Objective: To report on the evaluation of childhood tremor  in  its many forms utilizing noninvasive electrophysiological recordings to differentiate  clinical phenomenology from many entities thereby influencing therapy and outcome.

Background: Tremor in children and  adolescents accounts for 15020% of referrals in some pediatric movement disorder programs. Essential tremor is most commonly diagnosed, new criteria pertaining to essential tremor may require further clarification when applied to children. Utilizing non invasive electrophysiological recordings, other non-essential  type tremors may be defined that resemble essential tremor clinically.Differential diagnoses may be expanded.  Since tremor frequently coexists with other movement disorders separation of the tremor component requires more specific studies and defines therapy.

Method: Ten patients ages 14-18 years of age were enrolled an in NIH IRB (USA) approved study that included clinical evaluation, neurimaging and electrophysiology. EMG electrodes were placed on bilateral flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles. Bandpass filter for EMG was 10-200Hz. Monoaxial accelerometers were placed on the dorsum of the hands bilaterally for detection of hand tremor. Monoaxial accelerometers were placed on the middle fingers bilaterally for detection of hand tremor. Band pass filter was set at 10-50Hz. The effect of weighting using  1 lb weights on the hands was evaluated. Finger weighting urilized 1/2 lb weights.

Results: Data analysis revealed diagnoses that included physiological tremor, enhanced physiological tremor, dystonic tremor, myoclonic tremor, parkinsonian tremor, the latter four mimicking essential tremor, functional tremor and drug induced tremor .Differentiation of a central component allowed for more precise diagnosis.

Conclusion: Childhood tremor can be evaluated noninvasively and accurately throughout many age groups. The electophysiological evaluation allows for more precise diagnosis and. This series which continues to accrue patients specifically identified many entities that included dystonic tremor, myoclonic tremor, cerebellar tremor that were considered clinically but required confirmation electrophysiologicaly. These specific findings determined other diagnoses and informed therapy and outcome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-childhood-tremor-electrophysiogically-influences-diagnosis-and-treatment-and-outcome/