1
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Onder H, Ulker AC, Comoglu S. A Rare Presentation of Functional Movement Disorder Mimicking Normal Pressure Hydrocephalus. Asian J Neurosurg 2024; 19:305-308. [PMID: 38974455 PMCID: PMC11226252 DOI: 10.1055/s-0044-1779514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Herein, we describe a 55-year-old female patient with a functional movement disorder (FMD) who presented with normal pressure hydrocephalus (NPH)-like clinic. The neuroimaging data and positive response to the tap test initially suggested NPH. However, a detailed investigation of the clinic features yielded a final diagnosis of FMD. Via the presentation of this patient, we expand the phenomenology of FMD. To our knowledge, this is the first presentation of a patient with FMD mimicking NPH. Therefore, we think this rare illustration is interesting and may provide valuable perspectives for clinical practice.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Türkiye
| | - Aycan Cemil Ulker
- Department of Neurology, Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Türkiye
| | - Selcuk Comoglu
- Department of Neurology, Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Türkiye
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2
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Schwingenschuh P, Espay AJ. Functional tremor. J Neurol Sci 2022; 435:120208. [DOI: 10.1016/j.jns.2022.120208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 10/18/2022]
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3
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Prezelj N, Vogelnik K, Georgiev D, Schwingenschuh P, Kojović M. Distractibility predicts favourable response of functional tremor to transcranial magnetic stimulation: An electrophysiological study. Parkinsonism Relat Disord 2022; 96:91-97. [PMID: 35259609 DOI: 10.1016/j.parkreldis.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Generation of functional tremor relies on the structures involved in the control of voluntary movements. The clinical diagnosis is based on the presence of "positive signs", which are expression of cognitive and motor distractibility and reflect functional tremor dependence on explicit motor control. In patients who manifest less distractibility, habitual (implicit) control may be of greater significance. Habitual behaviours are inflexible and difficult to eradicate. OBJECTIVES To investigate if motor and cognitive distractibility predicts response to treatment with repetitive transcranial magnetic stimulation. METHODS 21 patients with functional tremor underwent 5-day repeated sessions of continuous theta burst stimulation over primary motor cortex. A battery of tests to provoke positive signs was performed during accelerometry recordings and the total functional tremor accelerometry score was calculated for each patient. Response to treatment was measured as change in tremor amplitude, expressed as total power of the spectra between 1 and 30 Hz. RESULTS On the group level, cTBS significantly changed postural tremor amplitude (Z = -1.9; p = 0.05), with the median decrease of 40%, IQR (-90-(+24)). There was a positive correlation between the functional tremor accelerometry score and reduction of postural tremor amplitude with treatment (rs = -0.75, p < 10-3). Responders had higher functional tremor accelerometry scores compared to non-responders (p = 0.001). The total functional tremor accelerometry score was a significant predictor of treatment response (OR = 2.8, p = 0.03; 95% CI 1.1; 7.2). CONCLUSIONS Patients who are more distractible are better candidates for treatment with transcranial magnetic stimulation. The likely explanation is the between-subjects differences on the reliance of functional tremor generation on explicit vs. implicit motor network.
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Affiliation(s)
- Neža Prezelj
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia
| | - Katarina Vogelnik
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia
| | - Dejan Georgiev
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia; Artificial Intelligence Laboratory, Faculty of Computer and Information Sciences, University of Ljubljana, Ljubljana, Slovenia
| | | | - Maja Kojović
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
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4
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Delgado C, Kurtis M, Martin B, Rada P, Martinez L, Sanz M, Borda B, Vicente C, Garcia M, Franch O, Pareés I. Clinical and demographic characteristics of patients with functional movement disorders: a consecutive cohort study from a specialized clinic. Acta Neurol Belg 2022; 122:97-103. [PMID: 33743163 DOI: 10.1007/s13760-021-01648-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
There is a growing interest in functional movement disorders (FMD). However, epidemiological data from large cohorts of patients with FMD are scarce and come mainly from General Neurology and Movement Disorders Clinics. Recently, specialized FMD clinics have been developed and epidemiological data from such clinics may provide useful information. We aimed to describe the clinical and sociodemographic features of patients diagnosed with FMD at our specialized FMD clinic. A standardized form was used to extract data from electronic records from the first-100 consecutive patients who were evaluated and diagnosed with FMD at our clinic from 2017 to 2019. Mean age was 40.88 ± (14.02) years, 63% females. Most patients were within working-age range, but only 16% were working at the time of consultation. Mean disease duration was 3.74 ± 5.73 years and was longer among men. The most common FMD were gait disturbance (42%), tremor (22%) and dystonia (15%). A precipitating event (mainly physical) was reported by 74%. The onset was mostly acute (83%) and the clinical course fluctuating (62%). Pain (64%) and fatigue (44%) were common comorbidities. Potential joint-hypermobility was present in 21%, mostly women (90%) and related to the presence of dystonia. FMD affects men and women mostly in working-age. Gait disturbance was the most common diagnosis, possibly because it causes a higher level of disability that may lead to consultation in a specialized clinic. Non-motor symptoms (pain and fatigue) were frequent in this cohort. Further data from specialized units may contribute to both understanding and management of FMD.
