Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 6/2015

01-06-2015 | Movement Disorders (M Okun, Section Editor)

Phenotype-Specific Diagnosis of Functional (Psychogenic) Movement Disorders

Authors: Alberto J. Espay, Anthony E. Lang

Published in: Current Neurology and Neuroscience Reports | Issue 6/2015

Login to get access

Abstract

Published diagnostic criteria for functional (psychogenic) movement disorders (FMDs) include psychiatric symptoms and some historical variables to affect the threshold between categories of diagnostic certainty. Clinically probable and possible categories, however, do not suffice to rule in FMD or rule out complex organic movement disorders and therefore are of little practical help. In contrast, a handful of unequivocal and reliably incongruent or inconsistent clinical features in each functional movement phenotype, when present, allow a clinically definite diagnosis of FMD, regardless of any psychiatric symptom. We suggest that the use of phenotype-specific clinically definite FMD diagnostic criteria will increase inter-rater reliability and minimize false-positive diagnostic errors. This process involves the ascertainment of core (mandatory) examination features instead of supportive but insufficiently sensitive historical, psychiatric, and inconsistent examination features.
Literature
1.
Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol. 1988;50:431–55.PubMed
2.
Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. In: Weiner WJ, Lang AE, editors. Behavioral neurology in movement disorders. New York: Raven; 1994. p. 231–57.
3.
Shill H, Gerber P. Evaluation of clinical diagnostic criteria for psychogenic movement disorders. Mov Disord. 2006;21:1163–8.CrossRefPubMed
4.••
Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol. 2009;22:430–6. This article argued against a “probable” and “possible” categories of diagnostic certainty to minimize diagnostic errors in FMD.CrossRefPubMed
5.
Goodson B, Martin K, Hunt T. Stiff person syndrome presenting with sudden onset of shortness of breath and difficulty moving the right arm: a case report. J Med Case Rep. 2010;4:118.CrossRefPubMedCentralPubMed
6.
Erro R, Sheerin UM, Bhatia KP. Paroxysmal dyskinesias revisited: a review of 500 genetically proven cases and a new classification. Mov Disord. 2014;29:1108–16.CrossRefPubMed
7.
Morgante F, Edwards MJ, Espay AJ. Psychogenic movement disorders. Continuum (Minneap Minn). 2013;19:1383–96.
8.
Bewley J, Murphy PN, Mallows J, Baker GA. Does alexithymia differentiate between patients with nonepileptic seizures, patients with epilepsy, and nonpatient controls? Epilepsy Behav. 2005;7:430–7.CrossRefPubMed
9.
Munts AG, Koehler PJ. How psychogenic is dystonia? Views from past to present. Brain. 2010;133:1552–64.CrossRefPubMed
10.
11.
Edwards MJ, Stone J, Lang AE. From psychogenic movement disorder to functional movement disorder: it’s time to change the name. Mov. Disord. 2014;29(7):849–52.
12.
Morgante F, Edwards MJ, Espay AJ, Fasano A, Mir P, Martino D, et al. Diagnostic agreement in patients with psychogenic movement disorders. Mov Disord. 2012;27:548–52.CrossRefPubMedCentralPubMed
13.
van der Salm SM, de Haan RJ, Cath DC, van Rootselaar AF, Tijssen MA. The eye of the beholder: inter-rater agreement among experts on psychogenic jerky movement disorders. J Neurol Neurosurg Psychiatry. 2013;84:742–7.CrossRefPubMed
14.
Gould R, Miller BL, Goldberg MA, Benson DF. The validity of hysterical signs and symptoms. J Nerv Ment Dis. 1986;174:593–7.CrossRefPubMed
15.
Krem MM. Motor conversion disorders reviewed from a neuropsychiatric perspective. J Clin Psychiatry. 2004;65:783–90.CrossRefPubMed
16.•
Espay AJ, Goldenhar LM, Voon V, Schrag A, Burton N, Lang AE. Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: an international survey of movement disorder society members. Mov Disord. 2009;24:1366–74. This article, a survey of movement disorders society members, highlighted the wide disparity of diagnostic and therapeutic patterns of practice for patients with FMD, revealing a rather high index of “exclusionary diagnosis”.CrossRefPubMed
17.
Kumru H, Begeman M, Tolosa E, Valls-Sole J. Dual task interference in psychogenic tremor. Mov Disord. 2007;22:2077–82.CrossRefPubMed
18.
Deuschl G, Koster B, Lucking CH, Scheidt C. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord. 1998;13:294–302.CrossRefPubMed
19.
Schwingenschuh P, Katschnig P, Seiler S, Saifee TA, Aguirregomozcorta M, Cordivari C, et al. Moving toward “laboratory-supported” criteria for psychogenic tremor. Mov Disord. 2011;26:2509–15.CrossRefPubMedCentralPubMed
20.
Morgan JC, Sethi K, Lang AE. Progression of dystonia in complex regional pain syndrome. Neurology. 2005;64:2162–3.CrossRefPubMed
21.
22.
