplitude, and frequency with frequent pauses. doi: 10.1016/j.parkreldis.2015.08.036. Individuals may stagger or veer from side to side when walking and appear to be losing their balance, but only rarely fall. “Psychogenic Tremor: A Video Guide to Its Distinguishing Features”. Drugs which reduce anxiety or tension in general may ameliorate tremor to the degree that such tremor is influenced by stress or emotional duress; it must be made clear, however, that not all organic tremor, nor even all neurotic tremor, is significantly influenced by emotional factors. In the case of the neuroses, particularly anxiety neuroses, it is frequently presumed that a repressed and unresolved emotional conflict may lead, among other things, to increased anxiety which in turn may be manifested by the motor symptom of tremor. Indeed, the inter-rater agreement on diagnosis is poor even amongst movement disorder specialists.5 There is no diagnostic gold standard and the diagnosis is primarily based on clinical history and examination. Figure 1. Your role and/or occupation, e.g. Copyright © 2010 Sociedad Española de Neurología. Submit only on articles published within the last 8 weeks. J Clin Neurosci 17: 959–965, DOI: [PubMed], Raethjen, J, Kopper, F, Govindan, RB, Volkmann, J and Deuschl, G (2004). Based on a study of 32 patients with psychogenic parkinsonism, patients with this type of PMD were typically found to exhibit an abrupt onset of “shaking”, often in response to some stressful event, followed by progressive slowness and early disability.13 On examination the tremor was easily distractible and, instead of decrementing amplitude when performing repetitive movements typically present in patients with Parkinson’s disease, the patients with psychogenic parkinsonism had no decrement when performing rapid succession movements. However, the specific presenting tremor may vary widely, from a very fine and passive tremor to one which is coarse and marked in amplitude, and in many instances may be combined with other abnormal movement symptoms and patterns of incoordination, such as ataxia and dysmetria. El diagnóstico es difícil y debe realizarlo un neurólogo experto. It is not uncommon for a physician to prescribe a cocktail before dinner or during the evening, or for the patient himself to develop this type of regimen. Psychogenic movement disorders. 2012 Jan;18 Suppl 1:S155-7. Rigidity, if present, is often associated with active resistance against passive movement and there is usually no cogwheeling. Psychogenic tremor: Long-term outcome. The diagnosis is not only based on exclusion of organic causes, but on clinical features characteristic of PT. Educating clinicians about psychogenic tremor will hopefully lead to earlier diagnosis and treatment. It is the most common movement disorder encountered in primary care. Edwards, MJ and Bhatia, KP (2012). Organic movement disorders must be excluded after a detailed neurological history, examination, and appropriate diagnostic studies.

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