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Affiliation(s)
- Celia Delgado
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain.
| | - Mónica Kurtis
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Beatriz Martin
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Pilar Rada
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Leticia Martinez
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Marta Sanz
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Blanca Borda
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Carmen Vicente
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Montserrat Garcia
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Oriol Franch
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Isabel Pareés
- Functional Movement Disorders Unit, Movement Disorders Program, Department of Neurology, Ruber International Hospital, Madrid, Spain.
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5
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Functional Movement Disorder and Functional Seizures: What have we learned from different subtypes of functional neurological disorders? Epilepsy Behav Rep 2021; 18:100510. [PMID: 35198951 PMCID: PMC8844274 DOI: 10.1016/j.ebr.2021.100510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022] Open
Abstract
Functional seizures (FS) and functional movement disorders (FMD) are the most common manifestations of functional neurological disorders. FMD and FS may have similarities in etiology and pathophysiology. FMD and FS share disabling comorbidities of chronic pain, fatigue, and cognitive symptoms. Neuroimaging has demonstrated structural and functional changes in emotional and motor planning pathways in FND. A multidisciplinary approach and psychotherapy are the treatments for FMD and FS, respectively.
The objective of this paper is to compare and contrast FMD and FS, and highlight important differences in etiology and the clinical approach towards these two entities. While patients with FMD often experience abnormal movements on a daily basis, FS is characterized by paroxysmal events. Both patient populations share psychiatric and environmental comorbidities, but patients with FS may have increased anxiety and neuroticism and a higher percentage of childhood trauma. Functional MRI scans have demonstrated impaired executive control over motor behavior in both groups. FMD responds well to multidisciplinary rehabilitation-oriented treatment, while psychotherapy remains the mainstay of treatment for FS. For practicing clinicians, recognizing commonalities and differences in patients with FMD and FS is important to develop the most appropriate treatment plan.
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6
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Lagrand T, Tuitert I, Klamer M, van der Meulen A, van der Palen J, Kramer G, Tijssen M. Functional or not functional; that's the question: Can we predict the diagnosis functional movement disorder based on associated features? Eur J Neurol 2020; 28:33-39. [PMID: 32813908 PMCID: PMC7820982 DOI: 10.1111/ene.14488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022]
Abstract
Background and purpose Functional movement disorders (FMDs) pose a diagnostic challenge for clinicians. Over the years several associated features have been shown to be suggestive for FMDs. Which features mentioned in the literature are discriminative between FMDs and non‐FMDs were examined in a large cohort. In addition, a preliminary prediction model distinguishing these disorders was developed based on differentiating features. Method Medical records of all consecutive patients who visited our hyperkinetic outpatient clinic from 2012 to 2019 were retrospectively reviewed and 12 associated features in FMDs versus non‐FMDs were compared. An independent t test for age of onset and Pearson chi‐squared analyses for all categorical variables were performed. Multivariate logistic regression analysis was performed to develop a preliminary predictive model for FMDs. Results A total of 874 patients were eligible for inclusion, of whom 320 had an FMD and 554 a non‐FMD. Differentiating features between these groups were age of onset, sex, psychiatric history, family history, more than one motor phenotype, pain, fatigue, abrupt onset, waxing and waning over long term, and fluctuations during the day. Based on these a preliminary predictive model was computed with a discriminative value of 91%. Discussion Ten associated features are shown to be not only suggestive but also discriminative between hyperkinetic FMDs and non‐FMDs. Clinicians can use these features to identify patients suspected for FMDs and can subsequently alert them to test for positive symptoms at examination. Although a first preliminary model has good predictive accuracy, further validation should be performed prospectively in a multi‐center study.
