Psychogenic tremor: long-term prognosis in patients with electrophysiologically confirmed disease.
We describe the presenting features and long-term outcomes of patients with electrophysiologically-confirmed psychogenic tremor. Clinical information for all patients with psychogenic tremor confirmed by our Movement Disorders Neurophysiology Laboratory (2003-2004) was reviewed. A follow-up questionnaire was administered to all included patients in 2007. Psychogenic tremor was documented in 62 patients; 33 responded to the questionnaire (53%). Median onset-age was 50 years (range, 15-71); 23 were female (70%). Clinical certainty of psychogenic etiology was: definite, 8 (24%); probable, 16 (49%), and possible, 9 (27%). Characteristic electrodiagnostic features of psychogenic tremor were documented in all. All but two patients were ultimately given a definite diagnosis of psychogenic tremor; recommended psychiatric consultation was only done by 12 (36%). Twenty-one patients (64%) rated tremor disability as moderate or severe after a median follow-up of 5.1 years (range, 3.3-19). Improvement occurred spontaneously in 5 (15%), and after a specific intervention in 4 (12%), whereas 3 (9%) had mild but unchanged symptoms. The mean duration of symptoms, prior to diagnosis with psychogenic tremor, was significantly shorter for patients with mild or no tremor at follow-up (P = 0.037). Physiologically-confirmed psychogenic tremor carries a poor prognosis, with unremitting or worse tremor persisting 3-years after diagnosis in most.
McKeon
Andrew
A
Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. mckeon.andrew@mayo.edu
Ahlskog
J Eric
JE
Bower
James H
JH
Josephs
Keith A
KA
Matsumoto
Joseph Y
JY
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001521:Behavior Therapy; D015331:Cohort Studies; D015897:Comorbidity; D003291:Conversion Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D018450:Disease Progression; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006990:Hypnosis; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010349:Patient Compliance; D011379:Prognosis; D012075:Remission, Spontaneous; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014202:Tremor / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D055815:Young Adult