Journal of Movement Disorders

Review Article

Functional Movement Disorders: Updates and Clinical Overview: Jung E Park; J Mov Disord. 2024;17(3):251-261. Published online July 1, 2024; DOI: https://doi.org/10.14802/jmd.24126

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Abstract PDF: Functional movement disorder (FMD) is a type of functional neurological disorder 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 assessing a patient with suspected FMD is important, and various diagnostic testing maneuvers may also be helpful. Treatment involving a multidisciplinary 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 has improved over the past few decades, as well as the 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. Recent neuroimaging studies that aid in understanding 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; DOI: https://doi.org/10.14802/jmd.16038

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Objective
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).
Methods
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.
Results
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.
Conclusion
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

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Kirsten R. Müller‐Vahl, Anna Pisarenko, Carolin Fremer, Martina Haas, Ewgeni Jakubovski, Natalia Szejko
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Living with functional movement disorders: a tale of three battles. An interpretative phenomenological analysis
Sylwia Bazydlo, Fiona J. R. Eccles
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Sara A. Finkelstein, Caitlin Adams, Margaret Tuttle, Aneeta Saxena, David L. Perez
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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
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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
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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
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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.; DOI: https://doi.org/10.14802/jmd.12013

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Abstract 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

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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.; DOI: https://doi.org/10.14802/jmd.12012

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Abstract 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

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Functional Movement Disorder as a Prodromal Symptom of Parkinson's Disease—Clinical and Pathophysiological Insights
Elie Matar, Michele Tinazzi, Mark J. Edwards, Kailash P. Bhatia
Movement Disorders.2024;[Epub] CrossRef
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.; DOI: https://doi.org/10.14802/jmd.12007

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2 Crossref

Abstract 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

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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.; DOI: https://doi.org/10.14802/jmd.11004

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Abstract 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.

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Investigation of Phase Shifts Using AUC Diagrams: Application to Differential Diagnosis of Parkinson’s Disease and Essential Tremor
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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.; DOI: https://doi.org/10.14802/jmd.10004

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Abstract 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.

Conclusions

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.

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Opinions and experience of neurologists and neurology trainees in Saudi Arabia on functional neurological disorders: a survey based study
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BMC Neurology.2024;[Epub] CrossRef
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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
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Journal of the Royal College of Physicians of Edinburgh.2021; 51(4): 330. CrossRef
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