Physical precipitating factors in functional movement disorders

Pareés, Isabel; Kojović, Maja; Pires, Carolina; Rubio-Agustí, Ignacio; Saifee, Tabish A.; Sadnicka, Anna; Kassavetis, Panagiotis; Macerollo, Antonella; Bhatia, Kailash P.; Carson, Alan; Stone, Jon; Edwards, Mark J.

doi:10.1016/j.jns.2013.12.046

Cited by 139 publications

(72 citation statements)

References 15 publications

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“…39 Yet disease modeling (which can occur both intraindividually and interindividually) does not seem to fully answer such a question. In fact, a recent study assessing the presence of physical events preceding the onset of PMD in 50 consecutive patients found that the phenomenology of the symptoms was plausibly related to the physical trigger in some of the cases, 36 confirming previous suggestions that the nature of the physical precipitating and the affected body parts during the physical illness may influence the subsequent psychogenic symptom. 64 This fits also with the common co-occurrence of epilepsy and PNES, where the epileptic seizure can be considered as a physical trigger (as well as perhaps a disease model) for PNES to develop.…”

supporting

confidence: 76%

“…30 However, this could also reflect a selection bias, since it has been recently found that up to 80% of patients can have a physical event shortly preceding the onset of the PMD. 36 In both groups, a family history of substance abuse has been reported as high as 32%, particularly with regard to alcohol abuse (about 25%). 7 Finally, there have been some suggestions that a positive family history of neurologic disease or frequent exposure to individuals with neurologic disease (for example, in health care workers) can act as modeling of organic disease and play an important role in the development of psychogenic symptoms.…”

Section: Risk Factorsmentioning

confidence: 96%

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Psychogenic nonepileptic seizures and movement disorders

et al. 2016

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Purpose of review: Neurologic symptoms due to a psychogenic cause are frequently seen in clinical practice. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are among the most common psychogenic neurologic disorders. PNES and PMD are usually investigated and managed separately by different neurology subspecialists. We review the main epidemiologic and clinical features of both PNES and PMD, aiming to highlight their similarities and differences and to see whether a common framework for these disorders exists. Recent findings:Data from the literature show that there is a profound overlap between PNES and PMD, which would argue for a larger unifying pathophysiology with variable phenotypic manifestations. Summary: Collaborative and integrated research among epileptologists, movement disorders experts, psychiatrists, psychologists, and physiotherapists may increase our collective knowledge about the pathophysiologic mechanisms of PNES and PMD and therefore improve outcomes for these patients. Neurol Clin Pract 2016;6:138-149 N eurologic symptoms due to a functional or psychogenic cause are common in clinical practice, accounting for up to 16% of patients presenting to neurology outpatient clinics, depending on the clinical definitions and methodology used for case ascertainment.1,2 The yearly costs of patients with medically unexplained symptoms in the United States have been estimated at approximately $256 billion per year.3 Despite their prevalence and associated economic and social burden, appropriate treatments for these disorders are an unmet need. This may reflect the absence of research interest and lack of discourse between neurology and psychiatry regarding these patients. Notably, although approximately 50% of the patients with somatoform disorders are identified by neurologists at the time of first contact, only 1.5% are referred to a psychiatrist or a psychologist.

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confidence: 76%

Section: Risk Factorsmentioning

confidence: 96%

Psychogenic nonepileptic seizures and movement disorders

et al. 2016

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“…Within the acute neurological setting the number of people presenting with FNSD symptoms increases significantly (Carson et al 2012). Some report suggest that CD is as common as other neurological conditions such as Parkinson's disease and Multiple Sclerosis , Carson et al 2012. The Scottish Neurological Symptoms Study (2005) found that approximately one third of 3781 patients seen in a neurology outpatient's clinic had medically unexplained symptoms.…”

Section: Epidemiologymentioning

confidence: 99%

Clinical briefing: functional neurological symptom disorder

Ratcliffe

2017

British Journal of Neuroscience Nursing

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“…Notably, physical precipitating factors (injury, illness) are common in patients with FMD. 58,59 Some of the described secondary and idiopathic PSM could be considered as FMD, but based on the available information this remains speculative.…”

Section: Follow-up and Therapy Follow-up Was Reported In 126 (70%) Cmentioning

confidence: 99%

Propriospinal myoclonus

et al. 2014

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Objective: Propriospinal myoclonus (PSM) is a rare disorder with repetitive, usually flexor arrhythmic brief jerks of the trunk, hips, and knees in a fixed pattern. It has a presumed generation in the spinal cord and diagnosis depends on characteristic features at polymyography. Recently, a historical paradigm shift took place as PSM has been reported to be a functional (or psychogenic) movement disorder (FMD) in most patients. This review aims to characterize the clinical features, etiology, electrophysiologic features, and treatment outcomes of PSM.Methods: Re-evaluation of all published PSM cases and systematic scoring of clinical and electrophysiologic characteristics in all published cases since 1991.Results: Of the 179 identified patients with PSM (55% male), the mean age at onset was 43 years (range 6-88 years). FMD was diagnosed in 104 (58%) cases. In 12 cases (26% of reported secondary cases, 7% of total cases), a structural spinal cord lesion was found. Clonazepam and botulinum toxin may be effective in reducing jerks.Conclusions: FMD is more frequent than previously assumed. Structural lesions reported to underlie PSM are scarce. Based on our clinical experience and the reviewed literature, we recommend polymyography to assess recruitment variability combined with a Bereitschaftspotential recording in all cases. Propriospinal myoclonus (PSM) is a rare hyperkinetic movement disorder involving the axial muscles.1 Brown et al. 1 were the first to describe the clinical phenomenology based on 3 cases. PSM is characterized by painless, usually flexor arrhythmic jerks of the trunk, hips, and knees, which are often stimulus sensitive and typically increase when supine.1-3 Based on the initial publications, PSM had a presumed generation in the spinal cord and diagnosis depended on characteristic features at polymyography. [1][2][3][4] The myoclonic activity in PSM was assumed to originate from a spinal generator and spread up and down the spinal cord via intrinsic propriospinal pathways, and these axial jerks were therefore termed propriospinal myoclonus.1 Electrophysiologic features of PSM were published after the first clinical descriptions and included a fixed pattern of muscle activation, a slow conduction velocity (5-15 m/s) consistent with spread within the propriospinal tract, EMG burst duration of less than 1,000 ms, synchronous activation of agonist and antagonist muscles, and no facial involvement. 4 Until recently, patients were subdivided into idiopathic PSM (i.e., primary, no underlying cause found) and secondary PSM. However, the diverse etiology of this disorder is currently highlighted by several movement disorders specialists, including our centres.5-7 A functional etiology was reported to underlie several PSM cases. Psychogenic or functional movement disorders (FMD) are common and characterized by abnormal movements inconsistent with a known organic etiology. 8

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Physical precipitating factors in functional movement disorders

Cited by 139 publications

References 15 publications

Psychogenic nonepileptic seizures and movement disorders

Psychogenic nonepileptic seizures and movement disorders

Clinical briefing: functional neurological symptom disorder

Propriospinal myoclonus

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