Holmes’ or functional tremor?

Abstract

HighlightsWe report the case of an Holmes tremor with atypical features.The association between Holmes and functional tremor has never been reported before.We propose a fast battery for the differential diagnosis of functional tremor.

Holmes’ tremor or functional tremor: Neurophysiological criteria can help diagnosis

“…We agree with Bocci et al (2018) that routine electrophysiological testing results in a high degree of diagnostic certainty regarding functional tremor. We emphasize that neurophysiological criteria applied to functional tremor could help with tremor diagnosis in routine clinical practice.…”

“…I read with much interest the case report ‘Holmes’ or functional tremor?’ by Bocci and coworkers ( Bocci et al, 2018 ) on a patient with mixed rest and action tremor following intracranial dermoid cyst surgery. Although the authors performed a neurophysiological study, the final diagnosis was inconclusive.…”

“…Functional tremor is considered definitive when there is intra-subject frequency variability >1.5 Hz or tremor suppression during attention distraction ( Table 1 ). Applying these criteria, we suggest that the patient reported by Bocci et al (2018) may have definitive functional (psychogenic) tremor. In this case, brain surgery and the lag between surgery and tremor would be a coincidence.…”

Towards an update in the neurophysiological assessment of functional tremors

“…For instance, Fig. 1 shows MEPs recorded at rest and during MI in the patient we reported in previous paper ( Bocci et al, 2018 ).

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“…I read with interest the letter by Gironell, recently accepted for publication in this Journal ( Gironell, 2019 ). The Author suggested the diagnosis of a definite functional (psychogenic) tremor for the case we previously described in the article entitled “Holmes’ or functional tremor?” ( Bocci et al, 2018 ). We completely agree with his interpretation, based both on clinical and neurophysiological features ( Gironell, 2016 , Schwingenschuh et al, 2016 ); nonetheless, given the common superimposition of organic and non-organic etiologies, we preferred to justify our views about the final diagnosis.…”