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Affiliation(s)
- T Lagrand
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I Tuitert
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Klamer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A van der Meulen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Martini Hospital, Groningen, The Netherlands
| | - J van der Palen
- Department of Epidemiology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands
| | - G Kramer
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Delhasse S, Debove I, Arnold-Kunz G, Ghika JA, Chabwine JN. Erratic movement disorders disclosing Graves' disease and paralleling thyroid function but not autoantibody levels. J Int Med Res 2019; 47:1378-1386. [PMID: 30761931 PMCID: PMC6421382 DOI: 10.1177/0300060518816873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Graves’ disease (GD) is an autoimmune pathology characterized by hyperthyroidism and the presence of specific anti-thyroid antibodies. Neurological symptoms such as seizures, cognitive impairment, and tremor can be observed during the course of GD, but more complex movement disorders such as chorea and myoclonus are less frequent. The mechanisms underlying movement disorders in GD are not fully understood. While some authors relate movement disorders to thyroid dysfunction, others claim an autoimmune origin. We herein report a case involving a 60-year-old woman who presented with erratic, intricate movement disorders for which a medical workup revealed GD. During the 2-year follow-up period, her neurological symptoms evolved in parallel with her thyroid function, but not with her autoimmune anti-thyroid antibody level. Her neurological symptoms completely disappeared when she became euthyroid. We herein discuss the complicated clinicobiological relationship between thyroid function and movement disorders. This relationship involves several factors, including the impact of radioactive treatment. The present case emphasizes the importance of including thyroid function screening in the workup of unexplained movement disorders.
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Affiliation(s)
- Sébastien Delhasse
- Internal Medicine Division, Department of Internal Medicine and
Geriatrics, Valais Hospital, Sion, Switzerland
| | - Ines Debove
- Department of Neurology, Bern University Hospital, Bern,
Switzerland
| | - Gabriella Arnold-Kunz
- External consultant in endocrinology; Department of Internal
Medicine and Geriatrics, Valais Hospital, Sion, Switzerland
| | - Joseph-André Ghika
- Neurology Unit, Department of Internal Medicine and Geriatrics,
Valais Hospital, Sion, Switzerland
| | - Joelle Nsimire Chabwine
- Neurology Unit, Department of Internal Medicine and Geriatrics,
Valais Hospital, Sion, Switzerland
- Neurology Unit, Medicine Section, Department of Neuroscience and
Movement Science, Faculty of Science and Medicine, University of Fribourg,
Fribourg, Switzerland
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8
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Kumar R, Kumar R. A case of psychogenic Parkinsonism: Late age of onset should not be a barrier to make the diagnosis. Aust N Z J Psychiatry 2018; 52:1098. [PMID: 30295052 DOI: 10.1177/0004867418804068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rohith Kumar
- 1 St George's Hospital, University of London, London, UK
| | - Rajeev Kumar
- 2 Academic Unit of Psychiatry and Addiction Medicine and College of Medicine, Biology, and Environment, ANU Medical School, Canberra, ACT, Australia.,3 Consultation-Liaison Psychiatry Unit, The Canberra Hospital, Canberra, ACT, Australia.,4 Neuropsychiatry Clinics, Canberra, ACT, Australia.,5 Psychiatry Department, Hamad Medical Corporation, Doha, Qatar
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9
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Abstract
PURPOSE OF REVIEW Tremor, which is a rhythmic oscillation of a body part, is among the most common involuntary movements. Rhythmic oscillations may manifest in a variety of ways; as a result, a rich clinical phenomenology surrounds tremor. For this reason, diagnosing tremor disorders can be particularly challenging. The aim of this article is to provide the reader with a straightforward approach to the diagnosis and management of patients with tremor. RECENT FINDINGS Scientific understanding of the pathophysiologic basis of tremor disorders has grown considerably in recent years with the use of a broad range of neuroimaging approaches and rigorous, controlled postmortem studies. The basal ganglia and cerebellum are structures that seem to play a prominent role. SUMMARY The diagnosis of tremor disorders is challenging. The approach to tremor involves a history and a neurologic examination that is focused on the nuances of tremor phenomenology, of which there are many. The evaluation should begin with a tremor history and a focused neurologic examination. The examination should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the main type of tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of differential diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the main tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common form of resting tremor, along with drug-induced resting tremor. This article details the clinical features of each of these as well as other tremor disorders.
