Noise-induced psychogenic tremor associated with post-traumatic stress disorder

Authors

  • Dr. Arthur S. Walters,

    Corresponding author
    1. Movement Disorder Group, Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, and Neurology Service, VA Medical Center, Lyons, New Jersey, U.S.A.
    • Department of Neurology CN 19, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, U.S.A.
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  • Wayne A. Hening

    1. Movement Disorder Group, Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, and Neurology Service, VA Medical Center, Lyons, New Jersey, U.S.A.
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Abstract

Tremors in post-traumatic stress disorders have not been previously well characterized. A 67-year-old man has a 46-year history of a noiseinduced exaggerated startle reflex followed by a large amplitude rest, postural and kinetic tremor that may persist for up to 3 days. This tremor is superimposed on a continuous mild organic postural/kinetic tremor whose electrophysiological characteristics are different from those of the overlying tremor. We attribute the exaggerated startle reflex and the noise-induced tremor to Post-Traumatic Stress Disorder (PTSD) and postulate a psychogenic origin for the noise-induced tremor. The patient alos believes the noise-induced tremor to be psychologically based and to be produced by the fear and anxiety he experiences when he hears loud, unexpected noises. The sudden onset of the noise-induced tremor, its intermittent character, its temporary disappearance on distraction despite the patient's inability to suppress it, inconsistencies in handwriting and figure drawing, and the fact that the noise-induced tremor is stimulus specific and persists long after the offending stimulus (noise) is no longer present all suggest a tremor of psychogenic origin.

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