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Semin Neurol
DOI: 10.1055/a-2769-7282
Review Article

Functional Tremor

Authors

  • Kartika Gulati

    1   Department of Neurology and Stroke Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India

  • Sanjay Pandey

    1   Department of Neurology and Stroke Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
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Abstract

Functional tremor (FT) is the most prevalent subtype of functional movement disorders, characterized by variability, distractibility, and entrainability on clinical examination. Diagnosis relies on positive clinical and electrophysiological signs, shifting emphasis from a diagnosis of exclusion to “rule-in” criteria. Surface electromyography and tremor analysis are essential tools in establishing the diagnosis. Pathophysiology involves abnormal motor co-activation, disrupted volitional awareness, and impaired predictive processing, resulting in tremor perceived as involuntary despite intact motor pathways. Management requires a multidisciplinary approach, including physiotherapy, occupational therapy, cognitive-behavioral interventions, biofeedback, and transcranial magnetic stimulation. FT often results in persistent disability, with limited treatment response. Management is hindered by diagnostic challenges, especially in functional overlay, limited training, cultural misconceptions, and underutilization of neurophysiological and rehabilitation interventions. Improving clinician training, expanding access to neurophysiology, and multidisciplinary care, along with high-quality prospective specific research and standardized care pathways, is essential to optimize outcomes.

Keywords

FT - surface electromyography - multidisciplinary management

Contributors' Statement

K.P. and S.P. contributed to the research project (conception, organization, and execution), statistical analysis (design, execution, and review and critique), and manuscript (writing of the first draft and review and critique).




Publication History

Received: 28 August 2025

Accepted: 09 December 2025

Accepted Manuscript online:
15 December 2025

Article published online:
24 December 2025

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