Schwingenschuh Petra, Saifee Tabish A, Katschnig-Winter Petra, Macerollo Antonella, Koegl-Wallner Mariella, Culea Valeriu, Ghadery Christine, Hofer Edith, Pendl Tamara, Seiler Stephan, Werner Ulrike, Franthal Sebastian, Maurits Natasha M, Tijssen Marina A, Schmidt Reinhold, Rothwell John C, Bhatia Kailash P, Edwards Mark J
Department of Neurology, Medical University of Graz, Graz, Austria.
Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria.
Mov Disord. 2016 Apr;31(4):555-62. doi: 10.1002/mds.26525. Epub 2016 Feb 16.
In a small group of patients, we have previously shown that a combination of electrophysiological tests was able to distinguish functional (psychogenic) tremor and organic tremor with excellent sensitivity and specificity.
This study aims to validate an electrophysiological test battery as a tool to diagnose patients with functional tremor with a "laboratory-supported" level of certainty.
For this prospective data collection study, we recruited 38 new patients with functional tremor (mean age 37.9 ± 24.5 years; mean disease duration 5.9 ± 9.0 years) and 73 new patients with organic tremor (mean age 55.4 ± 25.4 years; mean disease duration 15.8 ± 17.7 years). Tremor was recorded at rest, posture (with and without loading), action, while performing tapping tasks (1, 3, and 5 Hz), and while performing ballistic movements with the less-affected hand. Electrophysiological tests were performed by raters blinded to the clinical diagnosis. We calculated a sum score for all performed tests (maximum of 10 points) and used a previously suggested cut-off score of 3 points for a diagnosis of laboratory-supported functional tremor.
We demonstrated good interrater reliability and test-retest reliability. Patients with functional tremor had a higher average score on the test battery when compared with patients with organic tremor (3.6 ± 1.4 points vs 1.0 ± 0.8 points; P < .001), and the predefined cut-off score for laboratory-supported functional tremor yielded a test sensitivity of 89.5% and a specificity of 95.9%.
We now propose this test battery as the basis of laboratory-supported criteria for the diagnosis of functional tremor, and we encourage its use in clinical and research practice.
在一小部分患者中，我们之前已经表明，电生理测试组合能够以出色的敏感性和特异性区分功能性（心因性）震颤和器质性震颤。
本研究旨在验证一套电生理测试组合作为一种工具，以“实验室支持”的确定性水平诊断功能性震颤患者。
在这项前瞻性数据收集研究中，我们招募了38例新的功能性震颤患者（平均年龄37.9±24.5岁；平均病程5.9±9.0年）和73例新的器质性震颤患者（平均年龄55.4±25.4岁；平均病程15.8±17.7年）。在静息、姿势（负重和不负重）、动作、执行敲击任务（1、3和5赫兹）以及用受影响较小的手进行弹道运动时记录震颤。电生理测试由对临床诊断不知情的评估者进行。我们计算了所有进行测试的总分（最高10分），并使用先前建议的3分截断分数来诊断实验室支持的功能性震颤。
我们证明了评估者间信度和重测信度良好。与器质性震颤患者相比，功能性震颤患者在测试组合上的平均得分更高（3.6±1.4分对1.0±0.8分；P＜0.001），并且实验室支持的功能性震颤的预定义截断分数产生的测试敏感性为89.5%，特异性为95.9%。
我们现在提议将这套测试组合作为实验室支持的功能性震颤诊断标准的基础，并鼓励在临床和研究实践中使用。
