Functional tremor. (A) The tremor affects both hands but there is variation in amplitude and frequency between the right and left spirals. Functional tremor. (A)

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Presentation transcript:

Functional tremor. (A) The tremor affects both hands but there is variation in amplitude and frequency between the right and left spirals. Functional tremor. (A) The tremor affects both hands but there is variation in amplitude and frequency between the right and left spirals. (B) There is a marked discrepancy when the patient copies the spiral in alternate directions. (C) This patient presented with a right (dominant) hand tremor that was consistently unidirectional (8–2 o’clock direction). Other features were variable and inconsistent, suggesting a functional disorder. The site of tremor intrusion changed within a single spiral and between consecutive spirals; the amplitude changed from small to large within a single spiral but there was a consistent amplitude during straight line drawing; while the spirals were drawn quickly, there was freezing of drawing for straight lines. Note the increased density of oscillations, especially on the vertical line drawing. Jane Alty et al. Pract Neurol 2017;17:456-463 ©2017 by BMJ Publishing Group Ltd