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The bereitschaftspotential in jerky movement disorders.

Sandra M A van der Salm¹, Marina A J Tijssen, Johannes H T M Koelman

¹Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands.

Journal of Neurology, Neurosurgery, and Psychiatry

|September 7, 2012

Summary

The Bereitschaftspotential (BP) helps differentiate jerky movement disorders. Its absence before intended movements is a key indicator for psychogenic jerks, distinguishing them from myoclonus and Tourette syndrome.

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Area of Science:

Neuroscience
Clinical Neurology

Background:

Jerky movement disorders present diagnostic challenges.
The Bereitschaftspotential (BP), a premovement electrical signal in the brain, has been investigated for its diagnostic utility.

Purpose of the Study:

To evaluate the diagnostic value of the Bereitschaftspotential (BP) in distinguishing between psychogenic jerks, Gilles de la Tourette syndrome (GTS), and myoclonus.

Main Methods:

A cross-sectional case series included 48 patients with psychogenic jerks, GTS, or myoclonus.
BP was measured before spontaneous jerks and voluntary wrist extensions.
Healthy subjects imitated jerky movements for comparison.

Main Results:

Patients with psychogenic jerks showed significantly more BPs preceding jerks compared to GTS patients.
The absence of BP before self-paced wrist extensions had high sensitivity (0.59) and specificity (0.98) for psychogenic jerks.
Patients with myoclonus lacked BP before jerks but had it before voluntary movements; GTS patients showed BP in a minority of cases.

Conclusions:

The BP is a valuable tool for differentiating jerky movement disorders.
A novel finding is the absence of BP before intentional movements in psychogenic jerks.
Further validation in a prospective cohort is recommended.