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Review Article
Functional Movement Disorders: Updates and Clinical Overview
Jung E Park
Received May 26, 2024  Accepted July 1, 2024  Published online July 1, 2024  
DOI:    [Accepted]
  • 301 View
  • 42 Download
AbstractAbstract PDF
Functional movement disorder(FMD) is a type of functional neurological disorder(FND) that is common, but often difficult to diagnose or manage. FMD can present as various phenotypes including tremor, dystonia, myoclonus, gait disorders and Parkinsonism. Conducting a clinical examination appropriate for the assessment of a patient with suspected FMD is important, and various diagnostic testing maneuvers may also be helpful. Treatment involving a multi-disciplinary team, either outpatient or inpatient, has been found to be most effective. Examples of such treatment protocols are also discussed in this review. While recognition and understanding of the disorder appears to have improved over the past few decades, as well as development of treatments, it is not uncommon for patients and physicians to continue to experience various difficulties when dealing with this disorder. In this review, I provide a practical overview of FMD and discuss how the clinical encounter itself can play a role in patients’ acceptance of the diagnosis. Updates on recent neuroimaging studies that aid in the understanding of the pathophysiology are also discussed.
Original Article
Psychodynamic Psychotherapy for Functional (Psychogenic) Movement Disorders
Vibhash D. Sharma, Randi Jones, Stewart A. Factor
J Mov Disord. 2017;10(1):40-44.   Published online December 27, 2016
  • 12,625 View
  • 190 Download
  • 12 Web of Science
  • 12 Crossref
AbstractAbstract PDF
As the literature for the treatment of functional (psychogenic) movement disorders (FMD) is sparse, we assessed clinical outcomes in patients with FMD who underwent treatment with psychodynamic psychotherapy (PDP).
A retrospective analysis of the data of patients with FMD who were referred for PDP from 2008−2014 at Emory University Medical Center was performed.
Thirty patients were included, mean age at presentation was 50 years (SD 13.9) and majority were female (27/30). Most common movement disorder was involuntary shaking/jerky movements (50%) and tremor (43%). Mean duration of symptoms was 3.2 years and mean number of PDP visits was 4.9. PDP lead to good outcomes in 10, modest in 8, and poor in 9. Three patients lost to follow up. Mean duration of symptoms between two groups (good vs. poor) was not statistically significant (p = 0.11), mean number of PDP visits showed a trend towards significance (p = 0.053). In all cases of good outcomes precipitants of the movement disorder were identified and a majority (60%) was receptive of the diagnosis and had good insight.
PDP lead to improvement in 60% of the patients which is encouraging as the treatment is challenging. This study supports heterogeneous causes of FMD including varied roles of past/recent events and demonstrates importance of psychological approaches such as PDP. Treatment with PDP should be considered in some patients with FMD but predicting who will respond remains a challenge. Further long term prospective studies with large sample size and placebo control are needed.


