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. 2014 Jun;20(6):647-50.
doi: 10.1016/j.parkreldis.2014.02.029. Epub 2014 Mar 20.

Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor

A J Espay  1 , M J Edwards  2 , G D Oggioni  3 , N Phielipp  4 , B Cox  5 , H Gonzalez-Usigli  5 , C Pecina  5 , D A Heldman  6 , J Mishra  5 , A E Lang  4
Affiliations

Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor

A J Espay et al. Parkinsonism Relat Disord. 2014 Jun.

Abstract

Background: Entrainment, the change or elimination of tremor as patients perform a voluntary rhythmical movement by the unaffected limb, is a key diagnostic hallmark of psychogenic tremor.

Objective: To evaluate the feasibility of using entrainment as a bedside therapeutic strategy ('retrainment') in patients with psychogenic tremor.

Methods: Ten patients with psychogenic tremor (5 women, mean age, 53.6 ± 12.8 years; mean disease duration 4.3 ± 2.7 years) were asked to participate in a pilot proof-of-concept study aimed at "retraining" their tremor frequency. Retrainment was facilitated by tactile and auditory external cueing and real-time visual feedback on a computer screen. The primary outcome measure was the Tremor subscale of the Rating Scale for Psychogenic Movement Disorders.

Results: Tremor improved from 22.2 ± 13.39 to 4.3 ± 5.51 (p = 0.0019) at the end of retrainment. The benefits were maintained for at least 1 week and up to 6 months in 6 patients, with relapses occurring in 4 patients between 2 weeks and 6 months. Three subjects achieved tremor freedom.

Conclusions: Tremor retrainment may be an effective short-term treatment strategy in psychogenic tremor. Although blinded evaluations are not feasible, future studies should examine the long-term benefits of tremor retrainment as adjunctive to psychotherapy or specialized physical therapy.

Keywords: Entrainment; Psychogenic movement disorders; Psychogenic tremor.

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Conflict of interest statement

Competing interests: DH is Biomedical Research Manager at Great Lakes NeuroTechnologies, the manufacturer of the Crescendo system which was adapted to fit the objectives of this study. However, he did not directly participate in recruitment or analysis of data. AE has received research support from Great Lakes NeuroTechnologies for studies other than the one covered in this article. All other authors report no potential conflicts of interest related to the research covered in this article

Figures

Figure 1
Figure 1
A. Tremor scores before and after retrainment. B. Suppressibility and entrainability scores.
See this image and copyright information in PMC

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