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Historical and Clinical Features of Psychogenic Tremor: a Review of 70 Cases

Published online by Cambridge University Press:  02 December 2014

Yun J. Kim ,
Anthony S.-I. Pakiam  and
Anthony E. Lang
Yun J. Kim
Affiliation:
Morton and Gloria Shulman Movement Disorders Center and the Division of Neurology, Toronto Western Hospital, Division of the University Health Network and the Department of Medicine, University of Toronto
Anthony S.-I. Pakiam
Affiliation:
Morton and Gloria Shulman Movement Disorders Center and the Division of Neurology, Toronto Western Hospital, Division of the University Health Network and the Department of Medicine, University of Toronto
Anthony E. Lang
Affiliation:
Morton and Gloria Shulman Movement Disorders Center and the Division of Neurology, Toronto Western Hospital, Division of the University Health Network and the Department of Medicine, University of Toronto
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Abstract

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Objectives:

To review the clinical characteristics and associated features found in patients with psychogenic tremor.

Methods:

Ten-year retrospective review of charts of all patients and videotapes of fifty-one patients diagnosed by the senior author as having psychogenic tremor.

Results:

Seventy patients fulfilled the diagnostic criteria for clinically definite psychogenic tremors. Psychogenic tremors usually started abruptly (73%), often with the maximal disability at onset (46%), and then took static (46%) or fluctuating (17%) courses. Psychogenic tremors usually started in one limb and spread rapidly to a generalized or mixed distribution. Spontaneous resolution and recurrence, easy distractibility together with entrainment and response to suggestion were characteristic features. Presence of functional symptoms and signs and refractoriness to conventional antitremor drugs were common.

Conclusion:

Psychogenic tremor is generally not a diagnosis of exclusion. The presence of characteristic features on history and especially clinical examination can permit an accurate diagnosis and avoid unnecessary investigations.

Résumé

RÉSUMÉ<span class='bold'><span class='italic'>Objectifs:</span></span>

Nous revoyons les caractéristiques cliniques et les manifestations associées observées chez les patients atteints de tremblement psychogène.

<span class='italic'><span class='bold'>Méthodes:</span></span>

Nous avons procédé à une revue rétrospective des dossiers de tous les patients et aux enregistrements vidéo de cinquante et un patients chez qui l’auteur senior a posé un diagnostic de temblement psychogène.

<span class='italic'><span class='bold'>Résultats:</span></span>

Les critères diagnostiques cliniques du tremblement psychogène étaient présents chez soix-ante-dix patients. Le tremblement psychogène commençait habituellement abruptement (73%), donnant lieu souvent à une invalidité maximale au début (46%) avec une évolution stable (46%) ou fluctuante (17%). Les tremblements psychogènes commençaient habituellement dans un membre et se propageaient rapidement en une distribution généralisée ou mixte. La résolution spontanée et la récidive, la distractibilité ainsi que l’entraînement et la réponse à la suggestion étaient des manifestations caractéristiques. La présence de symptômes et de signes fonctionnels et le fait que le tremblement soit réfractaire aux médicaments antitremblement étaient fréquents.

<span class='italic'><span class='bold'>Conclusions:</span></span>

Le tremblement psychogène n’est généralement pas un diagnostic d’exclusion. La présence de manifestations caractéris- tiques à l’histoire et surtout à l’examen clinique peut permettre un diagnostic exact et éviter des investigations inutiles.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 3 , November 1999 , pp. 190 - 195
Copyright
Copyright © The Canadian Journal of Neurological 1999

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