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Functional Tremor
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DOI：10.1055/a-2769-7282.png)
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Abstract
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Functional tremor (FT) is the most prevalent subtype of functional movement disorders, characterized by variability, distractibility, and entrainability on clinical examination. Diagnosis relies on positive clinical and electrophysiological signs, shifting emphasis from a diagnosis of exclusion to rule-in criteria. Surface electromyography and tremor analysis are essential tools in establishing the diagnosis. Pathophysiology involves abnormal motor co-activation, disrupted volitional awareness, and impaired predictive processing, resulting in tremor perceived as involuntary despite intact motor pathways. Management requires a multidisciplinary approach, including physiotherapy, occupational therapy, cognitive-behavioral interventions, biofeedback, and transcranial magnetic stimulation. FT often results in persistent disability, with limited treatment response. Management is hindered by diagnostic challenges, especially in functional overlay, limited training, cultural misconceptions, and underutilization of neurophysiological and rehabilitation interventions. Improving clinician training, expanding access to neurophysiology, and multidisciplinary care, along with high-quality prospective specific research and standardized care pathways, is essential to optimize outcomes.
Keywords:
FT
surface electromyography
multidisciplinary management
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