Surface Electromyography for the Diagnosis of Tremor Syndrome: A Study of 97 Patients

Tremor is one of the most frequent movement disorders encountered in clinical practice with heterogeneous phenomenology and etiology. Surface electromyography (SEMG) is a noninvasive and reproducible test that can diagnose tremor syndromes.

In this retrospective study, the clinical and electrophysiologic records of 97 consecutive patients with tremor syndromes who visited our movement disorder clinic between January 2023 and March 2024 were examined.

In our study, 28.8% (n = 28) of patients were of essential tremor (ET) syndrome. SEMG of ET syndrome patients showed synchronous bursts in 71.4% (n = 20), alternating bursts in 10.7% (n = 3), synchronous bursts with co-contraction of agonist and antagonist muscles in 10.7% (n = 3), and both synchronous and alternating bursts in 3.6% (n = 1) of patients. Tremor-ataxia syndrome formed 21.6% (n = 21) of our study population, with 71.4% (n = 15) of patients showing synchronous bursts and co-contraction and 28.6% (n = 6) patients having alternating bursts. Moreover, 12.3% (n = 12) patients were of parkinsonian tremor, of whom alternating bursts were present in 75% (n = 9) and synchronous bursts with co-contraction were present in 25% (n = 3) of patients. In addition, 11.3% (n = 11) of patients had dystonic tremor (DT), of whom 81.8% (n = 9) had synchronous bursts and co-contraction and 18.2% (n = 2) had alternating bursts.

Synchronous bursts with co-contraction suggestive of DT were observed in most patients with tremor-ataxia syndrome and a small number of patients with ET syndrome. Our data suggests that SEMG helps differentiate these two clinical syndromes, which is difficult in a clinical setting.