Longardner Katherine, Satpathy Yasoda, Litvan Irene, Haubenberger Dietrich
University of California San Diego, Department of Neurosciences, 9500 Gilman Dr. MC 0886, La Jolla, CA 92093, USA.
University of California San Diego School of Medicine, 9500 Gilman Dr. MC 0886, La Jolla, CA 92093, USA.
Clin Neurophysiol Pract. 2025 Jun 12;10:188-201. doi: 10.1016/j.cnp.2025.05.003. eCollection 2025.
To assess the clinical utility of a standardized, non-invasive electrodiagnostic testing protocol in refining the diagnosis and management of patients referred for tremor evaluation.
In this prospective observational study, patients with tremulous limb movements with indeterminate clinical diagnoses involving tremor as a cardinal symptom were referred by movement disorders neurologists. Participants underwent standardized phenotyping and electrodiagnostic studies for tremor analysis including four-channel surface electromyography polygraphy and two-channel accelerometry.
Clinical and electrophysiological data from 31 consecutive individuals were analyzed. Electrodiagnostic testing refined the differential diagnosis in 25/31 (80.6 %) participants and changed therapy in 14/29 (48.3 %). Changes included adjusting pharmacotherapy (n = 10), undergoing deep brain stimulation surgery (n = 2), or avoiding invasive procedures (n = 2).
We propose that electrodiagnostic testing is a clinically valuable tool that can narrow the differential diagnosis and impact treatment of tremor.
Clinical evaluation alone may be insensitive in diagnosing the tremor type when findings are subtle or when multiple movement disorders coexist. This may lead to inaccurate diagnosis and management, increasing cost and patient burden, and prolonging or preventing a successful journey towards adequate treatment. Clinical neurophysiology is a useful diagnostic procedure that can detect and quantify movements that may be otherwise indistinguishable by visual observation.
评估一种标准化的非侵入性电诊断测试方案在完善因震颤评估而转诊患者的诊断和管理方面的临床效用。
在这项前瞻性观察研究中，运动障碍神经科医生转诊了以震颤为主要症状、临床诊断不明确的肢体震颤患者。参与者接受了标准化的表型分析和用于震颤分析的电诊断研究，包括四通道表面肌电图描记术和双通道加速度测量。
分析了连续31例个体的临床和电生理数据。电诊断测试使25/31（80.6%）的参与者的鉴别诊断更加精确，并使14/29（48.3%）的参与者的治疗发生了改变。改变包括调整药物治疗（n = 10）、接受脑深部刺激手术（n = 2）或避免进行侵入性手术（n = 2）。
我们认为电诊断测试是一种具有临床价值的工具，可以缩小震颤的鉴别诊断范围并影响其治疗。
当发现不明显或存在多种运动障碍共存时，仅靠临床评估在诊断震颤类型方面可能不够敏感。这可能导致诊断和管理不准确，增加成本和患者负担，并延长或阻碍通往充分治疗的成功进程。临床神经生理学是一种有用的诊断方法，可以检测和量化那些通过视觉观察可能无法区分的运动。
