Functional Movement Disorders in Children

Abstract

Functional movement disorders (FMDs) are not uncommon in children. The age at onset may have a bearing on the phenomenological pattern of abnormal movement, risk factors, and response to different treatment modalities in this age group. FMDs in children resemble their adult counterparts in terms of gender preponderance, but risk factors are quite different, and often influenced by cultural and demographic background. FMDs contribute to a significant proportion of acute pediatric movement disorder patients seen in emergency settings, ranging from 4.3 to 23% in different case series. The most common movement phenomenologies observed in pediatric FMDs patients are tremor, dystonia, gait disturbances, and functional tics. Various social, physical, and familial precipitating factors have been described. Common social risk factors include divorce of parents, sexual abuse, bullying at school, examination pressure, or other education-related issues, death of a close friend, relative, or family members. Physical trauma like minor head injury, immunization, tooth extraction, and tonsillectomy are also known to precipitate FMDs. The response to treatment appears to be better among pediatric patients. We aim to review FMDs in children to better understand the different aspects of their frequency, clinical features, precipitating factors, diagnosis, treatment, and outcome.

Rapid Onset Functional Tic‐Like Behaviors in Young Females During the COVID‐19 Pandemic

“…21 Behavioral treatment approaches, including personalized psychoeducation, seem more appropriate to initiate a therapeutic process. Intuitively, function-based therapeutic strategies, [22][23][24] including mitigating potential triggering exposures, particularly social media content associated with tics, initiating stress management interventions related to other identifiable psychosocial stressors, reducing social reactions to symptom expression, and addressing comorbid anxiety and depression, could be confirmed as high-yield strategies by future observations. Our prediction is that cognitive behavioral therapies, particularly when including components of the Comprehensive Behavioral Intervention for Tics, 25 might have a considerable chance of success to treat this type of repetitive behavior.…”

Acute Movement Disorders in Childhood

“…Functional MDs have been reported to account for 4.3–23% of all acute MDs in children and adolescents, representing one of the most common causes [ 233 ]. Tremor is the most common functional MD (illustrative case 4, Supplementary Material ), followed by myoclonus, dystonia and tics, and the combination of multiple MDs is frequent [ 3 ].…”

“…Diagnosis relies on the demonstration of specific features on history and examination. First, functional MDs often present with abrupt and dramatic onset [ 233 ]. Second, symptoms and their severity tend to vary, and disability is often selective or inconsistent [ 10 , 233 ].…”

“…First, functional MDs often present with abrupt and dramatic onset [ 233 ]. Second, symptoms and their severity tend to vary, and disability is often selective or inconsistent [ 10 , 233 ]. Distractibility (namely, the disappearance or reduction in the severity of the symptoms when the patient is unobserved or distracted by a cognitive task) is a strong argument in favor of a functional etiology.…”

“…For instance, dystonia lacks sensory tricks or overflow, dystonic posturing is usually fixed instead of mobile, and pain can be a prominent feature. Tics lack a premonitory urge and cannot be voluntarily suppressed, while tremor may emerge in a distant, previously unaffected body segment after constraining the originally tremulous body part (whack-a-mole sign, see [ 233 ] for a detailed list of incongruent features). Chronic underlying medical, psychiatric or neurologic conditions may be present, and psychosocial or physical stressors are frequent triggers [ 3 ].…”