功能性震颤的电生理诊断

doi:10.3969/j.issn.1672-6731.2024.07.012

摘要/Abstract

摘要：

功能性震颤是功能性运动障碍的最常见亚型，目前尚无诊断“金标准”，多数临床表现与器质性震颤重合，易误诊、误治。特征性电生理学表现可提供客观、可重复的诊断信息，有效补充病史和体格检查，也可用于与器质性震颤的鉴别诊断。本文综述功能性震颤电生理学特征及其在诊断与鉴别诊断中的应用，以提高临床对疾病的认识。

关键词: 转换障碍, 震颤, 电生理学, 综述

Abstract:

Functional tremor is the most common subtype of functional movement disorder (FMD). At present, there is no "gold standard" for diagnosis. Most clinical manifestations coincide with organic tremor, which can easily lead to misdiagnosis and mistreatment. Characteristic electrophysiological manifestations can provide objective and repeatable diagnostic information, effectively supplement the history and physical examination, and can also be used in the differential diagnosis from organic tremor. This article reviews the electrophysiological characteristics of functional tremor and its application in diagnosis and differential diagnosis, in order to improve the clinical understanding of this disease.

Key words: Conversion disorder, Tremor, Electrophysiology, Review

陈琳, 潘华. 功能性震颤的电生理诊断[J]. 中国现代神经疾病杂志, 2024, 24(7): 573-578.

Lin CHEN, Hua PAN. Electrophysiological diagnosis of functional tremor[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(7): 573-578.

https://journal11.magtechjournal.com/cjcnn/CN/Y2024/V24/I7/573

图/表 4

图 1 功能性双下肢震颤的震颤分析所见1a，1b静止时可见右下肢震颤，震颤频率为3 ~ 5 Hz，主动肌与拮抗肌同步收缩；左下肢无震颤（横坐标100 ms，纵坐标100 μV）1c直立时可见双下肢震颤，震颤频率约17 Hz，主动肌与拮抗肌同步收缩（横坐标100 ms；纵坐标各肌肉500 μV，右侧加速器为1 mV、左侧加速器为10 mV）1d嘱患者进行随机两位数加减法运算时，震颤节律消失，肢体颤动幅度降低（横坐标100 ms，纵坐标100 μV）

Figure 1 Findings of tremor analysis in patients with functional lower limb tremor When the patient was at rest, there was tremor in the right lower limb with a frequency of 3-5 Hz, synchronous contraction of the active and antagonistic muscles, and no tremor in the left lower limb (Panel 1a, 1b). When the patient was upright, tremors were seen in both lower limbs with a frequency of 17 Hz, and the active and antagonistic muscles contracted synchronously (Panel 1c). When the patient was asked to perform random two - digit addition and subtraction, the tremor rhythm disappeared and the amplitude of limb vibration decreased (Panel 1d).

图 2 震颤分析显示，功能性右上肢震颤发作时震颤频率约6.50 Hz，嘱患者左上肢以3 Hz的频率敲击桌面，其右上肢震颤频率短暂性消失，随后逐渐与左上肢敲击频率相同（粗箭头所示）上图横坐标100 ms，纵坐标100 μV；下图横坐标500 ms，纵坐标100 μV

Figure 2 When the patient with functional right upper limb tremor attacked, the tremor frequency was about 6.50 Hz. When the patient was asked to tap the desktop with the left upper limb at a frequency of 3 Hz, the tremor frequency of the right upper limb disappeared briefly, and then gradually become the same as the tapping frequency of the left upper limb (thick arrows indicate).

表 1 功能性震颤临床电生理检测组合^{[4, 21]}

Table 1. Functional tremor clinical electrophysiological test combination scale^{[4, 21]}

项目	阳性特征	评分
1 Hz的敲击任务	敲击频率与任务不符	1分
3 Hz的敲击任务	敲击频率与任务不符	1分
5 Hz的敲击任务	敲击频率与任务不符	1分
对侧1、3、5 Hz的敲击任务	震颤侧出现震颤抑制或夹带现象	1 ~ 3分
对侧曲线运动任务	震颤侧出现震颤中断	1分
重物负载	震颤波幅增高	1分
震颤发作前	短暂性共激活强直放电	1分
双侧震颤	频率高度一致	1分

表 2 功能性震颤与常见器质性震颤电生理学特征的比较

Table 2. Comparison of electrophysiological characteristics of functional tremor and common organic tremor

观察指标	功能性震颤	特发性震颤	帕金森病震颤	肌张力障碍震颤	直立性震颤
频率（Hz）	6 ~ 11	4 ~ 12	4 ~ 7	3 ~ 7	13 ~ 18
主动肌与拮抗肌收缩关系	同步	同步为主	交替为主	同步	同步
震颤分布	多变	双上肢、双下肢及头部	单侧上肢或下肢为主	与肌张力障碍部位一致	双下肢
震颤模式	静止、姿势均可见	姿势为主	静止为主	特定姿势	直立姿势

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