Citations to this article as recorded by  
  • Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome
    Kirsten R. Müller‐Vahl, Anna Pisarenko, Carolin Fremer, Martina Haas, Ewgeni Jakubovski, Natalia Szejko
    Movement Disorders Clinical Practice.2024; 11(3): 227.     CrossRef
  • Living with functional movement disorders: a tale of three battles. An interpretative phenomenological analysis
    Sylwia Bazydlo, Fiona J. R. Eccles
    Psychology & Health.2024; 39(8): 1130.     CrossRef
  • Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide
    Sara A. Finkelstein, Caitlin Adams, Margaret Tuttle, Aneeta Saxena, David L. Perez
    Seminars in Neurology.2022; 42(02): 204.     CrossRef
  • Functional tremor
    Petra Schwingenschuh, Alberto J. Espay
    Journal of the Neurological Sciences.2022; 435: 120208.     CrossRef
  • Psychological interventions for treating functional motor symptoms: A systematic scoping review of the literature
    Erin M. Beal, Peter Coates, Cara Pelser
    Clinical Psychology Review.2022; 94: 102146.     CrossRef
  • Management of Functional Seizures and Functional Movement Disorder: A Cross-Sectional Comparative Study
    Bruno Gabriel Dal Pasquale, Hélio Afonso Ghizoni Teive, Marcelo Daudt von der Heyde, Luana Francine Anad Dal Pasquale
    Neuropsychiatric Disease and Treatment.2022; Volume 18: 2121.     CrossRef
  • Efficacy of a 5-day, intensive, multidisciplinary, outpatient physical and occupational therapy protocol in the treatment of functional movement disorders: A retrospective study
    Megan Reid, Steven D. Mitchell, Katharine M. Mitchell, Christos Sidiropoulos
    Journal of the Neurological Sciences.2022; 443: 120461.     CrossRef
  • Diagnosis and therapy of functional tremor a systematic review illustrated by a case report
    Michael Bartl, Rebekka Kewitsch, Mark Hallett, Martin Tegenthoff, Walter Paulus
    Neurological Research and Practice.2020;[Epub]     CrossRef
  • Speech, language and swallowing impairments in functional neurological disorder: a scoping review
    Caroline Barnett, Jean Armes, Christina Smith
    International Journal of Language & Communication Disorders.2019; 54(3): 309.     CrossRef
  • Functional movement disorders in neurogeriatric inpatients
    Sara Mätzold, Johanna Geritz, Kirsten E. Zeuner, Daniela Berg, Steffen Paschen, Johanne Hieke, Simone Sablowsky, Christian Ortlieb, Philipp Bergmann, Werner Hofmann, Alberto J. Espay, Walter Maetzler
    Zeitschrift für Gerontologie und Geriatrie.2019; 52(4): 324.     CrossRef
  • Psychogenic (Functional) Movement Disorders
    Mary Ann Thenganatt, Joseph Jankovic
    CONTINUUM: Lifelong Learning in Neurology.2019; 25(4): 1121.     CrossRef
  • Disentangling Stigma from Functional Neurological Disorders: Conference Report and Roadmap for the Future
    Karen S. Rommelfanger, Stewart A. Factor, Suzette LaRoche, Phyllis Rosen, Raymond Young, Mark H. Rapaport
    Frontiers in Neurology.2017;[Epub]     CrossRef
Case Reports
A Case of Intractable Psychogenic Essential Palatal Tremor
Eun Joo Chung, Hyun Jung, Sang Jin Kim
J Mov Disord. 2012;5(2):55-56.
  • 11,916 View
  • 75 Download
  • 1 Crossref
AbstractAbstract PDF

Essential palatal tremor (EPT) is a rare disorder which shows rhythmic involuntary movement of the muscles of soft palate, especially tensor veli palatini muscle. EPT is classified by two subtypes, which is primary and secondary EPT. Secondary EPT includes psychogenic type. We describe a case of intractable psychogenic EPT.


Citations to this article as recorded by  
  • Botulinum toxin treatment for essential palatal tremors presenting with nasal clicks instead of pulsatile tinnitus: a case report
    Yufeng Ye, Shiyu Liao, Baozhen Luo, Liyan Ni
    Head & Face Medicine.2016;[Epub]     CrossRef
Attention in Parkinson’s Disease Mimicking Suggestion in Psychogenic Movement Disorder
Jong Sam Baik
J Mov Disord. 2012;5(2):53-54.
  • 13,765 View
  • 59 Download
  • 3 Crossref
AbstractAbstract PDF

The various reported psychogenic movement disorders (PMDs) include tremor, dystonia, myoclonus, gait disorder, Parkinsonism, tics, and chorea. Although it is not easy to diagnose PMDs, several features such as distractibility, entrainment, suggestion and placebo trial are quite helpful to diagnose. Especially, distractibility or suggestion is a good tool to do in outpatient clinic easily. We describe a patient with parkinsonian features which were improved by internal suggestion to focusing attention. Initially, we suspected her diagnosis as PMDs; however she was confirmed with organic Parkinson’s disease later.


