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Jenkinson A, Sharkey C, King M, Murphy AM, Gorman K. Tick-Tock on the Ward: Essential Palatal Tremor in a Pediatric Patient. J Pediatr 2020; 225:270-272. [PMID: 32522528 DOI: 10.1016/j.jpeds.2020.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Allan Jenkinson
- Department of Pediatrics, University Hospital Limerick, Limerick
| | - Claire Sharkey
- Department of Pediatrics, University Hospital Limerick, Limerick
| | - Mary King
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Ann-Marie Murphy
- Department of Pediatrics, University Hospital Limerick, Limerick
| | - Kathleen Gorman
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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2
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Harris SR. Psychogenic movement disorders in children and adolescents: an update. Eur J Pediatr 2019; 178:581-585. [PMID: 30635706 DOI: 10.1007/s00431-019-03317-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
Abstract
This short communication provides an update on childhood psychogenic movement disorders (PMD), focusing on descriptive studies and case reports from 2008 to 2018. Known also as functional movement/motor disorders, PMD diagnoses are relatively common in adults but less so in children. In group studies over the past decade, sample prevalence of childhood PMD ranged from 2.8 to 23.1%, with a higher percentage of girls in most studies (consistent with adult PMD literature). Common types of PMD included tremor (32.4%), dystonia (29.5%), and myoclonus (24.3%). Precipitating events for PMD onset included H1N1 influenza vaccinations, family/child stressors, anxiety/depression in the child or parent, panic attacks, behavior disorders, injury or accident, sexual abuse of the child or family member, death of a close relative, parental discord, domestic violence, school-related problems, medical illness/surgery, sleep disturbance, and participation in competitive sport or dance. The most frequently mentioned treatments were cognitive behavioral therapy, psychotherapy, relaxation techniques, and physiotherapy.Conclusion: Although additional cases of childhood PMD have been published over the past decade, little new information has appeared. There is still no "diagnostic gold standard," making an accurate estimate of prevalence virtually impossible and contributing to confusion among pediatricians when trying to identify children with PMD. What is Known: • Psychogenic movement disorders (PMD) occur in children as well as adults. • The most common types of childhood PMD are tremor, dystonia, and myoclonus. What is New: • The most common childhood PMD treatments were cognitive behavioral therapy, psychotherapy, physiotherapy, and relaxation techniques (2008-2018). • Due to lack of a standardized definition for PMD, confusion exists as to which movement disorders to include. With the inability to reliably diagnose PMD and the ambiguity as to which movement disorders it comprises, it is difficult to determine the most effective treatments.
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Affiliation(s)
- Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
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3
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Ye Y, Liao S, Luo B, Ni L. Botulinum toxin treatment for essential palatal tremors presenting with nasal clicks instead of pulsatile tinnitus: a case report. Head Face Med 2016; 12:33. [PMID: 27876040 PMCID: PMC5118902 DOI: 10.1186/s13005-016-0129-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background In this study, we report a rare case of an adult patient with essential palatal tremors (EPT) presenting as nasal clicks, instead of otic clicks or objective pulsatile tinnitus in common EPT. Case presentation Nasal endoscopic examination and EMG recordings of the soft palate muscles were performed to confirm the source of the clicks. Initial treatment with lidocaine provided symptomatic relief for four hours. The patient was then treated with four simultaneous injections of 12.5 U of botulinum toxin in four different sites of the soft palate. Palatal tremors and clicks completely disappeared within three months of treatment. Conclusions To our knowledge, this is the first case of EPT that presented with nasal clicks. We recommend that otolaryngologists should expect this rare occurrence in the clinical setting, and handle patients presenting with such symptoms with care and compassion in order not to worsen their psychological status. Electronic supplementary material The online version of this article (doi:10.1186/s13005-016-0129-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yufeng Ye
- ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China
| | - Shiyu Liao
- ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China
| | - Baozhen Luo
- ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China
| | - Liyan Ni
- ENT Department, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China.