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10
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Pastore A, Pierri G, Fabio G, Ferramosca S, Gigante A, Superbo M, Pellicciari R, Margari F. Differences in psychopathology and behavioral characteristics of patients affected by conversion motor disorder and organic dystonia. Neuropsychiatr Dis Treat 2018; 14:1287-1295. [PMID: 29849460 PMCID: PMC5965383 DOI: 10.2147/ndt.s151695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Typically, the diagnosis of conversion motor disorder (CMD) is achieved by the exclusion of a wide range of organic illnesses rather than by applying positive criteria. New diagnostic criteria are highly needed in this scenario. The main aim of this study was to explore the use of behavioral features as an inclusion criterion for CMD, taking into account the relationship of the patients with physicians, and comparing the results with those from patients affected by organic dystonia (OD). PATIENTS AND METHODS Patients from the outpatient Movement Disorder Service were assigned to either the CMD or the OD group based on Fahn and Williams criteria. Differences in sociodemographics, disease history, psychopathology, and degree of satisfaction about care received were assessed. Patient-neurologist agreement about the etiological nature of the disorder was also assessed using the k-statistic. A logistic regression analysis estimated the discordance status as a predictor to case/control status. RESULTS In this study, 31 CMD and 31 OD patients were included. CMD patients showed a longer illness life span, involvement of more body regions, higher comorbidity with anxiety, depression, and borderline personality disorder, as well as higher negative opinions about physicians' delivering of proper care. Contrary to our expectations, CMD disagreement with neurologists about the etiological nature of the disorder was not statistically significant. Additional analysis showed that having at least one personality disorder was statistically associated with the discordance status. CONCLUSION This study suggests that CMD patients show higher conflicting behavior toward physicians. Contrary to our expectations, they show awareness of their psychological needs, suggesting a possible lack of recognition of psychological distress in the neurological setting.
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Affiliation(s)
- Adriana Pastore
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Grazia Pierri
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giada Fabio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Silvia Ferramosca
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Angelo Gigante
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Superbo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Roberta Pellicciari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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11
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12
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Marotta A, Bombieri F, Zampini M, Schena F, Dallocchio C, Fiorio M, Tinazzi M. The Moving Rubber Hand Illusion Reveals that Explicit Sense of Agency for Tapping Movements Is Preserved in Functional Movement Disorders. Front Hum Neurosci 2017. [PMID: 28634447 PMCID: PMC5459911 DOI: 10.3389/fnhum.2017.00291] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Functional movement disorders (FMD) are characterized by motor symptoms (e.g., tremor, gait disorder, and dystonia) that are not compatible with movement abnormalities related to a known organic cause. One key clinical feature of FMD is that motor symptoms are similar to voluntary movements but are subjectively experienced as involuntary by patients. This gap might be related to abnormal self-recognition of bodily action, which involves two main components: sense of agency and sense of body ownership. The aim of this study was to systematically investigate whether this function is altered in FMD, specifically focusing on the subjective feeling of agency, body ownership, and their interaction during normal voluntary movements. Patients with FMD (n = 21) and healthy controls (n = 21) underwent the moving Rubber Hand Illusion (mRHI), in which passive and active movements can differentially elicit agency, ownership or both. Explicit measures of agency and ownership were obtained via a questionnaire. Patients and controls showed a similar pattern of response: when the rubber hand was in a plausible posture, active movements elicited strong agency and ownership; implausible posture of the rubber hand abolished ownership but not agency; passive movements suppressed agency but not ownership. These findings suggest that explicit sense of agency and body ownership are preserved in FMD. The latter finding is shared by a previous study in FMD using a static version of the RHI, whereas the former appears to contrast with studies demonstrating altered implicit measures of agency (e.g., sensory attenuation). Our study extends previous findings by suggesting that in FMD: (i) the sense of body ownership is retained also when interacting with the motor system; (ii) the subjective experience of agency for voluntary tapping movements, as measured by means of mRHI, is preserved.
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Affiliation(s)
- Angela Marotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVerona, Italy.,Neurology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Federica Bombieri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVerona, Italy
| | - Massimiliano Zampini
- CiMeC Center for Mind/Brain Sciences, University of TrentoRovereto, Italy.,Department of Psychology and Cognitive Science, University of TrentoRovereto, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVerona, Italy
| | - Carlo Dallocchio
- Division of Neurology, Civil Hospital, Azienda Ospedaliera della Provincia di PaviaVoghera, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVerona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of VeronaVerona, Italy
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13
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Abstract
Functional tremor is the commonest reported functional movement disorder. A confident clinical diagnosis of functional tremor is often possible based on the following "positive" criteria: a sudden tremor onset, unusual disease course, often with fluctuations or remissions, distractibility of the tremor if attention is removed from the affected body part, tremor entrainment, tremor variability, and a coactivation sign. Many patients show excessive exhaustion during examination. Other somatizations may be revealed in the medical history and patients may show additional functional neurologic symptoms and signs. In cases where the clinical diagnosis remains challenging, providing a "laboratory-supported" level of certainty aids an early positive diagnosis. In rare cases, in which the distinction from Parkinson's disease is difficult, dopamine transporter single-photon emission computed tomography (DAT-SPECT) can be indicated.
