Psychogenic tremor of hands and trunk, distractible, "la belle indifference"

This 16-year-old girl had a sudden onset of tremor of her hands and shaking of her body several months prior to this video, about a year after a close friend died while playing basketball. Two other friends developed similar movement disorders within months of this incident, 1 of them seen by us and diagnosed as functional. She is described by her parents as an extreme perfectionist. The examination shows a “la belle indifference" attitude, jerky movements with variable frequency and amplitude involving her shoulders and upper body. The tremors are markedly distractible and suppressible (not shown). Because topiramate was associated with resolution of the tremor in her girlfriend, we also tried it in this patient with the same result. The tremor did not recur after topiramate was discontinued. These features support the diagnosis of functional tremor. (Contributed by Dr. Joseph Jankovic.)