Eken Hatice N, Louis Elan D
Department of Neurology, Yale School of Medicine, Yale University, LCI 710, 15 York Street, PO Box 208018, New Haven, CT 06520-8018 USA.
Department of Neurology, Yale School of Medicine, Yale University, LCI 710, 15 York Street, PO Box 208018, New Haven, CT 06520-8018 USA ; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT USA ; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT USA.
J Clin Mov Disord. 2016 Feb 12;3:4. doi: 10.1186/s40734-016-0032-0. eCollection 2016.
Lack of awareness of involuntary movements is a curious phenomenon in patients with certain movement disorders. An interesting anecdotal observation is that patients with essential tremor (ET) often seem unaware of their own head tremor. In the current study, we asked ET patients whether they were aware of head tremor while it was occurring on examination, thereby allowing us to gauge real-time awareness of their involuntary movement.
ET cases enrolled in an ongoing clinical research study at the Columbia University Medical Center (2009-2014). During a videotaped tremor examination, they were questioned about the presence of head tremor. True positives were cases who exhibited head tremor on examination and were aware of it; false negatives were cases who exhibited head tremor but were unaware of it.
The 126 ET cases had a mean age of 72.6 ± 12.4 years. Nineteen (48.7 %) of 39 cases with head tremor on examination did not report having head tremor at that moment. Even among cases with moderate or severe head tremor on examination, unawareness of head tremor was 45.5 %. We assessed the clinical correlates of unawareness of head tremor, comparing true positives to false negatives, and unawareness was correlated with older age, lower mental status test scores and several other clinical variables.
Nearly one-half of ET cases with head tremor on examination were acutely unaware of their tremor. Whether such agnosia for tremor may be leveraged as a diagnostic feature of ET is a question for future clinical studies.
在某些运动障碍患者中，对不自主运动缺乏认知是一种奇特的现象。一个有趣的轶事观察是，特发性震颤（ET）患者常常似乎未意识到自己头部的震颤。在本研究中，我们询问ET患者在检查时头部震颤发生时他们是否意识到，从而使我们能够评估他们对自身不自主运动的实时认知情况。
入选哥伦比亚大学医学中心正在进行的一项临床研究（2009 - 2014年）的ET病例。在一次震颤检查录像过程中，询问他们是否存在头部震颤。真阳性病例是指检查时表现出头部震颤且意识到的；假阴性病例是指表现出头部震颤但未意识到的。
126例ET病例的平均年龄为72.6±12.4岁。检查时有头部震颤的39例病例中，19例（48.7%）当时未报告有头部震颤。即使在检查时有中度或重度头部震颤的病例中，未意识到头部震颤的比例也为45.5%。我们评估了未意识到头部震颤的临床相关因素，将真阳性与假阴性进行比较，未意识到与年龄较大、精神状态测试得分较低以及其他几个临床变量相关。
检查时有头部震颤的ET病例中近一半对其震颤完全没有察觉。这种对震颤的失认是否可作为ET的一个诊断特征是未来临床研究的一个问题。