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Affiliation(s)
- P Schwingenschuh
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - G Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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14
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Zach H, Gerrits WLJ, van de Warrenburg BP, Bloem BR. A Positive 'Pointing Test' in a Parkinson's Disease Patient. JOURNAL OF PARKINSONS DISEASE 2015; 5:727-9. [PMID: 26444092 PMCID: PMC4927838 DOI: 10.3233/jpd-150638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Heidemarie Zach
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wieneke L J Gerrits
- Department of Psychiatry, Centre for Psychotherapy, Pro Persona Mental Health Care, Lunteren, The Netherlands
| | - Bart P van de Warrenburg
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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15
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Koegl-Wallner M, Schwingenschuh P. An update on functional (psychogenic) tremor. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Functional tremor accounts for at least 50% of patients with functional movement disorders. The diagnostic work-up of these patients can be challenging. It is a multistep process based on patients’ history and clinical criteria finally providing a ‘positive’ diagnosis. Variability of the tremor over the disease course and during clinical examination is characteristic. Patients often show increased attention toward the tremulous body part and distractability of the tremor once attention is drawn away. Sometimes distractability becomes obvious during history taking or neurological examination, in others certain distraction tasks are needed. If uncertainty remains, ancillary investigations such as electrophysiological tests may be helpful. Recent studies suggested that a loss of sense of control of ones actions may help to explain why patients with functional tremor report that they do not experience the abnormal movement as voluntary. Treatment has to be placed in a multidisciplinary team involving neurologists, psychiatrists, physiotherapists and psychologists.
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Affiliation(s)
- Mariella Koegl-Wallner
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | - Petra Schwingenschuh
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
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16
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Daum C, Gheorghita F, Spatola M, Stojanova V, Medlin F, Vingerhoets F, Berney A, Gholam-Rezaee M, Maccaferri GE, Hubschmid M, Aybek S. Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. J Neurol Neurosurg Psychiatry 2015; 86:425-30. [PMID: 24994927 DOI: 10.1136/jnnp-2013-307381] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability. PATIENTS AND METHODS Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign. RESULTS A score of ≥ 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate). CONCLUSIONS Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.
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Affiliation(s)
- Corinna Daum
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
| | - Fulvia Gheorghita
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
| | - Marianna Spatola
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
| | - Vesna Stojanova
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
| | - Friedrich Medlin
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
| | - François Vingerhoets
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland
| | - Mehdi Gholam-Rezaee
- Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Giorgio E Maccaferri
- Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland
| | - Monica Hubschmid
- Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland
| | - Selma Aybek
- Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland
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Paola LD, Marchetti RL, Teive HAG, LaFrance WC. Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin? ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:793-802. [DOI: 10.1590/0004-282x20140111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/25/2014] [Indexed: 11/22/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.
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Affiliation(s)
- Luciano De Paola
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Renato L Marchetti
- Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Hélio Afonso Ghizoni Teive
- Departamento de Transtornos do Movimento, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - W Curt LaFrance
- Psychiatry and Neurology Departments, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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Hedera P, Cibulčík F, Davis TL. Pharmacotherapy of essential tremor. J Cent Nerv Syst Dis 2013; 5:43-55. [PMID: 24385718 PMCID: PMC3873223 DOI: 10.4137/jcnsd.s6561] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/10/2013] [Accepted: 11/25/2013] [Indexed: 12/11/2022] Open
Abstract
Essential tremor (ET) is a common movement disorder but its pathogenesis remains poorly understood. This has limited the development of effective pharmacotherapy. The current therapeutic armamentaria for ET represent the product of careful clinical observation rather than targeted molecular modeling. Here we review their pharmacokinetics, metabolism, dosing, and adverse effect profiles and propose a treatment algorithm. We also discuss the concept of medically refractory tremor, as therapeutic trials should be limited unless invasive therapy is contraindicated or not desired by patients.
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Affiliation(s)
- Peter Hedera
- Department of Neurology, Vanderbilt University, Nashville, TN
| | - František Cibulčík
- Department of Neurology, Slovak Medical University and University Hospital Bratislava, Slovakia
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University, Nashville, TN
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Abstract
The neurobiological basis of psychogenic movement disorders (PMDs) has been elusive, and they remain difficult to treat. In the last few years, functional neuroimaging studies have provided insight into their pathophysiology and neural correlates. Here, we review the various methodological approaches that have been used in both clinical and research practice to address neural correlates of functional disorders. We then review the dominant hypotheses generated from the literature on psychogenic paralysis. Overall, these studies emphasize abnormalities in the prefrontal and anterior cingulate cortices. Recently, functional neuroimaging has been used to specifically examine PMDs. These studies have addressed a major point of controversy: whether higher frontal brain areas are directly responsible for inhibiting motor areas or whether they reflect modulation by attentional and/or emotional processes. In addition to elucidating the mechanism and cause, recent work has also explored the lack of agency that characterizes PMDs. We describe the results and implications of the results of these imaging studies and discuss possible interpretations.
