Jackson Lauren, Klassen Bryan T, Hassan Anhar, Bower James H, Matsumoto Joseph Y, Coon Elizabeth A, Ali Farwa
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
Clin Park Relat Disord. 2021 Sep 24;5:100108. doi: 10.1016/j.prdoa.2021.100108. eCollection 2021.
To determine the utility of tremor electrophysiology testing in differentiating clinically indeterminate tremor due to organic, functional, and mixed tremor types.
Prior studies have shown that electrophysiological studies increase diagnostic sensitivity of tremor syndromes; however, few have examined mixed organic and functional tremors.
Patients referred for tremor to the Mayo Clinic, Rochester movement disorders lab were consecutively selected and retrospectively reviewed. Surface electromyography (EMG) recordings of upper limb muscles were performed at rest, posture, with action and distractibility tasks.
Of 116 patients, all were clinically described as having either a resting tremor, postural tremor, action tremor, postural and action tremor, mixed resting, postural, and action tremor, or nonspecific tremulousness. Based on electrophysiological features, patients were diagnosed with organic tremor (parkinsonian, essential, mixed, rubral, cerebellar, non-specific tremulousness), functional tremor, or mixed functional and organic tremors. The median disease duration at electrophysiological confirmation of diagnosis was shorter for functional tremor at 1.5 years (IQR 1-9.3), and organic tremor at 3 years (IQR 1-15), versus mixed organic and functional tremor at 11 years (IQR 2-15) ( = 0.0422). The electrophysiology study clarified the referral/clinical diagnosis in 87 patients (75%), 26 (29.5%) of whom had functional tremor, and 61 (70.1%) had organic tremor or mixed organic/functional tremor. Variability of tremor during electrophysiology testing was associated with a change in diagnosis (p = 0.0286).
Our findings show that electrophysiological assessment of tremor can be helpful in the clinical diagnosis of patients with both organic and functional tremor.
确定震颤电生理检测在鉴别由器质性、功能性及混合性震颤类型所致临床诊断不明确的震颤中的作用。
既往研究表明，电生理检查可提高震颤综合征的诊断敏感性；然而，很少有研究对器质性和功能性混合震颤进行过检查。
连续选取转诊至罗切斯特梅奥诊所运动障碍实验室的震颤患者，并进行回顾性分析。对上肢肌肉进行静息、姿势、动作及注意力分散任务时的表面肌电图（EMG）记录。
116例患者临床上均表现为静止性震颤、姿势性震颤、动作性震颤、姿势性和动作性震颤、静止性、姿势性和动作性混合震颤或非特异性震颤。根据电生理特征，患者被诊断为器质性震颤（帕金森病性、特发性、混合性、红核性、小脑性、非特异性震颤）、功能性震颤或功能性与器质性混合震颤。在电生理确诊时，功能性震颤的疾病持续时间中位数为1.5年（四分位间距1 - 9.3），器质性震颤为3年（四分位间距1 - 15），而器质性与功能性混合震颤为11年（四分位间距2 - 15）（P = 0.0422）。电生理检查明确了87例患者（75%）的转诊/临床诊断，其中26例（29.5%）为功能性震颤，61例（70.1%）为器质性震颤或器质性/功能性混合震颤。电生理检测期间震颤的变异性与诊断改变相关（P = 0.0286）。
我们的数据表明，震颤的电生理评估有助于器质性和功能性震颤患者的临床诊断。
