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Published Online: 22 July 2024

Functional Neurological Disorders Among Patients With Tremor

José Fidel Baizabal-Carvallo, M.D., M.Sc. [email protected], Marlene Alonso-Juarez, M.D., and Joseph Jankovic, M.D.Authors Info & Affiliations
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Preprint
https://doi.org/10.1176/appi.neuropsych.20230126
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Abstract

Objective:

Functional neurological disorders (FNDs) are increasingly recognized in the general population and neurology clinics, and there is evidence that patients with neurological disorders are more likely to have a FND. This study was designed to identify the clinical features of FNDs among patients with movement disorders when the two disorders coexist.

Methods:

The clinical histories and video recordings of 150 consecutive patients with tremors were examined: the types of tremor included essential tremor; essential tremor plus; dystonic tremor; tremor associated with dystonia; and drug-induced, myoclonic, orthostatic, task-specific, parkinsonian, Holmes, and unclassified tremor. Using criteria for “possible” and “probable” coexistent FND, clinical features that helped differentiate between functional and other neurological tremors were identified.

Results:

There were 27 (18%) patients with functional manifestations, and 17 (11% of full sample) of these patients had signs suggestive of comorbid functional tremor. Patients with comorbid functional manifestations were younger at presentation, and these patients had greater severity of tremor, particularly upper limb postural tremor. Functional manifestations were not more commonly observed among patients with any particular type of tremor, except for patients with Holmes tremor, who were more likely to have comorbid functional neurological manifestations.

Conclusions:

About 18% of patients with diverse types of tremors also had comorbid functional neurological manifestations. Of the coexistent FNDs, functional tremor was the most common. Patients with co-occurring functional and other neurological tremors presented for evaluation at a younger age and had greater severity of arm tremor than those without comorbid functional neurological manifestations.

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Information & Authors

Information

Published In

Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Preprint

History

Received: 4 August 2023
Revision received: 16 January 2024
Accepted: 24 April 2024
Published online: 22 July 2024

Keywords

  1. Cerebral Disorders
  2. Diagnosis and Classification in Neuropsychiatry
  3. Essential Tremors
  4. Functional Movement Disorders
  5. Functional Neurological Disorders
  6. Holmes Tremor

Authors

Affiliations

José Fidel Baizabal-Carvallo, M.D., M.Sc. [email protected]
Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston (Baizabal-Carvallo, Jankovic); Department of Sciences and Engineering, University of Guanajuato, Campus León, León, México (Baizabal-Carvallo); Instituto Politécnico Nacional, Mexico City, Mexico (Alonso-Juarez).
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Marlene Alonso-Juarez, M.D.
Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston (Baizabal-Carvallo, Jankovic); Department of Sciences and Engineering, University of Guanajuato, Campus León, León, México (Baizabal-Carvallo); Instituto Politécnico Nacional, Mexico City, Mexico (Alonso-Juarez).
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Joseph Jankovic, M.D.
Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston (Baizabal-Carvallo, Jankovic); Department of Sciences and Engineering, University of Guanajuato, Campus León, León, México (Baizabal-Carvallo); Instituto Politécnico Nacional, Mexico City, Mexico (Alonso-Juarez).
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Notes

Send correspondence to Dr. Baizabal-Carvallo ([email protected]).

Competing Interests

Dr. Baizabal-Carvallo has received royalties from Medlink Neurology. Dr. Jankovic has received research or training funding from Allergan, CHDI Foundation, Dystonia Coalition, F. Hoffmann-La Roche, Huntington Study Group, Medtronic Neuromodulation, Merz, Michael J. Fox Foundation for Parkinson Research, Neurocrine Biosciences, NIH, Nuvelution Pharma, Parkinson’s Foundation, Parkinson Study Group, Revance, and Teva; he has served as a consultant or adviser for Abide, Allergan, Lundbeck, Parexel, Retrophin, and Teva; he has served on editorial boards for several journals; and he has received royalties from Cambridge, Elsevier, Future Science Group, Hodder Arnold, Lippincott Williams and Wilkins, Medlink Neurology, and Wiley-Blackwell. Dr. Alonso-Juarez reports no financial relationships with commercial interests.

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