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Affiliation(s)
- Arpan R. Mehta
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, Cambridge, UK
| | - Anette E. Schrag
- Institute of Neurology, Royal Free Campus, University College London, London, UK
- UCL Institute of Neurology, University College London, Royal Free Campus, Clinical Neurosciences, Rowland Hill Street, London, NW3 2PF UK
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Heintz CEJ, van Tricht MJ, van der Salm SMA, van Rootselaar AF, Cath D, Schmand B, Tijssen MAJ. Neuropsychological profile of psychogenic jerky movement disorders: importance of evaluating non-credible cognitive performance and psychopathology. J Neurol Neurosurg Psychiatry 2013; 84:862-7. [PMID: 23418216 DOI: 10.1136/jnnp-2012-304397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Psychogenic movement disorders are disorders of movements that cannot be explained by a known neurological disorder and are assumed to be associated with psychiatric symptoms such as depression and anxiety. OBJECTIVE To examine the neuropsychological profile of patients with psychogenic movement disorders. METHODS We examined cognitive functioning using neuropsychological tests in 26 patients with clinically established psychogenic jerky movement disorders (PMD). We included 16 patients with Gilles de la Tourette syndrome (GTS) who served as a patient control group, in addition to 22 healthy control subjects. Non-credible test performance was detected using a Symptom Validity Test (SVT). Psychopathology was also assessed. RESULTS Apart from a worse performance on a verbal memory task, no evidence of neuropsychological impairments was found in our PMD sample. Interestingly however, patients with PMD reported more cognitive complaints in daily life and performed worse on the SVT than the two other groups. Patients with GTS did not report, or show, cognitive impairments. In patients with PMD, we found associations between verbal learning, SVT performance and severity of depression and anxiety complaints. CONCLUSIONS We conclude that some patients with PMD show non-credible cognitive symptoms. In contrast, no evident cognitive impairments were present in patients with PMD or GTS. Our study underlines the importance of assessment of non-credible response in patients with PMD. Additionally, non-credible response might aid in the differentiation of PMD from other movement disorders.
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Affiliation(s)
- Carolien E J Heintz
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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Ellenstein A, Yusuf N, Hallett M. Middle ear myoclonus: two informative cases and a systematic discussion of myogenic tinnitus. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 23610741 PMCID: PMC3629860 DOI: 10.7916/d8rx9bs1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 03/08/2013] [Indexed: 12/01/2022]
Abstract
Background The term middle ear myoclonus (MEM) has been invoked to explain symptoms of tinnitus presumably caused by the dysfunctional movement of either of the two muscles that insert in the middle ear: tensor tympani and stapedius. MEM has been characterized through heterogeneous case reports in the otolaryngology literature, where clinical presentation is variable, phenomenology is scarcely described, the pathogenic muscle is usually not specified, natural history is unknown, and the presumptive definitive treatment, tensor tympani or stapedius tendon lysis, is inconsistently effective. It is not surprising that no unique acoustogenic mechanism or pathophysiologic process has been identified to explain MEM, one of several descriptive diagnoses associated with the complicated disorders of myogenic tinnitus. Methods Here, we explore MEM from the neurologist’s perspective. Following the detailed descriptions of two informative cases from our clinic, we systematically evaluate the different mechanisms and movement disorder phenomena that could lead to a diagnosis of MEM. Results From a functional neuroanatomic perspective, we explain how tensor tympani MEM is best explained as a form of peritubal myogenic tinnitus, similar to the related disorder of essential palatal tremor. From a pathogenic perspective, we discuss how MEM symptomatology may reflect different mechanical and neurologic processes. We emphasize the diagnostic imperative to recognize when myogenic tinnitus is consistent with a psychogenic origin. Discussion Both individual patient care and further elucidation of MEM will rely on more detailed clinical characterization as well as multidisciplinary input from neurology, otolaryngology, and dentistry.
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Affiliation(s)
- Aviva Ellenstein
- Department of Neurology, George Washington University, Washington, DC, United States of America
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23
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Abstract
PURPOSE OF REVIEW This review provides an overview of recent developments in diagnosis, pathophysiology, neuroimaging and management of functional (psychogenic) movement disorders (FMD). RECENT FINDINGS There has been increasing interest to study the underlying pathophysiology of FMD, which has resulted in a broadened disease model, taking neurobiologic and psychosocial factors equally into account. In this context, the term 'psychogenic' has been replaced by 'functional' movement disorders by many authors in the field to express the changing focus toward a multifactorial disease model. The need for establishing a positive diagnosis of FMD as opposed to providing a diagnosis of exclusion is increasingly recognized and reflected by the introduction of 'laboratory-supported' diagnostic criteria of FMD. Important advances have been made through behavioral, electrophysiological and neuroimaging studies, although the fundamental cause of FMD remains poorly understood. Of particular interest have been several reports on abnormal sensorimotor features and cortical inhibition in both organic and functional dystonia, highlighting possible shared traits of both conditions. In terms of treatment, recent studies have reported benefit from both psychiatric and physical therapy-based interventions. SUMMARY Increasing efforts have been made toward better understanding of FMD, and the disease model has been broadened to include neurobiologic and psychosocial factors. Laboratory-based diagnostic criteria have been established for many FMD to support the clinical diagnosis. To determine the most effective management strategies for FMD, a closer collaboration between neurologists and psychiatrists and intensified research efforts with prospective treatment trials are needed.
