Zusammenfassung
Der funktionelle (psychogene) Tremor gehört zu den häufigsten funktionellen Bewegungsstörungen. Zu den klinischen „red flags“ zählen verschiedene motorische, kognitive oder suggestive Möglichkeiten der Ablenkbarkeit, um damit eine Beeinflussung der Frequenz, der Amplitude oder der Richtung des Tremors zu erreichen. Anamnestisch findet man häufig ein plötzliches Auftreten oder aber eine ausgeprägte Variabilität. Manchmal wird eine Remission über Monate oder Jahre beschrieben. Obwohl ein willkürlich erscheinender Bewegungsaspekt charakteristisch ist, nehmen die Patienten den Tremor als unwillkürlich war. Pathophysiologisch spielt ein beeinträchtigtes Handlungsbewusstsein, also das Gefühl, die eigenen Handlungen selbst zu verursachen und deren Konsequenzen zu kontrollieren, eine entscheidende Rolle. Neben den klinischen Besonderheiten kann die Diagnose neurophysiologisch mithilfe der Akzelerometrie untermauert werden. In einer validierten Testbatterie konnten so eine Sensitivität von 89,5 % und eine Spezifität von 95,9 % erreicht werden. Die Behandlung sollte interdisziplinär angelegt sein und ausgerichtet am individuellen Bedarf medizinische, funktions- und psychotherapeutische Maßnahmen integrieren. Ein für den funktionellen Tremor spezifisches Verfahren ist das „retrainment“.
Abstract
Functional (psychogenic) tremor is the most common functional movement disorder. Characteristic clinical features, so called red flags, can help to make the clinical distinction of this type from other tremor disorders. The most common features include the variability of frequency and amplitude. Clinical examination should include different types of distraction including motor or cognitive tasks or testing the influence of suggestibility on tremor amplitude, frequency or direction. Patients often report sudden onset and remissions that may last for months or even years. In some cases, the tremor is only present in highly specific situations. Although functional tremor shares characteristics with voluntary actions, patients experience their abnormal movements as involuntary. Recent experimental approaches have revealed an impairment in sense of agency. The diagnosis can be supported by neurophysiological measurements including accelerometry, which achieved a sensitivity of 89.5% and a specificity of 95.9% in a validated test battery, thus providing a useful additional diagnostic tool. Psychotherapeutic treatment is indicated in patients with and without evident psychological symptoms. A specific physiotherapeutic approach for functional tremor is re-trainment.
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K.E. Zeuner, R. Schmidt und P. Schwingenschuh geben an, dass kein Interessenkonflikt besteht.
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Zeuner, K.E., Schmidt, R. & Schwingenschuh, P. Klinische und kognitive Neurologie des funktionellen (psychogenen) Tremors. Nervenarzt 89, 400–407 (2018). https://doi.org/10.1007/s00115-017-0476-y
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DOI: https://doi.org/10.1007/s00115-017-0476-y