Citations to this article as recorded by  
  • Functional neurological disorder and placebo and nocebo effects: shared mechanisms
    Mirta Fiorio, Miriam Braga, Angela Marotta, Bernardo Villa-Sánchez, Mark J. Edwards, Michele Tinazzi, Diletta Barbiani
    Nature Reviews Neurology.2022; 18(10): 624.     CrossRef
  • Functional Motor Symptoms in Parkinson’s Disease and Functional Parkinsonism: A Systematic Review
    Marine Ambar Akkaoui, Pierre A. Geoffroy, Emmanuel Roze, Bertrand Degos, Béatrice Garcin
    The Journal of Neuropsychiatry and Clinical Neurosciences.2020; 32(1): 4.     CrossRef
  • Somatization in Parkinson's Disease: A systematic review
    Danilo Carrozzino, Per Bech, Chiara Patierno, Marco Onofrj, Bo Mohr Morberg, Astrid Thomas, Laura Bonanni, Mario Fulcheri
    Progress in Neuro-Psychopharmacology and Biological Psychiatry.2017; 78: 18.     CrossRef
Psychogenic Balance Disorders: Is It a New Entity of Psychogenic Movement Disorders?
Jong Sam Baik, Myung Sik Lee
J Mov Disord. 2012;5(1):24-27.
  • 16,619 View
  • 99 Download
  • 2 Crossref
AbstractAbstract PDF

The various reported psychogenic dyskinesias include tremor, dystonia, myoclonus, gait disorder, Parkinsonism, tics, and chorea. It is not easy to diagnose psychogenic movement disorders, especially in patients with underlying organic disease. We describe three patients with balance and/or posture abnormalities that occur when they stand up, start to move, or halt from walking, although their gaits are normal. One had an underlying unilateral frontal lobe lesion. All patients improved dramatically after receiving a placebo-injection or medication. These abnormal features differ from the previously reported features of astasia without abasia and of psychogenic gait disorders, including recumbent gait. We describe and discuss the patients’ unique clinical characteristics.


Citations to this article as recorded by  
  • Somatization in Parkinson's Disease: A systematic review
    Danilo Carrozzino, Per Bech, Chiara Patierno, Marco Onofrj, Bo Mohr Morberg, Astrid Thomas, Laura Bonanni, Mario Fulcheri
    Progress in Neuro-Psychopharmacology and Biological Psychiatry.2017; 78: 18.     CrossRef
  • Functional movement disorders
    Anita Barbey, Selma Aybek
    Current Opinion in Neurology.2017; 30(4): 427.     CrossRef
Review Article
Electrophysiologic Evaluation of Psychogenic Movement Disorders
Pramod Kumar Pal
J Mov Disord. 2011;4(1):21-32.
  • 31,558 View
  • 356 Download
  • 8 Crossref
AbstractAbstract PDF

Psychogenic movement disorders (PMD) are a group of disorders which are in the border zone between neurology and psychiatry. All necessary laboratory investigations should be done to rule out an underlying organic disorder. While clinical acumen of a trained movement disorder specialist may be sufficient to diagnose most PMD, there are clinical situations where electrophysiological tests are required either to rule out an organic movement disorder or even diagnose a PMD. Current electrophysiological test are most useful for tremor, followed by jerks and least for spasms or dystonia. Commonly used electrophysiologic tests include multichannel surface electromyography (EMG), accelerometry, electroencephalography time locked with EMG, premovement potential (Bereitschaftspotential), and somatosensory evoked potentials. Psychogenic tremor is a low frequency tremor with variable frequency and duration of EMG bursts, entrainable, has a high coherence with voluntary movements, and presence of coactivation sign. Patients with psychogenic jerks have well organized triphasic pattern of activation of agonist and antagonist muscles. The jerks are associated with EMG bursts of long duration (usually > 70 ms), long and variable latencies in stimulus induced jerks, absence of craniocaudal pattern of muscle recruitment in apparent startle response, and often a Breitschaftspotential (premovement potential) precedes the jerk. Electrophysiological characterization of psychogenic dystonia is difficult and the tests are usually performed to rule out organic dystonia with characteristic findings. Finally, caution should be exerted in interpreting the electrophysiological tests as both false positive and false negative diagnosis of PMD may still occur.