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Affiliation(s)
- Kathrin Czarnecki
- Human Motor Control Section, NINDS, NIH, Bethesda, Maryland 20892-1428, USA
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Hedera P. Metabolic hyperactivity of the medial posterior parietal lobes in psychogenic tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2012; 2. [PMID: 23440006 PMCID: PMC3379878 DOI: 10.7916/d87w69x8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 02/15/2012] [Indexed: 12/02/2022]
Abstract
Background The pathophysiology of psychogenic movement disorders, including psychogenic tremor (PT), is only emerging. Case Report This is a single case report of a patient who met diagnostic criteria for PT. He underwent positron emission tomography (PET) of brain with 18F-deoxyglucose at resting state. His PET study showed symmetrically increased 18F-deoxyglucose uptake in both posterior medial parietal lobes. There was no corresponding abnormality on structural imaging. Discussion Hypermetabolism of the medial aspects of posterior parietal lobes bilaterally may reflect abnormal activity of sensory integration that is important in the pathogenesis of PT. This further supports the idea that non-organic movement disorders may be associated with detectable functional brain abnormalities.
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Affiliation(s)
- Peter Hedera
- Department of Neurology, Vanderbilt University, Nashville, Tennessee, United States of America
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25
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Degenerative parkinsonism in patients with psychogenic parkinsonism: A dopamine transporter imaging study. Clin Neurol Neurosurg 2010; 112:282-5. [DOI: 10.1016/j.clineuro.2009.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 12/06/2009] [Accepted: 12/13/2009] [Indexed: 11/19/2022]
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Abstract
Movement disorders are commonly encountered in the clinic. In this Review, aimed at trainees and general neurologists, we provide a practical step-by-step approach to help clinicians in their 'pattern recognition' of movement disorders, as part of a process that ultimately leads to the diagnosis. The key to success is establishing the phenomenology of the clinical syndrome, which is determined from the specific combination of the dominant movement disorder, other abnormal movements in patients presenting with a mixed movement disorder, and a set of associated neurological and non-neurological abnormalities. Definition of the clinical syndrome in this manner should, in turn, result in a differential diagnosis. Sometimes, simple pattern recognition will suffice and lead directly to the diagnosis, but often ancillary investigations, guided by the dominant movement disorder, are required. We illustrate this diagnostic process for the most common types of movement disorder, namely, akinetic-rigid syndromes and the various types of hyperkinetic disorders (myoclonus, chorea, tics, dystonia and tremor).
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Voon V, Gallea C, Hattori N, Bruno M, Ekanayake V, Hallett M. The involuntary nature of conversion disorder. Neurology 2010; 74:223-8. [PMID: 20083798 PMCID: PMC2809033 DOI: 10.1212/wnl.0b013e3181ca00e9] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND What makes a movement feel voluntary, and what might make it feel involuntary? Motor conversion disorders are characterized by movement symptoms without a neurologic cause. Conversion movements use normal voluntary motor pathways, but the symptoms are paradoxically experienced as involuntary, or lacking in self-agency. Self-agency is the experience that one is the cause of one's own actions. The matched comparison between the prediction of the action consequences (feed-forward signal) and actual sensory feedback is believed to give rise to self-agency and has been in part associated with the right inferior parietal cortex. Using fMRI, we assessed the correlates of self-agency during conversion tremor. METHODS We used a within-subject fMRI block design to compare brain activity during conversion tremor and during voluntary mimicked tremor in 8 patients. RESULTS The random effects group analysis showed that conversion tremor compared with voluntary tremor had right temporoparietal junction (TPJ) hypoactivity (p < 0.05 family-wise error whole brain corrected) and lower functional connectivity between the right TPJ, sensorimotor regions (sensorimotor cortices and cerebellar vermis), and limbic regions (ventral anterior cingulate and right ventral striatum). CONCLUSIONS The right TPJ has been implicated as a general comparator of internal predictions with actual events. We propose that the right TPJ hypoactivity and lower TPJ and sensorimotor cortex interactions may reflect the lack of an appropriate sensory prediction signal. The lack of a match for the proprioceptive feedback would lead to the perception that the conversion movement is not self-generated.
