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

Abstract

View Supplementary Video 1 View Supplementary Video 2 Background Psychogenic movement disorders (PMDs) represent 2% to 20% of patients with movement disorders. There is a paucity of literature on PMD in children, with most existing literature relating to adults only. Methods For this detailed report of 58 patients (33 adults and 25 children) with PMD, history was assessed in the form of disease onset, duration, precipitating factors, diagnosis, and outcome. Movement phenotype was classified in terms of its appearance as tremor, dystonia, myoclonus, chorea, and others. Clinical evaluations were done to document variability, distractibility, and entrainment. Surface electromyography studies were obtained in patients with tremor. Results Seven adults and 7 children were classified with “documented” PMD, and 26 adults and 18 children were classified with “clinically established” PMD. Abrupt onset was common in adults (75.75%) and children (68%). The most common precipitating factors were family and social issues (42.42%) in adults and fear of examination (40%) and school‐related issues (24%) in children. Tremor was the most common PMD in both adults and children. The second most common PMD was hemifacial spasm in adults. Conclusion The majority of patients had abrupt onset of symptoms, and tremor was the most common form of movement disorder. The second most common PMDs were hemifacial spasm in adults and dystonia and gait abnormality in children. The most common precipitating factors in adults were related to family and social issues; whereas, in children, examination and school‐related issues were most common. Complete improvement was seen in only 405 of patients.

Gender Differences in Functional Movement Disorders

“…15 In another study, tremor was the most common phenomenology in adults and children with FMDs. 16 FMDs also present at the extremes of age: children and the elderly. In a meta-analysis of 120 children with FMDs reported in six different studies, 33 (27.5%) were males, [17][18][19] a figure very similar to the one reported in this study (26.3%).…”

Movement Disorders in Children: An Observational Study in a Tertiary Care Center in North India

“…Yet there are few such studies in the Indian literature that can be counted on fingers. 5,[10][11][12] . Our study showed a relatively high proportion of abnormality on imaging (35/53 or 66%) because this was done only when an abnormality was strongly suspected.…”

“…There are very few studies on spectrum, types, and etiology of childhood movement disorders from anywhere and from India and other developing countries in particular. [9][10][11][12] The spectrum and etiology of movement disorders are likely to differ in different geographic areas of the world. 13 There are no studies on pediatric movement disorders from India which have documented severity with the help of scales.…”

Functional Movement Disorders in Children

“…FMDs can adopt the phenomenology of any known movement disorder seen with an organic cause ( Table 1). The three most common observed phenomenology among pediatric FMDs patients included tremor, dystonia, and myoclonus (13)(14)(15). Functional gait is also not uncommon in children.…”