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Neurology (Expert Forum)
psychogeni tremor vs. PD
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psychogeni tremor vs. PD
by Molot, Mar 30, 2002 12:00AM
Greetings,
1. Can one determine if a tremor is psychogenic in origin, ie. due to post-traumatic stress, rather than PD? How does one distinguish between the two?
2. I have a unilateral left hand and occasional left foot rest tremor that is also postural sometimes. This has gradually come on during the last 1-2 years. My jaw and tongue also tremor, though it is more like vibrate. The hand & foot tremors increase when I am under emotional stress (both happy and sad). Since I have been in therapy to deal with past issues of abuse, my thought was that the tremors were a coping mechanism. My neurologist floored me when he suggested I might have Parkinson's.He noted a cog-wheel effect in the left elbow.
3. Can tremors be "internal" such as a feeling of a very strong pulse or thumping, even if the limb does not visibly seem to be moving?
4. What do neurologists actually mean when they ask if you have trouble getting up out of chairs, or bed? My body works just fine, but for a while, I have had to mentally prepare for such movements - kind of muster the energy, if you will. Is that what they are talking about?
5. Thank you for your time to answer these questions. I appreciate your service.
Molot
1. Can one determine if a tremor is psychogenic in origin, ie. due to post-traumatic stress, rather than PD? How does one distinguish between the two?
2. I have a unilateral left hand and occasional left foot rest tremor that is also postural sometimes. This has gradually come on during the last 1-2 years. My jaw and tongue also tremor, though it is more like vibrate. The hand & foot tremors increase when I am under emotional stress (both happy and sad). Since I have been in therapy to deal with past issues of abuse, my thought was that the tremors were a coping mechanism. My neurologist floored me when he suggested I might have Parkinson's.He noted a cog-wheel effect in the left elbow.
3. Can tremors be "internal" such as a feeling of a very strong pulse or thumping, even if the limb does not visibly seem to be moving?
4. What do neurologists actually mean when they ask if you have trouble getting up out of chairs, or bed? My body works just fine, but for a while, I have had to mentally prepare for such movements - kind of muster the energy, if you will. Is that what they are talking about?
5. Thank you for your time to answer these questions. I appreciate your service.
Molot
Doctor's Answer
by CCF-Neuro-M.D.-JT, Mar 31, 2002 12:00AM
1.Yes, this can be distinguished by certain findings on the physical exam that can be picked up by most neurologists such as when the tremor is present, does it go away with distraction, does the amplitude and frequency change, etc...
2.Possible, depending on your exam. Both psychogenic and PD tremors can be increased with stress/emotion. Asymmetric tremor and Cogwheeling rigidity are more typical of PD, but can also occur in psychogenic causes.
3.Absolutely
4.They are asking about balance, stability, and slowness of movement/freezing which point to PD if there is a problem.
Consider a second opinion or go to a movement disorders clinic for further evaluation. Some of your symptoms and signs do sound like PD, but I cannot say definitively as I would have to examine you myself.
Good luck.
2.Possible, depending on your exam. Both psychogenic and PD tremors can be increased with stress/emotion. Asymmetric tremor and Cogwheeling rigidity are more typical of PD, but can also occur in psychogenic causes.
3.Absolutely
4.They are asking about balance, stability, and slowness of movement/freezing which point to PD if there is a problem.
Consider a second opinion or go to a movement disorders clinic for further evaluation. Some of your symptoms and signs do sound like PD, but I cannot say definitively as I would have to examine you myself.
Good luck.
I noticed that I had gained approx. 26 pounds within approx. 2 months. I was under a bit of stress (emotional) due to my father's illness with being a renal care patient in Florida and having a double amputation being performed on him. My medical physician during my November yearly checkup noticed that my cholestrol was quite a bit high and thought that I might have a thyroid problem, but the test results for the thyroid problem came back negative. So at the end of November, I noticed while working that my hands would tremble alot and my muscles would spasm alot. I noticed that I was becoming more fatigued alot. So, I continued to just try and ignore the pain with stiffness throughout my body. So once again while visiting in Florida on vacation in March, 2002, I was hospitalized with severe chest pains. It felt like I was suffocating and was transported to a nearby hospital. They gave me shots of warfarin and they also performed a stress-test- which showed that I had a lack of oxygen going somewhere. So the cardiologist immediately did a cardiac catherization and it showed no signs of heart damage at all. But there still was a lack of oxygen present. The cardiologist also stated to me that my cholestrol level was high. So, I was released from the hospital and returned back home in Tennessee. I contacted my MD and set an appointment with him and the tremors were taking place while at his office. He placed me on Zanaflex 4mg. and scheduled a appointment with a neurologist (he diagnosed me with resting tremors) a speculation. So on May 28th, 2002 I saw the neurologist and he did some simple testing while consulting with me and said that it was essential or physiologic tremors. He wanted to place me on Buspar (fianancial I couldn't afford) so he placed me on Xanax 0.25 mg twice daily. Since, June 10th, 2002 I have relocated to Charleston, South Carolina and I just shake alot and the stiffness has occured more across the shoulder and neck area. The left side of my body becomes numb and so does the right side of my head. The pressure on my head is so hard to explain at times. It's not like a migraine headache at all. Sometimes, the muscles in my entire body just makes it hard for me to move even at a rapid pace. But, the neurologist says that my thyroid functions, CBC, chemistry profile are all normal. I know that I live in constant pain anymore. I can't write legible at times or hold a cup anymore. It seems like it takes me a long time to get dressed. I can't remember things anymore. There is a history of Parkinson's on my father's side of the family. My mother,sister and two of aunt's on my mother's side has progressive MS. I am going to see a neurologist here in South Carolina within the next month. So, I just wanted to share this bit of news and see what you would suggest.
Thank you,
Mable Sidener