Citations to this article as recorded by  
  • Investigation of Phase Shifts Using AUC Diagrams: Application to Differential Diagnosis of Parkinson’s Disease and Essential Tremor
    Olga S. Sushkova, Alexei A. Morozov, Ivan A. Kershner, Margarita N. Khokhlova, Alexandra V. Gabova, Alexei V. Karabanov, Larisa A. Chigaleichick, Sergei N. Illarioshkin
    Sensors.2023; 23(3): 1531.     CrossRef
  • Electrophysiology in Functional Movement Disorders: An Update
    Nitish Kamble, Pramod Kumar Pal
    Tremor and Other Hyperkinetic Movements.2023;[Epub]     CrossRef
  • Video electroencephalogram combined with electromyography in the diagnosis of hyperkinetic movement disorders with an unknown cause
    Jianhua Chen, Xiangqin Zhou, Qiang Lu, Liri Jin, Yan Huang
    Neurological Sciences.2021; 42(9): 3801.     CrossRef
  • Suggestibility as a valuable criterion for laboratory-supported definite functional movement disorders
    Gerard Saranza, Daniel Vargas-Mendez, Anthony E. Lang, Robert Chen
    Clinical Neurophysiology Practice.2021; 6: 103.     CrossRef
  • Principles of Electrophysiological Assessments for Movement Disorders
    Kai-Hsiang Stanley Chen, Robert Chen
    Journal of Movement Disorders.2020; 13(1): 27.     CrossRef
  • A case of abdominal functional myoclonus analyzed by movement related cortical potentials
    Ryosuke Urabe, Masaya Kubota
    Brain and Development.2020; 42(9): 700.     CrossRef
  • Focal localized enhanced physiological tremor after physical insult
    Sang-Won Yoo, Myungah Lee, Joong-Seok Kim, Kwang-Soo Lee
    Neurological Sciences.2019; 40(12): 2641.     CrossRef
  • Sleep-Related Movement Disorders: Hypnic Jerks
    Robyn Whitney, Shelly K. Weiss
    Current Sleep Medicine Reports.2018; 4(1): 19.     CrossRef
Original Article
Psychogenic Gait Disorders after Mass School Vaccination of Influenza A
Jung Ho Ryu, Jong Sam Baik
J Mov Disord. 2010;3(1):15-17.
  • 8,025 View
  • 34 Download
  • 5 Crossref
AbstractAbstract PDF
Background and Purpose

Psychogenic movement disorders (PMD) after war or mass vaccination was reported and well known disease entity already. However, we have seldom been met those patients because we don’t have any chance to experience of those events. Recently, influenza A (H1N1) spreads around world, and many countries have a program of mass vaccination of H1N1. Although PMD in adult is well characterized, childhood-onset PMD has not been extensively studied.

Case Reports

We present four children of psychogenic gait disorders (PGDs) after mass school vaccination of H1N1. They had fluctuating weakness and their prognosis was good. We confirmed all patients as PGD by placebo.


Our four cases have two common characteristics. One is that all were young and their prognosis was good. And the other is that all were induced their abnormal gait symptoms after mass school vaccination. We observed that mass PMD has a different characteristics comparing to personal PMD, and PMD in children is differ from adult onset PMD.


Citations to this article as recorded by  
  • Diagnosing Common Movement Disorders in Children
    Jennifer A. O’Malley
    CONTINUUM: Lifelong Learning in Neurology.2022; 28(5): 1476.     CrossRef
  • Immunization stress-related responses: Implications for vaccination hesitancy and vaccination processes during the COVID-19 pandemic
    Steven Taylor, Gordon J.G. Asmundson
    Journal of Anxiety Disorders.2021; 84: 102489.     CrossRef
  • Functional Neurological Disorder after Vaccination: A Balanced Approach Informed by History
    Stefanie C Linden, Alan J Carson, Simon Wessely
    Journal of the Royal College of Physicians of Edinburgh.2021; 51(4): 330.     CrossRef
  • Psychogenic Gait Disorder Complicating Recovery after Concussion: A Case Series
    Scott I. Otallah
    Pediatric Neurology.2020;[Epub]     CrossRef
  • Psychogenic movement disorders in children and adolescents: an update
    Susan R. Harris
    European Journal of Pediatrics.2019; 178(4): 581.     CrossRef

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