PDF(Pubmed)
Abstract：
The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient\'s disabilities.
摘要：
由于震颤综合征中的复杂和重叠表型，震颤患者的诊断方法具有挑战性。评估震颤的第一步是识别震颤运动并排除震颤模仿。第二步是根据历史线索和重点检查（轴1）的震颤特征对震颤综合征进行分类。综合震颤检查涉及评估不同条件下的震颤(休息，动作或混合，位置或特定任务)，震颤的分布(上肢，下肢,头部,jaw),如果怀疑是功能性震颤(FT)的积极迹象(注意力不集中，夹带,共同收缩)，和相关的神经系统症状，包括帕金森病，肌张力障碍的姿势，小脑/脑干体征,神经病,和认知障碍。该步骤中的关键特征是确定特定的孤立或组合的震颤综合征的任何明显特征。在这次审查中,我们提出了一种评估上肢震颤的算法。如果临床评估不清楚，应进行辅助测试。调查的选择取决于被认为缩小病因范围的震颤类型(轴2)。实验室血液检查被认为是急性发作和急性加重的震颤，虽然结构神经成像显示在急性发作的单侧震颤中，非古典演讲，和神经症状的组合。神经生理学研究是帮助区分震颤和肌阵颤的重要工具。震颤的病因和FT的具体征象。治疗主要根据震颤的病因和患者的残疾进行对症治疗。
