title: Severe psychogenic tremor of both wrists in a 13-year-old girl treated successfully with a customized wrist brace: a case report.
abstract: BACKGROUND
  Psychogenic movement disorders in childhood have been little researched. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed.
  
  
  METHODS
  A 13-year-old Caucasian girl with tremor in both wrists, severe enough to prevent her from attending school, was sent to our hospital. After a complete neurological and psychiatric examination, in-patient child-psychotherapeutic treatment was started, with careful consideration given to both chronic and acute stress factors which constitute her performance and exam anxiety in school as well as the girl's parents' conflicted relationship. With the aid of a customized wrist brace our patient was able to go to school and write despite the presence of a marked tremor, which in turn reduced her avoidance behavior and exam anxiety. By the end of her in-patient treatment, the tremor was still noticeable, but markedly reduced in severity (reduction 80%). Two weeks after she was discharged from hospital, the tremor had completely disappeared.
  
  
  CONCLUSIONS
  After careful clinical diagnostics, this kind of dissociative disorder should be treated appropriately with age-adapted cognitive-behavioral therapy to achieve positive and lasting benefits.
authors.affiliation: Department of Child and Adolescent Mental Health, University of Erlangen, 91054 Erlangen, Germany. elisabeth.sauerhoefer@uk-erlangen.de.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sauerhoefer
authors.forename: Caroline
authors.initials: C
authors.lastname: Schafflhuber
authors.forename: Oliver
authors.initials: O
authors.lastname: Kratz