Everlo Cheryl S J, Elting Jan Willem J, Tijssen Marina A J, van der Stouwe A M Madelein
Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands.
Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
Clin Neurophysiol Pract. 2022 Jan 29;7:51-58. doi: 10.1016/j.cnp.2021.12.002. eCollection 2022.
We investigated how clinical neurophysiological testing can help distinguish tremor and myoclonus and their subtypes.
We retrospectively analysed clinical and neurophysiological data from patients who had undergone polymyography (EMG + accelerometry) to diagnose suspected tremor or myoclonus. We show a systematic approach, which includes contraction pattern, rhythm regularity, burst duration and evidence of cortical drive.
We detected 773 patients in our database, of which 556 patients were ultimately diagnosed with tremor (enhanced physiological tremor n = 169, functional tremor n = 140, essential tremor n = 90, parkinsonism associated tremor n = 64, cerebellar tremor n = 19, Holmes tremor n = 12, dystonic tremor n = 8, tremor not further specified n = 9), 140 with myoclonus and 23 with a combination of tremor and myoclonus. Polymyography confirmed the presumptive diagnosis in the majority of the patients and led to a change of diagnosis in 287 patients (37%). Conversions between diagnoses of tremor and myoclonus occurred most frequently between enhanced physiological tremor, essential tremor, functional tremor and cortical myoclonus.
Neurophysiology is a valuable additional tool in clinical practice to differentiate between tremor and myoclonus, and can guide towards a specific subtype.
We show how the stepwise neurophysiological approach used at our medical center aids the diagnosis of tremor versus myoclonus.
我们研究了临床神经生理学检测如何有助于区分震颤和肌阵挛及其亚型。
我们回顾性分析了接受多导肌电图检查（肌电图 + 加速度测量）以诊断疑似震颤或肌阵挛患者的临床和神经生理学数据。我们展示了一种系统的方法，包括收缩模式、节律规律性、爆发持续时间和皮质驱动的证据。
我们在数据库中检测到773例患者，其中556例最终被诊断为震颤（增强的生理性震颤n = 169，功能性震颤n = 140，特发性震颤n = 90，帕金森病相关性震颤n = 64，小脑性震颤n = 19，霍尔姆斯震颤n = 12，肌张力障碍性震颤n = 8，未进一步明确的震颤n = 9），140例为肌阵挛，23例为震颤和肌阵挛合并。多导肌电图在大多数患者中证实了初步诊断，并导致287例患者（37%）的诊断改变。震颤和肌阵挛诊断之间的转换最常发生在增强的生理性震颤、特发性震颤、功能性震颤和皮质性肌阵挛之间。
神经生理学是临床实践中区分震颤和肌阵挛的有价值的辅助工具，可指导确定特定亚型。
我们展示了我们医疗中心使用的逐步神经生理学方法如何有助于震颤与肌阵挛的诊断。
