Historical and clinical features of psychogenic tremor: a review of 70 cases

Objectives: To review the clinical characteristics and associated features found in patients with psychogenic tremor. Methods: Ten-year retrospective review of charts of all patients and videotapes of fifty-one patients diagn osed by the senior author as having psychogenic tremor. Results: Seventy pa tients fulfilled the diagnostic criteria for clinically definite psychogeni c tremors. Psychogenic tremors usually started abruptly (73%), often with t he maximal disability at onset (46%), and then took static (46%) or fluctua ting (17%) courses. Psychogenic tremors usually started in one limb and spr ead rapidly to a generalized or mixed distribution. Spontaneous resolution and recurrence, easy distractibility together with entrainment and response to suggestion were characteristic features. Presence of functional symptom s and signs and refractoriness to conventional antitremor drugs were common . Conclusions: Psychogenic tremor is generally not a diagnosis of exclusion . The presence of characteristic features on history and especially clinica l examination can permit an accurate diagnosis and avoid unnecessary invest igations.