Neurológia pre prax 6/2010

Development of functional tremor as part of organic brain syndrome

In 1997, a 29-year-old female patient suffered a complicated craniocerebral injury (a fall off a horse) with foci of hemorrhagic contusion in the left parietal, right temporal and frontal cerebral lobes and a subsequent development of secondary post-traumatic epilepsy, with a confirmed epileptogenic focus located in the right centro-parieto-temporal region. She underwent right anterior temporal lobectomy and ventriculo-peritoneal drainage for hydrocephalus of the third and fourth ventricles as well as rehabilitation therapy with a minimal neurological residuum. An unusual „tremor“ of the right-sided limbs possibly triggered by the conflict situation is discussed. EEG and EMG analyses of the dyskinetic phenomenon do not indicate its organic origin. A thorough clinical and neuropsychological examination provides evidence of functional pathogenesis. Behavioral disinhibition in a possibly predisposed area potentiated by organic brain syndrome is assumed. Psychotherapeutic treatment was initiated.

Keywords: functional/psychogenic movement disorder, tremor, epilepsy.