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Kaski D, Bronstein AM, Edwards MJ, Stone J. Cranial functional (psychogenic) movement disorders. Lancet Neurol 2016; 14:1196-205. [PMID: 26581970 DOI: 10.1016/s1474-4422(15)00226-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/21/2015] [Accepted: 08/27/2015] [Indexed: 01/15/2023]
Abstract
Functional (psychogenic) neurological symptoms are frequently encountered in neurological practice. Cranial movement disorders--affecting the eyes, face, jaw, tongue, or palate--are an under-recognised feature of patients with functional symptoms. They can present in isolation or in the context of other functional symptoms; in particular, for functional eye movements, positive clinical signs such as convergence spasms can be triggered by the clinical examination. Although the specialty of functional neurological disorders has expanded, appreciation of cranial functional movement disorders is still insufficient. Identification of the positive features of cranial functional movement disorders such as convergence and unilateral platysmal spasm might lend diagnostic weight to a suspected functional neurological disorder. Understanding of the differential diagnosis, which is broad and includes many organic causes (eg, stroke), is essential to make an early and accurate diagnosis to prevent complications and initiate appropriate management. Increased understanding of these disorders is also crucial to drive clinical trials and studies of individually tailored therapies.
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Affiliation(s)
- Diego Kaski
- Department of Neuro-otology, National Hospital for Neurology and Neurosurgery, London, UK; Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK.
| | - Adolfo M Bronstein
- Department of Neuro-otology, National Hospital for Neurology and Neurosurgery, London, UK; Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Mark J Edwards
- Department of Neuro-otology, National Hospital for Neurology and Neurosurgery, London, UK; Sobell Department of Motor Neuroscience and Movement, UCL Institute of Neurology, London, UK
| | - Jon Stone
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
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Legrand AP, Hainque E, Roze E, Vidailhet M, Apartis E. Essential Palatal Tremor Synchronization: A Study by Video Record Numerical Analysis. Mov Disord Clin Pract 2015; 2:66-68. [PMID: 30713880 DOI: 10.1002/mdc3.12128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/05/2014] [Accepted: 11/14/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Elodie Hainque
- AP-HP, Hôpital Saint-Antoine Unité de Neurophysiologie Paris France.,Inserm, U 1127 Paris France.,CNRS, UMR 7225 Paris France.,Institut du Cerveau et de la Moelle épinière, ICM Paris France.,Sorbonne Universités UPMC Univ Paris 06, UMR S 1127 Paris France
| | - Emmanuel Roze
- Inserm, U 1127 Paris France.,CNRS, UMR 7225 Paris France.,Institut du Cerveau et de la Moelle épinière, ICM Paris France.,Sorbonne Universités UPMC Univ Paris 06, UMR S 1127 Paris France.,Département des maladies du système nerveux, AP-HP Hôpital de la Pitié Salpêtrière Paris France
| | - Marie Vidailhet
- Inserm, U 1127 Paris France.,CNRS, UMR 7225 Paris France.,Institut du Cerveau et de la Moelle épinière, ICM Paris France.,Sorbonne Universités UPMC Univ Paris 06, UMR S 1127 Paris France.,Département des maladies du système nerveux, AP-HP Hôpital de la Pitié Salpêtrière Paris France
| | - Emmanuelle Apartis
- AP-HP, Hôpital Saint-Antoine Unité de Neurophysiologie Paris France.,Inserm, U 1127 Paris France.,CNRS, UMR 7225 Paris France.,Institut du Cerveau et de la Moelle épinière, ICM Paris France.,Sorbonne Universités UPMC Univ Paris 06, UMR S 1127 Paris France
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Baizabal-Carvallo JF, Fekete R. Recognizing uncommon presentations of psychogenic (functional) movement disorders. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:279. [PMID: 25667816 PMCID: PMC4303603 DOI: 10.7916/d8vm4b13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/23/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psychogenic or functional movement disorders (PMDs) pose a challenge in clinical diagnosis. There are several clues, including sudden onset, incongruous symptoms, distractibility, suggestibility, entrainment of symptoms, and lack of response to otherwise effective pharmacological therapies, that help identify the most common psychogenic movements such as tremor, dystonia, and myoclonus. METHODS In this manuscript, we review the frequency, distinct clinical features, functional imaging, and neurophysiological tests that can help in the diagnosis of uncommon presentations of PMDs, such as psychogenic parkinsonism, tics, and chorea; facial, palatal, and ocular movements are also reviewed. In addition, we discuss PMDs at the extremes of age and mass psychogenic illness. RESULTS Psychogenic parkinsonism (PP) is observed in less than 