Treatment Approach for Tremor in Conversion Disorder

Understanding Functional Tremor

Functional tremors often show variable frequency, amplitude, and direction, and may be entrainable, which can be influenced by voluntary movements, in patients with conversion disorder 1
Symptoms of functional tremor may develop in the context of injury, illness, or psychological distress, though absence of psychological factors does not rule out the diagnosis, according to the American Academy of Neurology 2
Functional tremors typically worsen with attention and improve with distraction, as observed in studies published by the Journal of Neurology, Neurosurgery and Psychiatry 1, 3

Providing a clear, empathetic explanation of the diagnosis that acknowledges the involuntary nature of symptoms is crucial, as recommended by the American Heart Association 4, 5
Ruling out organic causes of tremor through appropriate neurological examination is essential, according to the Journal of Neurology, Neurosurgery and Psychiatry 1
Evaluating the impact of tremor on daily functioning and quality of life is necessary, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 1, 3

The American College of Physicians recommends rhythm modification, superimposing alternative, voluntary rhythms on top of the existing tremor and gradually slowing all movement to complete rest, as an effective treatment for functional tremor 1, 6
Entrainment techniques, such as using the unaffected limb to dictate a new rhythm, can help entrain the tremor to stillness, according to the Journal of Neurology, Neurosurgery and Psychiatry 1
Music incorporation, introducing music to dictate a rhythm for the patient to follow, can help override the tremor pattern, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 1, 7
Cognitive behavioral therapy (CBT) may be beneficial in patients with functional neurological symptoms, though evidence shows a non-statistically significant trend toward improvement, according to the American Heart Association 4, 5

Minimizing the use of adaptive equipment is recommended, as aids and equipment are generally unhelpful in the rehabilitation process for functional disorders, according to the Journal of Neurology, Neurosurgery and Psychiatry 1, 6
If aids are necessary, they should be considered as short-term solutions only, and a minimalist approach should be used, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 1

Reinforcing illness behavior, such as avoiding excessive focus on symptoms or providing unnecessary aids, should be avoided, as recommended by the Journal of Neurology, Neurosurgery and Psychiatry 1, 6
Dismissive approach, failing to acknowledge the involuntary nature of symptoms, can damage therapeutic alliance, according to the American Heart Association 4
Pharmacotherapy limitations, unlike essential tremor, there is no evidence supporting significant benefit from pharmacotherapy for functional tremor, as suggested by the American Heart Association 4