Phenomenology of psychogenic movement disorders in children

Abstract

Psychogenic movement disorders are heterogeneous and diagnostically challenging. Despite the growing literature on adult forms, clinical features in children have received relatively little attention. We retrospectively reviewed medical records and video of patients <18 years diagnosed with a psychogenic movement disorder at our institute between 2007 and 2010. We identified 14 patients (6 males and 8 females) with a mean onset age of 11.5 years. Levels of diagnostic confidence were documented (2 patients), clinically established (8 patients), and probable (4 patients). A single movement disorder was present in 10 patients (71%); 4 patients (29%) presented an association of two or more movement disorders. Eleven patients presented other medically unexplained symptoms associated with their movement disorders. Five patients, among 6 with chronic occurrence, performed a polymyographic study showing significant modifications of frequency, amplitude, and distribution of electromyographic activity, related to distracting maneuvers. The present series represents 5% of all movement disorders observed in the considered period and 32% of nonorganic neurological manifestations. The most frequent movement disorders were tremor (36%) and dystonia (29%). We describe two phenotypes not previously reported among psychogenic movement disorders: myoclonus and association of myoclonus with dystonia. We remark on the presence of psychogenic symptoms associated with movement disorders (79%) as being one of the most useful clinical clues as well as on the value of polymyographic study in chronic psychogenic movement disorders, which provide evidence of the inconsistency of movement disorders.

Psychogenic Movement Disorders in Adults and Children: A Clinical and Video Profile of 58 Indian Patients

“…In a large cohort of 54 children with PMD, Ferrara and Jankovic reported tremor as the most common movement disorder (65%), followed by dystonia, myoclonus, and gait abnormality . Canavese and colleagues reported that tremor (36%) was the most common PMD phenotype in 14 children . Fernandez‐Alvarez also reported 16 children with PMD and observed that tremor (68%) was the predominant movement disorder, followed by myoclonus .…”

“…Limited data are available on PMD in children, and most of the existing literature relates only to adults . Therefore, we undertook this retrospective study of 33 adults and 25 children who were diagnosed with PMD to delineate their clinical characteristics, risk factors, and outcomes.…”

Functional Movement Disorders: Updated Overview

“…FMD usually presents as a single movement disorder affecting the dominant extremities, however, complex movements or gait disorders are also common [26][27][28]. Children with functional disorders are expected to make a full recovery, as the conversion symptoms last no longer than 3 months typically [29].…”

Paroxysmal non-kinesigenic dyskinesia, post-streptococcal syndromes and psychogenic movement disorders: a diagnostic challenge

“…The most common motor presentations are tremor, dystonia, gait disorders and myoclonus,17 23 24 but parkinsonism, chorea and tics have also been reported 23. Psychogenic paroxysmal movements have been described and differential diagnosis with PNKD could constitute a diagnostic challenge 25…”