Impact of clinical neurophysiological assessment on diagnosis and management of tremor disorders

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice Pub Date : 2025-01-01 DOI:10.1016/j.cnp.2025.05.003

Katherine Longardner , Yasoda Satpathy , Irene Litvan , Dietrich Haubenberger

{"title":"Impact of clinical neurophysiological assessment on diagnosis and management of tremor disorders","authors":"Katherine Longardner , Yasoda Satpathy , Irene Litvan , Dietrich Haubenberger","doi":"10.1016/j.cnp.2025.05.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To assess the clinical utility of a standardized, non-invasive electrodiagnostic testing protocol in refining the diagnosis and management of patients referred for tremor evaluation.</div></div><div><h3>Methods</h3><div>In this prospective observational study, patients with tremulous limb movements with indeterminate clinical diagnoses involving tremor as a cardinal symptom were referred by movement disorders neurologists. Participants underwent standardized phenotyping and electrodiagnostic studies for tremor analysis including four-channel surface electromyography polygraphy and two-channel accelerometry.</div></div><div><h3>Results</h3><div>Clinical and electrophysiological data from 31 consecutive individuals were analyzed. Electrodiagnostic testing refined the differential diagnosis in 25/31 (80.6 %) participants and changed therapy in 14/29 (48.3 %). Changes included adjusting pharmacotherapy (n = 10), undergoing deep brain stimulation surgery (n = 2), or avoiding invasive procedures (n = 2).</div></div><div><h3>Conclusions</h3><div>We propose that electrodiagnostic testing is a clinically valuable tool that can narrow the differential diagnosis and impact treatment of tremor.</div></div><div><h3>Significance</h3><div>Clinical evaluation alone may be insensitive in diagnosing the tremor type when findings are subtle or when multiple movement disorders coexist. This may lead to inaccurate diagnosis and management, increasing cost and patient burden, and prolonging or preventing a successful journey towards adequate treatment. Clinical neurophysiology is a useful diagnostic procedure that can detect and quantify movements that may be otherwise indistinguishable by visual observation.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 188-201"},"PeriodicalIF":2.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurophysiology Practice","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2467981X2500023X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To assess the clinical utility of a standardized, non-invasive electrodiagnostic testing protocol in refining the diagnosis and management of patients referred for tremor evaluation.

Methods

In this prospective observational study, patients with tremulous limb movements with indeterminate clinical diagnoses involving tremor as a cardinal symptom were referred by movement disorders neurologists. Participants underwent standardized phenotyping and electrodiagnostic studies for tremor analysis including four-channel surface electromyography polygraphy and two-channel accelerometry.

Results

Clinical and electrophysiological data from 31 consecutive individuals were analyzed. Electrodiagnostic testing refined the differential diagnosis in 25/31 (80.6 %) participants and changed therapy in 14/29 (48.3 %). Changes included adjusting pharmacotherapy (n = 10), undergoing deep brain stimulation surgery (n = 2), or avoiding invasive procedures (n = 2).

Conclusions

We propose that electrodiagnostic testing is a clinically valuable tool that can narrow the differential diagnosis and impact treatment of tremor.

Significance

Clinical evaluation alone may be insensitive in diagnosing the tremor type when findings are subtle or when multiple movement disorders coexist. This may lead to inaccurate diagnosis and management, increasing cost and patient burden, and prolonging or preventing a successful journey towards adequate treatment. Clinical neurophysiology is a useful diagnostic procedure that can detect and quantify movements that may be otherwise indistinguishable by visual observation.

查看原文本刊更多论文

临床神经生理学评估对震颤障碍诊断和治疗的影响

目的探讨一种标准化的、无创的电诊断测试方案在改进震颤评估患者诊断和管理中的临床应用价值。方法在这项前瞻性观察研究中，以震颤为主要症状的不确定临床诊断的震颤性肢体运动患者由运动障碍神经科医生转诊。参与者进行了标准化的表型和电诊断研究，以进行震颤分析，包括四通道表面肌电图和双通道加速度测量。结果对31例患者的临床和电生理资料进行分析。电诊断试验改善了25/31（80.6%）参与者的鉴别诊断，改变了14/29（48.3%）参与者的治疗方法。改变包括调整药物治疗（n = 10），接受深部脑刺激手术（n = 2），或避免侵入性手术（n = 2）。结论电诊断是一种有临床价值的工具，可以缩小震颤的鉴别诊断范围和影响治疗。意义当症状不明显或多种运动障碍共存时，单纯的临床评估可能对诊断震颤类型不敏感。这可能导致不准确的诊断和管理，增加费用和患者负担，并延长或阻止获得适当治疗的成功旅程。临床神经生理学是一种有用的诊断方法，可以检测和量化视觉观察无法区分的运动。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neurophysiology Practice NEUROSCIENCES-

CiteScore

3.90

自引率

0.00%

发文量

审稿时长

71 days

期刊介绍： Clinical Neurophysiology Practice (CNP) is a new Open Access journal that focuses on clinical practice issues in clinical neurophysiology including relevant new research, case reports or clinical series, normal values and didactic reviews. It is an official journal of the International Federation of Clinical Neurophysiology and complements Clinical Neurophysiology which focuses on innovative research in the specialty. It has a role in supporting established clinical practice, and an educational role for trainees, technicians and practitioners.