Format

Send to

Choose Destination
Parkinsonism Relat Disord. 2014 Jun;20(6):647-50. doi: 10.1016/j.parkreldis.2014.02.029. Epub 2014 Mar 20.

Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor.

Author information

1
James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA; UC Neuroscience Institute, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: alberto.espay@uc.edu.
2
Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, UK.
3
A. Avogadro University and Maggiore della Carità Hospital, Novara, Italy.
4
Movement Disorders Clinic and The Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada.
5
James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
6
Biomedical Research Division, Great Lakes NeuroTechnologies, Cleveland, OH, USA.

Abstract

BACKGROUND:

Entrainment, the change or elimination of tremor as patients perform a voluntary rhythmical movement by the unaffected limb, is a key diagnostic hallmark of psychogenic tremor.

OBJECTIVE:

To evaluate the feasibility of using entrainment as a bedside therapeutic strategy ('retrainment') in patients with psychogenic tremor.

METHODS:

Ten patients with psychogenic tremor (5 women, mean age, 53.6 ± 12.8 years; mean disease duration 4.3 ± 2.7 years) were asked to participate in a pilot proof-of-concept study aimed at "retraining" their tremor frequency. Retrainment was facilitated by tactile and auditory external cueing and real-time visual feedback on a computer screen. The primary outcome measure was the Tremor subscale of the Rating Scale for Psychogenic Movement Disorders.

RESULTS:

Tremor improved from 22.2 ± 13.39 to 4.3 ± 5.51 (p = 0.0019) at the end of retrainment. The benefits were maintained for at least 1 week and up to 6 months in 6 patients, with relapses occurring in 4 patients between 2 weeks and 6 months. Three subjects achieved tremor freedom.

CONCLUSIONS:

Tremor retrainment may be an effective short-term treatment strategy in psychogenic tremor. Although blinded evaluations are not feasible, future studies should examine the long-term benefits of tremor retrainment as adjunctive to psychotherapy or specialized physical therapy.

KEYWORDS:

Entrainment; Psychogenic movement disorders; Psychogenic tremor

PMID:
24679736
PMCID:
PMC4028378
DOI:
10.1016/j.parkreldis.2014.02.029
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center