Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor

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• 作者：A.J. Espay^a ; ^b ; ^{alberto.espay@uc.edu" class="auth_mail} ; ^{aespay@gmail.com" class="auth_mail} ; M.J. Edwards^c ; G.D. Oggioni^d ; N. Phielipp^e ; B. Cox^a ; H. Gonzalez-Usigli^a ; C. Pecina^a ; D.A. Heldman^f ; J. Mishra^a ; A.E. Lang^e
• 关键词：Psychogenic movement disorders ; Psychogenic tremor ; Entrainment
• 刊名：Parkinsonism and Related Disorders
• 出版年：June 2014
• 年：2014
• 卷：20
• 期：6
• 页码：647-650
• 全文大小：257 K

文摘

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.