Objective: To assess concordance between initial clinical diagnosis and neurophysiological tremor study-based diagnosis, combining surface EMG and accelerometry, and to explore the diagnostic utility of neurophysiological assessment in patients referred for tremor in a joint Neurology-Neurophysiology Movement Disorders clinic.

Background: Accurate diagnosis of tremor disorders remains challenging in routine clinical practice, particularly when differentiating among distinct tremor phenotypes. Although careful history taking and neurological examination remain the cornerstone of tremor assessment, diagnostic doubts may persist in a subset of patients [1,2]

In such cases, neurophysiological study can provide objective information on tremor characteristics. However, its impact on the clinical approach to tremor has seldom been systematically evaluated [1–3].

Method: We retrospectively reviewed neurophysiological tremor studies from 83 patients at two tertiary hospitals in the Community of Madrid, Spain, performed during 2025. Demographic data, tremor phenomenology, initial clinical diagnosis and neurophysiological variables were collected. A final neurophysiological diagnosis was assigned using predefined criteria, and diagnostic concordance was assessed [3–5].

Results: Data from 83 patients were analyzed (median age 59.2 years; 68.7% female). Tremor predominantly involved the upper limbs (95.2%) and was most often postural (92.8%) [table 1].

Clinical and neurophysiology-based diagnoses were discordant in 39 patients (47%) [figure 1]. The most frequent diagnostic transition among discordant cases were functional tremor changed to essential tremor (n=8) and essential tremor to functional tremor (n=3) [table2, figure 2, figure 3].

Tremor recordings were performed within a specialized consultation with a neurologist, management changes were recorded after the visit, irrespective of whether they were directly attributable to neurophysiological findings [figure 3].

Conclusion: Neurophysiological tremor study integrated within specialized tremor consultations is associated with substantial diagnostic reclassification in clinical practice. These findings support its utility as an adjunctive tool to improve tremor phenotyping and guide clinical decision-making. Limitations include the retrospective design and possible selection bias toward more complex presentations.

Table 1.

Table 2.

Figure 1.

Figure 2.

Figure 3.

References: 1. Van Der Veen S, Klamer MR, Elting JWJ, Koelman JHTM, Van Der Stouwe AMM, Tijssen MAJ. The diagnostic value of clinical neurophysiology in hyperkinetic movement disorders: A systematic review. Parkinsonism & Related Disorders. 2021 Aug;89:176–85. doi:10.1016/j.parkreldis.2021.07.033
2. Grippe T, Chen R. Utility of Neurophysiological Evaluation in Movement Disorders Clinical Practice. Movement Disord Clin Pract. 2023 Nov;10(11):1599–610. doi:10.1002/mdc3.13856
3. Longardner K, Satpathy Y, Litvan I, Haubenberger D. Impact of clinical neurophysiological assessment on diagnosis and management of tremor disorders. Clinical Neurophysiology Practice. 2025;10:188–201. doi:10.1016/j.cnp.2025.05.003
4. Schwingenschuh P, Saifee TA, Katschnig‐Winter P, Macerollo A, Koegl‐Wallner M, Culea V, et al. Validation of “laboratory‐supported” criteria for functional (psychogenic) tremor. Movement Disorders. 2016 Apr;31(4):555–62. doi:10.1002/mds.26525
5. Schwingenschuh P, Espay AJ. Functional tremor. Journal of the Neurological Sciences. 2022 Apr;435:120208. doi:10.1016/j.jns.2022.120208

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-utility-of-neurophysiological-tremor-study-within-a-joint-neurology-neurophysiology-movement-disorders-clinic-one-year-retrospective-two-center-study/