Psychogenic facial movement disorders: Clinical features and associated conditions

Abstract

The facial phenotype of psychogenic movement disorders has not been fully characterized. Seven tertiary-referral movement disorders centers using a standardized data collection on a computerized database performed a retrospective chart review of psychogenic movement disorders involving the face. Patients with organic forms of facial dystonia or any medical or neurological disorder known to affect facial muscles were excluded. Sixty-one patients fulfilled the inclusion criteria for psychogenic facial movement disorders (91.8% females; age: 37.0 ± 11.3 years). Phasic or tonic muscular spasms resembling dystonia were documented in all patients most commonly involving the lips (60.7%), followed by eyelids (50.8%), perinasal region (16.4%), and forehead (9.8%). The most common pattern consisted of tonic, sustained, lateral, and/or downward protrusion of one side of the lower lip with ipsilateral jaw deviation (84.3%). Ipsi- or contralateral blepharospasm and excessive platysma contraction occurred in isolation or combined with fixed lip dystonia (60.7%). Spasms were reported as painful in 24.6% of cases. Symptom onset was abrupt in most cases (80.3%), with at least 1 precipitating psychological stress or trauma identified in 57.4%. Associated body regions involved included upper limbs (29.5%), neck (16.4%), lower limbs (16.4%), and trunk (4.9%). There were fluctuations in severity and spontaneous exacerbations and remissions (60%). Prevalent comorbidities included depression (38.0%) and tension headache (26.4%). Fixed jaw and/or lip deviation is a characteristic pattern of psychogenic facial movement disorders, occurring in isolation or in combination with other psychogenic movement disorders or other psychogenic features. © 2012 Movement Disorder Society

Cranial functional (psychogenic) movement disorders

“…Cranial movement abnormalities are perhaps an under-recognized feature of patients with functional (psychogenic) neurological symptoms [1][2][3] , and in our experience a common concomitant of other functional neurological symptoms.…”

“…Fasano et al, most described patients were female (92%) and relatively young (mean age 37yrs) 3 . Platysma is commonly contracted which leads to the corner of the mouth being pulled down on one side giving an appearance of weakness (Video 8).…”

“…longer than 10 seconds) 3 . As voluntary facial movements may also exacerbate synkinetic movements seen after facial palsy and sometimes in hemifacial spasm, it is the finding of sustained orbicularis oculis or platysma contraction that is the key finding.…”

“…Between 5 and 50% of all patients with functional movement disorders present with a facial movement disorder 3 but the prevalence of functional eye movement disorders is largely unknown. Patients may present overtly with a complaint suggestive of an eye movement disorder (e.g.…”

Functional Movement Disorders: Updated Overview

“…The most common pattern of movements was lateral or downward lip protrusion with an ipsilateral deviation of the jaw. In contrast to organic oromandibular dystonia, patients had a unilateral involvement, and no sensory tricks or speech [65]. In psychogenic hemifacial spasm, an earlier age of onset was noted with no simultaneous compensatory contractions of the frontalis muscle and a normal blink reflex [66][67][68].…”