10% of the case series about PMDs, with a female-male ratio of roughly 1:1. Lack of amplitude decrement in repetitive movements and of cogwheel rigidity help to differentiate PP from true parkinsonism. Dopamine transporter imaging with photon emission tomography can also help in the diagnostic process. Psychogenic movements resembling tics are reported in about 5% of PMD patients. Lack of transient suppressibility of abnormal movements helps to differentiate them from organic tics. Psychogenic facial movements can present with hemifacial spasm, blepharospasm, and other movements. Some patients with essential palatal tremor have been shown to be psychogenic. Convergence ocular spasm has demonstrated a high specificity for psychogenic movements. PMDs can also present in the context of mass psychogenic illness or at the extremes of age. DISCUSSION Clinical features and ancillary studies are helpful in the diagnosis of patients with uncommon presentations of psychogenic movement disorders.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA ; University of Guanajuato, Mexico
| | - Robert Fekete
- Department of Neurology, New York Medical College, Valhalla, NY, USA
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7
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Chung EJ, Jung H, Kim SJ. A case of intractable psychogenic essential palatal tremor. J Mov Disord 2012; 5:55-6. [PMID: 24868416 PMCID: PMC4027662 DOI: 10.14802/jmd.12013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 11/30/2022] Open
Abstract
Essential palatal tremor (EPT) is a rare disorder which shows rhythmic involuntary movement of the muscles of soft palate, especially tensor veli palatini muscle. EPT is classified by two subtypes, which is primary and secondary EPT. Secondary EPT includes psychogenic type. We describe a case of intractable psychogenic EPT.
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Affiliation(s)
- Eun Joo Chung
- Departments of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Jung
- Otorhinolaryngology-Head & Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Jin Kim
- Departments of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Stamelou M, Saifee TA, Edwards MJ, Bhatia KP. Psychogenic palatal tremor may be underrecognized: reappraisal of a large series of cases. Mov Disord 2012; 27:1164-1168. [PMID: 22434706 DOI: 10.1002/mds.24948] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/11/2012] [Accepted: 01/19/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palatal tremor is characterized by rhythmic movements of the soft palate and can be essential or symptomatic. Some patients can have palatal movements as a special skill or due to palatal tics. Psychogenic palatal tremor is recognized but rarely reported in the literature. METHODS We retrospectively evaluated all patients with palatal tremor seen in our center over a period of 10 years. RESULTS Of 17 patients with palatal tremor, we identified 10 patients with isolated palatal tremor. In 70% of those the diagnosis of psychogenic palatal tremor could be made. Of the remainder, 2 had palatal tics and 1 essential palatal tremor. CONCLUSIONS We suggest that psychogenic palatal tremor may be underrecognized and propose that targeted clinical examination of positive signs for psychogenic movement disorders in these patients is essential. The correct identification of such patients has important clinical and scientific implications.
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Affiliation(s)
- Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
| | - Tabish A Saifee
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
| | - Mark J Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
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Abstract
An 8-year-old boy was seen by his primary care pediatrician with a chief complaint of "intermittent rapid vibrations of the epiglottis" that began several weeks prior. Intraoral examination revealed rapid, symmetrical bilateral contractions of the soft palate muscles (velum), accompanied by clicking sounds audible to physician (objective tinnitus) and patient. The patient was able to volitionally control the initiation and cessation of the palatal movements. The child's mother stated that there had been no clicking noises heard while the boy was sound asleep. Palatal "clonus" was tentatively diagnosed as the cause of the problem. A normal magnetic resonance imaging study with contrast enhancement confirmed that there was no anatomical basis for the localized movement disorder.Palatal myoclonus is an uncommon localized intraoral movement disorder. There are 2 distinct types, and our patient was diagnosed with the essential palatal myoclonus type. This type is characteristically associated with clicking tinnitus, heard by the affected person as well as those in close proximity. The clicking noise is not continuous, ceases during sleep, and is not lifelong.
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