Psychogenic (Functional) Movement Disorders

Mary Ann Thenganatt, MD; Joseph Jankovic, MD, FAAN p. 1121-1140 August 2019, Vol.25, No.4 doi: 10.1212/CON.0000000000000755
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PURPOSE OF REVIEW: This article reviews a practical approach to psychogenic movement disorders to help neurologists identify and manage this complex group of disorders.

RECENT FINDINGS: Psychogenic movement disorders, also referred to as functional movement disorders, describe a group of disorders that includes tremor, dystonia, myoclonus, parkinsonism, speech and gait disturbances, and other movement disorders that are incongruent with patterns of pathophysiologic (organic) disease. The diagnosis is based on positive clinical features that include variability, inconsistency, suggestibility, distractibility, suppressibility, and other supporting information. While psychogenic movement disorders are often associated with psychological and physical stressors, the underlying pathophysiology is not fully understood. Although insight-oriented behavioral and pharmacologic therapies are helpful, a multidisciplinary approach led by a neurologist, but also including psychiatrists and physical, occupational, and speech therapists, is needed for optimal outcomes.

SUMMARY: The diagnosis of psychogenic movement disorders is based on clinical features identified on neurologic examination, and neurophysiologic and imaging studies can provide supporting information.

Address correspondence to Dr Joseph Jankovic, Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine 7200 Cambridge, Ste 9A, Houston, TX 77030-4202, josephj@bcm.edu.

RELATIONSHIP DISCLOSURE: Dr Thenganatt has received an honorarium from MedLink Neurology. Dr Jankovic has received personal compensation for serving on the advisory boards of and as a consultant for Parexel; Retrophin, Inc; and Teva Pharmaceutical Industries Ltd. Dr Jankovic has received personal compensation as an editor for and has received royalties from Cambridge University Press, Elsevier, Future Science Group, and Hodder Arnold. Dr Jankovic has received research/grant support from Allergan, CHDI Foundation, Dystonia Coalition, F. Hoffman-La Roche AG, Huntington Study Group, Michael J. Fox Foundation for Parkinson’s Research, and the National Institutes of Health.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Thenganatt and Jankovic report no disclosures.

© 2019 American Academy of Neurology.