Zeuner K E, Schmidt R, Schwingenschuh P
Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Deutschland.
Psychotherapeutische Neurologie, Kliniken Schmieder, Neurologisches Fach- und Rehabilitationskrankenhaus, Konstanz, Deutschland.
Nervenarzt. 2018 Apr;89(4):400-407. doi: 10.1007/s00115-017-0476-y.
Functional (psychogenic) tremor is the most common functional movement disorder. Characteristic clinical features, so called red flags, can help to make the clinical distinction of this type from other tremor disorders. The most common features include the variability of frequency and amplitude. Clinical examination should include different types of distraction including motor or cognitive tasks or testing the influence of suggestibility on tremor amplitude, frequency or direction. Patients often report sudden onset and remissions that may last for months or even years. In some cases, the tremor is only present in highly specific situations. Although functional tremor shares characteristics with voluntary actions, patients experience their abnormal movements as involuntary. Recent experimental approaches have revealed an impairment in sense of agency. The diagnosis can be supported by neurophysiological measurements including accelerometry, which achieved a sensitivity of 89.5% and a specificity of 95.9% in a validated test battery, thus providing a useful additional diagnostic tool. Psychotherapeutic treatment is indicated in patients with and without evident psychological symptoms. A specific physiotherapeutic approach for functional tremor is re-trainment.
功能性（心因性）震颤是最常见的功能性运动障碍。其特征性临床特征，即所谓的警示信号，有助于在临床上将这种类型与其他震颤障碍区分开来。最常见的特征包括频率和幅度的变异性。临床检查应包括不同类型的干扰，包括运动或认知任务，或测试暗示性对震颤幅度、频率或方向的影响。患者常报告突然发作和缓解，缓解期可能持续数月甚至数年。在某些情况下，震颤仅在高度特定的情境中出现。尽管功能性震颤与随意动作有共同特征，但患者将其异常运动体验为不自主的。最近的实验方法揭示了能动性感知受损。神经生理学测量（包括加速度测量）可辅助诊断，在经过验证的测试组中，加速度测量的灵敏度为89.5%，特异性为95.9%，因此提供了一种有用的辅助诊断工具。无论有无明显心理症状的患者都适合进行心理治疗。针对功能性震颤的一种特定物理治疗方法是重新训练。
