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Abstract Details

Electrophysiology Screening for Functional Tremor Amongst Essential Tremor Patients Referred for Surgical Treatment
Movement Disorders
Movement Disorders Posters (7:00 AM-5:00 PM)
016

To determine the utility of surface electrophysiology in screening for functional tremor as part of routine surgical evaluation for medication-refractory essential tremor (ET).
Deep brain stimulation (DBS) and focused ultrasound thalamotomy are effective surgical treatments for medically-refractory ET. However, cases of functional tremor misdiagnosed as ET have reportedly been treated with surgery. Therefore, electrophysiology studies may help identify functional tremor and prevent unnecessary surgery. 
Retrospective record review of all ET patients referred to the DBS clinic at Mayo Clinic Rochester from January 2018 to June 2019. All patients underwent a surface electrophysiological tremor study as part of the DBS multidisciplinary work-up prior to surgery.  
Of 87 patients referred for surgery, 9 (10.3%) were clinically suspected of a functional tremor or functional overlay. Electrophysiology verified 1 of these 9 had isolated functional tremor, 6 had mixed functional tremor and ET, and the remaining 2 had organic ET. Electrophysiology also identified an additional 5 patients with previously unsuspected functional features in combination with clinically diagnosed organic tremor. Thus, of 12/87 patients (13.8%) with electrophysiologically-confirmed functional tremor, 11 had mixed functional and organic ET, and 1 had isolated functional tremor.  Six of the 11 patients with mixed tremor had mild-to-minimal functional overlay and were approved for surgery for ET. The isolated functional tremor patient and 5/11 mixed tremor patients were declined surgery and referred to our functional motor retraining program. One had residual disabling ET after the program and was later approved for surgery. Thus five patients (5.7%) avoided unnecessary surgery.  

Functional tremor is relatively common amongst patients referred for ET surgery. Electrophysiology studies appear valuable to help identify patients with predominant functional features and can prevent unnecessary surgery. 

Authors/Disclosures
Claudia Z. Chou, MD (Mayo Clinic)
PRESENTER 		Dr. Chou has nothing to disclose.
J. E. Ahlskog, MD, PhD (Mayo Clinic) Dr. Ahlskog has received publishing royalties from a publication relating to health care.
Bryan T. Klassen, MD (Mayo Clinic) The institution of Dr. Klassen has received research support from Insightec.
Farwa Ali, MD (Mayo Clinic) Dr. Ali has nothing to disclose.
James H. Bower, MD, MSc, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) The institution of Dr. Bower has received research support from Abbvie.
Elizabeth A. Coon, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Coon has received publishing royalties from a publication relating to health care. Dr. Coon has a non-compensated relationship as a Non-Voting Member of the Board of Directors with UCNS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Andrea C. Adams, MD (Mayo Clinic) Dr. Adams has nothing to disclose.
Anhar Hassan, MBBCH, FRACP, FRCPI, FÂ鶹´«Ã½Ó³»­ (Beaumont Hospital) The institution of Dr. Hassan has received research support from Intrabio . Dr. Hassan has received personal compensation in the range of $500-$4,999 for serving as a Invited speaker with Korean Movement Disorders Society.