Cranial Functional Movement Disorders: A Case Series with Literature Review

Mishra, Anumeha; Pandey, Sanjay

doi:10.5334/tohm.352

Cited by 4 publications

(5 citation statements)

References 42 publications

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“…incongruent signs in patients presenting with unilateral facial spasms mimicking hemifacial spasm include asynchronous involvement of the upper and lower face, and bilateral involvement of the lower face. 49,[60][61][62] Paroxysmal dystonia may be accompanied by other functional hyperkinetic movements (tremor, jerks) and dissociation, overlapping with functional seizures. 63 Just as there are features typical of FMD and not other movement disorders, some typical features seen in non-FMDs may not be seen in FMD.…”

Section: Diagnosing Functional Movement Disorder Gilmour Lidstonementioning

confidence: 99%

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Gilmour

Lidstone

2023

Semin Neurol

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Functional movement disorder (FMD) is a complex neuropsychiatric syndrome, encompassing abnormal movements and weakness, and is a common cause of potentially disabling neurological symptoms. It is vital to recognize that FMD is a syndrome, with nonmotor manifestations negatively affecting a patient's quality of life. This review highlights a diagnostic algorithm, where a history suggestive of FMD is combined with the presence of positive signs on examination and appropriate investigations to make the diagnosis. Positive signs indicate internal inconsistency such as variability and distractibility, and clinical findings that are incongruent with other known neurological disease. Importantly, the clinical assessment acts as the first opportunity to allow patients to understand FMD as the cause for their symptoms. Accurate and early diagnosis of FMD is necessary given that it is a treatable and potentially reversible cause of disability, with significant risk of iatrogenic harm associated with misdiagnosis.

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Section: Diagnosing Functional Movement Disorder Gilmour Lidstonementioning

confidence: 99%

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Gilmour

Lidstone

2023

Semin Neurol

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“…In one series of 184 FMD patients, 18 (9.8%) had functional hemifacial spasm (HFS) among which 14 (78%) were women 76. Similarly, 10 out of 26 (38.46%) functional craniofacial movement disorder patients in one study from India had these spasms and the authors of this study concluded that fixed unilateral facial contraction, especially of the lower face, generally favors a functional disorder 77. Babinski’s “other” sign, which has a specificity of 100% may be present 78.…”

Section: Spectrum Of Fndsmentioning

confidence: 85%

“…76 Similarly, 10 out of 26 (38.46%) functional craniofacial movement disorder patients in one study from India had these spasms and the authors of this study concluded that fixed unilateral facial contraction, especially of the lower face, generally favors a functional disorder. 77 Babinski's "other" sign, which has a specificity of 100% may be present. 78 Functional weakness (FW) in the ipsilateral limb is also common, reported in 90% of functional HFS cases.…”

Section: Excess Of Movementsmentioning

confidence: 99%

Functional Neurological Disorders

Mishra

Pandey

2022

The Neurologist

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Background: Functional neurological disorders (FNDs) are common but often misdiagnosed. Review Summary: The incidence of FNDs is between 4 and 12 per 100,000, comparable to multiple sclerosis and amyotrophic lateral sclerosis, and it is the second most common diagnosis in neurology clinics. Some clues in the history are sudden onset, intermittent time course, variability of manifestation over time, childhood trauma, and history of other somatic symptoms. Anxiety and depression are common, but not necessarily more than in the general population. Although there are no tests currently capable of demonstrating whether symptoms are willfully produced, there may not be a clear categorical difference between voluntary and involuntary symptoms. The prognosis of an FND is linked to early diagnosis and symptom duration, but unfortunately, the majority of the patients are diagnosed after considerable delays. Conclusions: A positive diagnosis of FNDs can be made on the basis of history and neurological signs without reliance on psychological stressors. Past sensitizing events and neurobiological abnormalities contribute to the pathogenesis of FNDs. Physical rehabilitation and psychological interventions alone or in combination are helpful in the treatment.

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“…Although we have to consider functional movement disorder as a differential diagnosis, it is less likely. While functional movement disorders are known for their variable presentations and time lengths, they fall under the category of conversion disorders [ 9 ]; this implies that there are specific triggers preceding the onset of the movement, which go away once the initial stressor is addressed [ 9 ]. This does not match the description of our patient, whose oromandibular dyskinesia is present regardless of the presence of stressors and has even worsened over time to the point of causing him distress.…”

Section: Discussionmentioning

confidence: 99%

Concussion-Induced Oromandibular Dyskinesia

Zhang¹,

Settineri²,

Chajet³

et al. 2023

Cureus

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We present a rare case of concussion-induced chronic oromandibular dyskinesia. The patient is a 51-year-old Caucasian male with complex medical history (including a history of multiple concussions) who presented to the emergency department for suicidal and paranoid ideation. At the time of the visit, the patient was noted to be exhibiting an oromandibular dyskinesia in the form of “teeth-chattering.” The first documented episode of his oromandibular dyskinesia dates back to a medical visit in December 2017. During this visit, the patient presented with teeth-chattering and tremors in his legs, hands, and head after a concussive event. Similar symptoms were noted by two different providers during two unrelated appointments one month later in January 2018. These symptoms were not mentioned in his records for four years and three months following the initial onset. They were noted again during an outpatient encounter for insomnia. During these four years, he was treated for a variety of conditions in both inpatient and outpatient settings, including gout, human immunodeficiency virus (HIV), stage four lymphoma, insomnia, and hepatitis C. Curiously, the dyskinesia symptoms reappeared several months after the completion of six cycles of etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride (R-EPOCH) chemotherapy in May 2021. Since reappearing, the symptoms have been worsening and significantly impacting the patient’s quality of life. Although concussion-induced dyskinesia has been previously described in the literature, this is to our knowledge the first described case of concussion-induced oromandibular dyskinesia.

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Cranial Functional Movement Disorders: A Case Series with Literature Review

Cited by 4 publications

References 42 publications

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Functional Neurological Disorders

Concussion-Induced Oromandibular Dyskinesia

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