Abstract
Background: The diagnosis of psychogenic paroxysmal movement disorders (PPMD) can be challenging, in particular their distinction from the primary paroxysmal dyskinesias (PxD) remains difficult. Methods: Here we present a large series of 26 PPMD cases, describe their characteristics, contrast them with primary PxD and focus on their distinguishing diagnostic features. Results: Mean age at onset was 38.6 years, i.e. much later than primary PxD. Women were predominantly affected (73%). Most subjects (88.4%) had long attacks, and unlike primary PxD there was a very high within-subject variability for attack phenomenology, duration and frequency. Dystonia was the most common single movement disorder presentation, but 69.2% of the patients had mixed or complex PxD. In 50% of PPMD cases attack triggers could be identified but these were unusual for primary PxD. 42.3% of patients employed unusual strategies to alleviate or stop the attacks. Response to typical medication used for primary PxD was poor. Precipitation of the disorder due to physical or emotional life events and stressors were documented in 57.6% and 65.3% of the cases respectively. Additional interictal psychogenic signs were documented in 34.6% and further medically unexplained somatic symptoms were present in 50% of the cases. 19.2% of patients had a comorbid organic movement disorder and 26.9% had pre-existing psychiatric comorbidities. Conclusion: Although the phenotypic presentation of PPMD can be highly diverse, certain clinical characteristics help in distinguishing this condition from the primary forms of PxD. Recognition is important as multidisciplinary treatment approaches led to significant improvement in most cases.
| Original language | English |
|---|---|
| Journal | Parkinsonism and Related Disorders |
| Volume | 20 |
| Issue number | 1 |
| Pages (from-to) | 41-46 |
| Number of pages | 6 |
| ISSN | 1353-8020 |
| DOIs | |
| Publication status | Published - 01.01.2014 |
Funding
Commercial research support Grants by Pharm Allergan, Ipsen, Merz Pharmaceuticals Honoraria for lectures from Pharm Allergan, Ipsen, Merz Pharmaceuticals, Actelion, GlaxoSmithKline and Desitin Support from non-profit foundations or societies Possehl-Stiftung, Lübeck Dystonia Coalition (USA) Tourette Syndrome Association (Germany) European Huntington Disease Network N. E.MO. Charity supporting the research of paediatric movement disorders Academic research support not attributed in the manuscript Deutsche Forschungsgemeinschaft (SFB 936). Else Kröner-Fresenius-Stiftung Receives royalties from publication of the Oxford Specialist Handbook of Parkinson's Disease and Other Movement Disorders (Oxford University Press, 2008); he also receives research support from a National Institute for Health Research grant for a study in which he is the principal investigatory and from Parkinson's UK, UK Dystonia Society, and the Guarantors of Brain; and he has received honoraria for speaking from UCB. Funding for travel from GlaxoSmithKline, Orion Corporation, Ipsen, and Merz Pharmaceuticals, LLC; serves on the editorial boards of Movement Disorders and Therapeutic Advances in Neurological Disorders; receives royalties from the publication of Oxford Specialist Handbook of Parkinson's Disease and Other Movement Disorders (Oxford University Press, 2008); received speaker honoraria from GlaxoSmithKline, Ipsen, Merz Pharmaceuticals, LLC, and Sun Pharmaceutical Industries Ltd.; personal compensation for scientific advisory board for GSK and Boehringer Ingelheim; received research support from Ipsen and from the Halley Stewart Trust through Dystonia Society UK, and the Wellcome Trust MRC strategic neurodegenerative disease initiative award (Ref. number WT089698), a grant from the Dystonia Coalition and a grant from Parkinson's UK (Ref. number G-1009). Appendix A