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Affiliation(s)
- V Voon
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
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Grimaldi I, Dubuc M, Kahane P, Bougerol T, Vercueil L. Anxiety and depression in psychogenic movement disorder and non-epileptic seizures: a prospective comparative study. Rev Neurol (Paris) 2010; 166:515-22. [PMID: 20056263 DOI: 10.1016/j.neurol.2009.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 08/25/2009] [Accepted: 10/27/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compared anxiety and depression in patients presenting with psychogenic non-epileptic seizures (PNES) with those suffering from psychogenic movement disorders (PMD) to assess the link between these psychiatric pathologies and neurological symptoms. METHODS This clinically descriptive, prospective study involved consecutive patients who fulfilled the clinical and video-EEG criteria for PNES and PMD, and who were recruited over an 18-month period. Semi-structured (according to DSM-IV criteria) psychiatric interviews and self-evaluation using the Beck Depression Inventory and Spielberger State-Trait Anxiety Inventory were carried out. Clinical follow-up was conducted 8-12 months after the first evaluation. RESULTS A total of 17 patients were recruited: nine presented with PNES; and eight had PMD. Both patient groups had similar demographic and clinical data as well as depression and personality disorders. Although not statistically significant, there was a trend towards an increased prevalence of a familial medical history of epilepsy and a higher incidence of anxiety disorders among patients with PNES. CONCLUSION The data from this prospective study underscore the clinical and psychiatric similarity between PNES and PMD patients. Further studies involving a larger number of subjects should confirm, from a statistical point of view, the differences suggested in the present investigation and, in particular, the greater incidence of anxiety disorders in PNES patients and the presence of an epileptic parent as a risk factor for PNES.
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Affiliation(s)
- I Grimaldi
- Clinique psychiatrique, CHU de Grenoble, pavillon Dominique-Villars, Grenoble, France.
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29
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Redondo L, Morgado Y, Durán E. Psychogenic tremor: a positive diagnosis. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The role for neuroimaging in the management of patients with tremor is gradually increasing, particularly with respect to stereotactic neurosurgery and deep brain stimulation where less than 2-mm tolerance is required for accurate electrode placement. The routine use of single photon emission CT technology to image the nigrostriatal dopaminergic system is proving helpful in distinguishing essential and dystonic tremors from neurodegenerative forms of parkinsonism and in improving our understanding of the pathophysiology of rarer tremors.
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Abstract
Psychogenic movement disorders (PMDs) represent a challenging dilemma for the treating neurologist. The terminology to classify this disorder is confusing and making the diagnosis is difficult. Once the diagnosis has been established, treatment options are limited, and the patient generally does not accept the diagnosis.
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Nowak DA, Fink GR. Psychogenic movement disorders: aetiology, phenomenology, neuroanatomical correlates and therapeutic approaches. Neuroimage 2009; 47:1015-25. [PMID: 19426818 DOI: 10.1016/j.neuroimage.2009.04.082] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 04/26/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022] Open
Abstract
Paralysis and movement disorders unexplained by identifiable neurological disease are common clinical presentations in neurological outpatient clinics. Despite their frequency and potential importance from a neuroscientific viewpoint these disorders have received surprisingly little attention in clinically oriented neuroscientific research. In this review we summarize the available literature that specifically relates to the functional neuroanatomy of psychogenic movement disorders. We discuss the aetiology, clinical phenomenology, the current concepts of the dynamic neuroanatomical networks underlying psychogenic neurological syndromes as elucidated by neuroimaging and their potential implications for novel therapeutic approaches.
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Affiliation(s)
- Dennis A Nowak
- Department of Neurology, University of Cologne, Cologne, Germany.
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Abstract
Tremor, a rhythmical involuntary oscillatory movement, is the most common movement disorder to afflict man. It is classified on both phenomenonological and aetiological grounds and can be measured using clinical rating scales or physiological techniques. Investigation of tremor is guided by the clinical scenario but where appropriate may include neurophysiological tests, imaging the nigro-striatal dopaminergic system with SPECT or PET, cerebral MR imaging and also genetic testing. Treatment of tremor depends on the severity and cause of tremor and includes medical therapy and stereotactic surgery including deep brain stimulation.
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Affiliation(s)
- Peter G Bain
- Movement Disorders & Neuromodulation Group, Division of Neurosciences & Mental Health, Imperial College London, UK.
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Kobylecki C, Marshall AG, Varma A, Kellett MW, Dick JP, Silverdale MA. Topiramate-responsive cerebellar axial postural tremor. Mov Disord 2008; 23:1189-91. [DOI: 10.1002/mds.22068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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