Laub HN, Dwivedi AK, Revilla FJ, Duker AP, Pecina-Jacob C, Espay AJ. Diagnostic performance of the “huffing and puffing” sign in functional (psychogenic) movement disorders. Mov Disord Clin Pract. 2014. doi:10.​1002/​mdc3.​12102.
23.
24.
Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord. 2007;22:395–9.CrossRefPubMed
25.
Okun MS, Rodriguez RL, Foote KD, Fernandez HH. The “chair test” to aid in the diagnosis of psychogenic gait disorders. Neurologist. 2007;13:87–91.CrossRefPubMed
26.
Lempert T, Brandt T, Dieterich M, Huppert D. How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol. 1991;238:140–6.CrossRefPubMed
27.
28.
Kenney C, Diamond A, Mejia N, Davidson A, Hunter C, Jankovic J. Distinguishing psychogenic and essential tremor. J Neurol Sci. 2007;263:94–9.CrossRefPubMed
29.
Espay AJ, Edwards MJ, Oggioni GD, Phielipp N, Cox B, Gonzalez-Usigli H, et al. Tremor retrainment as therapeutic strategy in psychogenic (functional) tremor. Parkinsonism Relat Disord. 2014;20:647–50.CrossRefPubMed
30.
Kumru H, Valls-Sole J, Valldeoriola F, Marti MJ, Sanegre MT, Tolosa E. Transient arrest of psychogenic tremor induced by contralateral ballistic movements. Neurosci Lett. 2004;370:135–9.CrossRefPubMed
31.
Lang AE. Psychogenic dystonia: a review of 18 cases. Can J Neurol Sci. 1995;22:136–43.PubMed
32.
Rinne JO, Lee MS, Thompson PD, Marsden CD. Corticobasal degeneration. A clinical study of 36 cases. Brain. 2010;133(Pt 7):1860–2.
33.
Gautschi M, Merlini L, Calza AM, Hayflick S, Nuoffer JM, Fluss J. Late diagnosis of fucosidosis in a child with progressive fixed dystonia, bilateral pallidal lesions and red spots on the skin. Eur J Paediatr Neurol. 2014;18(4):516–9.
34.
Kalita J, Misra UK. Markedly severe dystonia in Japanese encephalitis. Mov Disord. 2000;15:1168–72.CrossRefPubMed
35.
Krystkowiak P, Martinat P, Defebvre L, Pruvo JP, Leys D, Destee A. Dystonia after striatopallidal and thalamic stroke: clinicoradiological correlations and pathophysiological mechanisms. J Neurol Neurosurg Psychiatry. 1998;65:703–8.CrossRefPubMedCentralPubMed
36.
Choi YC, Lee MS, Choi IS. Delayed-onset focal dystonia after stroke. Yonsei Med J. 1993;34:391–6.CrossRefPubMed
37.••
Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain. 2004;127:2360–72. This article reassessed a large cohort of patients with the syndrome of “fixed dystonia” from Queen Square, many of whom also had complex regional pain syndrome and had been thought to have organic dystonia. It showed that most of these patients fulfilled clinically definite criteria for FMD. This was a landmark effort, and has been supported by subsequent research efforts.CrossRefPubMed
38.
van Rijn MA, Marinus J, Putter H, van Hilten JJ. Onset and progression of dystonia in complex regional pain syndrome. Pain. 2007;130:287–93.CrossRefPubMed
39.
Avanzino L, Martino D, van de Warrenburg BP, Schneider SA, Abbruzzese G, Defazio G, et al. Cortical excitability is abnormal in patients with the “fixed dystonia” syndrome. Mov Disord. 2008;23:646–52.CrossRefPubMed
40.
41.
Erro R, Bhatia KP, Edwards MJ, Farmer SF, Cordivari C. Clinical diagnosis of propriospinal myoclonus is unreliable: an electrophysiologic study. Mov Disord. 2013;28:1868–73.CrossRefPubMed
42.
Demartini B, Ricciardi L, Parees I, Ganos C, Bhatia KP, Edwards MJ. A positive diagnosis of functional (psychogenic) tics. Eur. J. Neurol. 2014.
43.
Hallett M. Tourette syndrome: update. Brain Dev. 2015.
44.
Jankovic J. Diagnosis and treatment of psychogenic parkinsonism. J Neurol Neurosurg Psychiatry. 2011;82:1300–3.CrossRefPubMed
45.
Hayes MW, Graham S, Heldorf P, de Moore G, Morris JG. A video review of the diagnosis of psychogenic gait: appendix and commentary. Mov Disord. 1999;14:914–21.CrossRefPubMed
46.
Ruzicka E, Zarubova K, Nutt JG, Bloem BR. “Silly walks” in Parkinson’s disease: unusual presentation of dopaminergic-induced dyskinesias. Mov Disord. 2011;26:1782–4.CrossRefPubMed
Metadata
Title
Phenotype-Specific Diagnosis of Functional (Psychogenic) Movement Disorders
Authors
Alberto J. Espay
Anthony E. Lang
Publication date
01-06-2015
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 6/2015
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-015-0556-y

Other articles of this Issue 6/2015

Current Neurology and Neuroscience Reports 6/2015 Go to the issue

Headache (RB Halker, Section Editor)

Pediatric Migraine Variants: a Review of Epidemiology, Diagnosis, Treatment, and Outcome

Infection (ML Solbrig, Section Editor)

Current Neurological Observations and Complications of Dengue Virus Infection

Genetics (V Bonifati, Section Editor)

Recent Advances in the Genetics of Autism Spectrum Disorder

Genetics (V Bonifati, Section Editor)

New Genes for Focal Epilepsies with Speech and Language Disorders

Neuroimaging (DJ Brooks, Section Editor)

Capillary Dysfunction: Its Detection and Causative Role in Dementias and Stroke

Headache (RB Halker, Section Editor)

Headaches of the Elderly