Psychogenic facial movement disorder: a case report

Abstract

Background: Psychogenic movement disorders (PMD) include a wide range of involuntary motor function disturbances that lack an organic cause. Presentation with the form of any known organic movement disorder can be seen. Psychogenic facial movement disorder (PFMD) is an interesting form of PMD and it is not yet fully characterized. Case report: A 44-year-old female patient was evaluated because of deviation of her mouth. She was admitted to another hospital before, in which cranial MRI had been performed and did not demonstrate any abnormality. Steroid therapy had been initiated with the diagnosis of peripheral facial paralysis (PFP). The patient was admitted to our outpatient clinic because the deviation of her mouth was not resolved completely. Neurological examination revealed flattening of the right nasolabial fold and downward retraction of the contralateral edge of the mouth, which disappeared during talking and exacerbated at rest. These findings suggested psychogenic facial dystonia and she was diagnosed as having PFMD. Her steroid therapy was discontinued and treatment with alprazolam was initiated. A prominent resolution of her complaints was observed during post-treatment follow-up control visits. Discussion: Although PFMD is not a rare condition, it is still under-recognized and under-treated. In patients with PFMD, phasic or tonic muscular spasms resembling dystonia can be seen. It involves most commonly the lips. A prompt diagnosis based on positive clinical signs will prevent unnecessary investigations and lessen the morbidity.