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Psychogenic Movement Disorders

Morgante, Francesca MD, PhD; Edwards, Mark J. MD, MBBS, PhD; Espay, Alberto J. MD, MSc, FAAN

doi: 10.1212/01.CON.0000436160.41071.79
Review Articles

Purpose of Review: This review describes the main clinical features of psychogenic (functional) movement disorders and reports recent advances in diagnosis, pathophysiology, and treatment.

Recent Findings: The terminology and definition of patients with psychogenic movement disorders remain subjects of controversy; the term “functional” has been used more frequently in the literature in recent years regarding the neurobiological substrate underpinning these disorders. Correct diagnosis of psychogenic movement disorders should rely not on the exclusion of organic disorders or the sole presence of psychological factors but on the observation or elicitation of clinical features related to the specific movement disorder (ie, a positive or inclusionary rather than exclusionary diagnosis). Sudden onset, spontaneous remissions, and variability over time or during clinical examination are useful “red flags” suggestive of a psychogenic movement disorder. Imaging studies have demonstrated impaired connectivity between limbic and motor areas involved in movement programming and hypoactivity of a brain region that compares expected data with actual sensory data occurring during voluntary movement. Treatment of psychogenic movement disorders begins with ensuring the patient’s acceptance of the diagnosis during the initial debriefing and includes nonpharmacologic (cognitive-behavioral therapy, physiotherapy) and pharmacologic options.

Summary: Psychogenic movement disorders represent a challenging disorder for neurologists to diagnose and treat. Recent advances have increased understanding of the neurobiological mechanism of psychogenic movement disorders. Treatment with cognitive strategies and physical rehabilitation can benefit some patients. As short duration of disease correlates with better prognosis, early diagnosis and initiation of treatment are critical.

Address correspondence to Dr Francesca Morgante, Movement Disorders Unit, Department of Neuroscience, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy, fmorgante@gmail.com.

Relationship Disclosure: Dr Morgante serves on a scientific advisory board for Allergan; has received research funding from the Neureca Foundation and honoraria for speaking engagements from Lundbeck, Novartis, Medtronic, Chiesi Farmaceutici, and UCB Pharma; and serves on the editorial advisory board of Frontiers in Movement Disorders. Dr Edwards is supported by grants from the National Institutes of Health Research, Parkinson’s UK, UK Dystonia Society, and the Bachmann Strauss Foundation. Dr Edwards receives royalties from his book Oxford Specialist Handbook of Parkinson Disease and Other Movement Disorders, serves on the editorial board of Movement Disorders Journal, and has received honoraria from the Movement Disorders Society and UCB Pharma. Dr Espay is supported by the K23 career development award (NIMH, 1K23MH092735) and has received grant support from CleveMed/Great Lakes Neurotechnologies and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Solvay (now Abbvie), Chelsea Therapeutics, TEVA, Impax, Merz, Solstice Neurosciences, Eli Lilly, and US WorldMeds; royalties from Lippincott Williams & Wilkins and Cambridge; and honoraria from Novartis, UCB, TEVA, the American Academy of Neurology, and the Movement Disorders Society. Dr Espay serves as associate editor of Movement Disorders and Frontiers in Movement Disorders and on the editorial board of The European Neurological Journal.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Morgante, Edwards, and Espay report no disclosures.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and iPad versions of this article; the URLs are provided in the print version. Video legends begin on page 1393.

© 2013 American Academy of Neurology
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