The Role of Electrophysiology in Movement Disorders

Đặng Thị Huyền Thương; Trần Ngọc Tài

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Tổng quan Issue: Số 37 - 2023 Rối loạn vận động

The Role of Electrophysiology in Movement Disorders

Published: June 22, 2023

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Abstract

Clinical observation and history-taking remain the primary tools for diagnosing movement disorders, but neurophysiological studies serve as a valuable adjunct for clarifying the nature and origin of abnormal movements and distinguishing functional from organic disorders. This review covers key electrophysiological techniques, including surface electromyography (EMG), electroencephalography (EEG), combined EMG-EEG with jerk-locked back-averaging, Bereitschaft potential, somatosensory evoked potentials (SEPs), the C-reflex, blink reflex, startle reflex, and transcranial magnetic stimulation (TMS). For tremor, surface EMG combined with accelerometry helps differentiate tremor subtypes (Parkinsonian, essential, enhanced physiological, cerebellar, Holmes, dystonic, orthostatic, and functional tremor) based on frequency, agonist-antagonist activation patterns, and response to weight loading. For myoclonus, classification by anatomical origin (cortical, cortical-subcortical, subcortical, spinal, peripheral) relies on EMG, EEG, and C-reflex characteristics. For dystonia, the hallmark electrophysiological feature is co-contraction of agonist and antagonist muscles, useful in evaluating focal dystonias and guiding muscle selection for botulinum toxin injection. Electrophysiology increasingly plays a key role in distinguishing functional (psychogenic) movement disorders from organic disease, using signs such as tremor arrest during contralateral ballistic movements, irregularity of tremor/jerk patterns, and the presence of a Bereitschaft potential preceding movement. Clinicians should integrate electrophysiological findings with clinical signs to reach an accurate diagnosis.

Keywords

electrophysiology movement disorders tremor myoclonus dystonia

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Authors

Đặng Thị Huyền Thương Bệnh viện Đại Học Y Dược TP. Hồ Chí Minh; Đại Học Y Dược TP. Hồ Chí Minh Trần Ngọc Tài Bệnh viện Đại Học Y Dược TP. Hồ Chí Minh; Đại Học Y Dược TP. Hồ Chí Minh