4 Parkinson’s disease and conversion disorder: Case report and literature review

Abstract

Parkinson’s disease (PD) is one of the most common movement disorders and is characterized by progressive neurodegeneration of the basal ganglia, with tremor, postural instability, rigidity and Akinesia as main clinical features, but also psychiatric symptoms such as depression, anxiety and insomnia are common in PD. Conversion disorder (CD), formerly known as hysteria, is defined as a condition in which patients suffers from neurological symptoms without neurological causes, and is considered a psychiatric disorder according to the DSM-IV. Psychogenic movement disorders (PMD) are characterized by either hyperkinetic or hypokinetic movement disorders, or their combinations not fully explained by organic disease and occurring in association with underlying psychiatric or psychological factors. We present a case of a 60-year old woman with extrapyramidal signs such as tremor, postural instability, and both akinesia and dyskinesia, with acute onset after a psychological traumata. Observed in various movement disorders centers different diagnostic hypotheses were postulated including Huntington’s disease, Parkinson’s disease, distonia, corticobasal degeneration. SPECT DAT-scan evaluation showed reduced dopaminergic innervation in the striatum bilaterally predominantly on the right. No consistent response to dopaminergic replacement therapy was observed. Neuropsychological examination revealed a conversion disorder. We discuss the long diagnositic iter with many clinical evaluations and neuroradiological investigations, their economical burden and the diagnostic difficulties on behalf of literature data.