Psychogenic movement disorders in children

Abstract

Psychogenic movement disorders (PMDs) are well characterized in adults, but childhood-onset PMDs have not been extensively studied. We reviewed the medical records of children who were diagnosed in our clinic with PMDs since 1988 and identified 54 patients with PMDs, representing 3.1% of our pediatric movement disorder population and 5.7% of all PMD cases. The mean age at symptom onset was 14.2 years (+/-2.11, range 7.6-17.7). Similar to published data in adults, two-thirds of children exhibited multiple PMD phenotypes, the most common being tremor followed by dystonia and myoclonus. Most PMDs were abrupt in onset, paroxysmal and triggered by identifiable physical or psychological trauma. As in adults, childhood PMDs were more likely to affect females, but there was no female predominance in children less than 13 years old. Although prior studies suggest that medically unexplained symptoms beginning in childhood often follow a benign course, this cohort of children experienced marked disability and morbidity related to PMDs, including prolonged school absences and unnecessary surgical procedures in more than one-fifth of patients.

A prospective study of acute movement disorders in children

“…2,17 As anticipated, PMDs were more common in female adolescents. Interestingly, 9 of 12 children with PMDs had comorbid psychiatric diagnoses.…”

“…PMD assumed a generalized distribution in many participants, but when localized affected the dominant limb. 2,17 PMD is also associated with a high incidence of gait disturbance, headache, and other neurological symptoms. 17 The diagnosis of PMD requires a constellation of these characteristics because the diagnosis based on the existence of a single feature is not infallible.…”

“…2,17 PMD is also associated with a high incidence of gait disturbance, headache, and other neurological symptoms. 17 The diagnosis of PMD requires a constellation of these characteristics because the diagnosis based on the existence of a single feature is not infallible. It is often more straightforward to make a confident diagnosis of psychogenic tremor than of psychogenic dystonia, which often requires extensive testing for organic causes.…”

“…1 Tremor, dystonia, and myoclonus are the most commonly described PMDs in both adults and children. 1,2,17 However, caution is required as tremor was also a feature in two participants with 'organic' disorders.…”

Psychogenic movement disorders: an unusual presentation in childhood with improvement after placebo test

“…Psychogenic dropped head, especially associated with other movement disorders, has not yet been reported in children 2,4 . Although assessment of PMDs can be complex in childhood, our case showed that assessment of clinical features combined with therapeutic intervention (placebo test) may be useful for PMDs diagnosis 1,3,5 .…”