Psychogenic facial movement disorders: Clinical features and associated conditions

Alfonso Fasano,Renato P Munhoz,L.K Prashanth,Anthony E Lang,Alberto J Espay,Daniel Tarsy,Kailash P Bhatia,Anna Rita Bentivoglio,Andrew P Duker,Anabela Valadas,Paolo Girlanda,Francesca Morgante

doi:10.1002/mds.25190

Abstract

The facial phenotype of psychogenic movement disorders has not been fully characterized. Seven tertiary-referral movement disorders centers using a standardized data collection on a computerized database performed a retrospective chart review of psychogenic movement disorders involving the face. Patients with organic forms of facial dystonia or any medical or neurological disorder known to affect facial muscles were excluded. Sixty-one patients fulfilled the inclusion criteria for psychogenic facial movement disorders (91.8% females; age: 37.0 ± 11.3 years). Phasic or tonic muscular spasms resembling dystonia were documented in all patients most commonly involving the lips (60.7%), followed by eyelids (50.8%), perinasal region (16.4%), and forehead (9.8%). The most common pattern consisted of tonic, sustained, lateral, and/or downward protrusion of one side of the lower lip with ipsilateral jaw deviation (84.3%). Ipsi- or contralateral blepharospasm and excessive platysma contraction occurred in isolation or combined with fixed lip dystonia (60.7%). Spasms were reported as painful in 24.6% of cases. Symptom onset was abrupt in most cases (80.3%), with at least 1 precipitating psychological stress or trauma identified in 57.4%. Associated body regions involved included upper limbs (29.5%), neck (16.4%), lower limbs (16.4%), and trunk (4.9%). There were fluctuations in severity and spontaneous exacerbations and remissions (60%). Prevalent comorbidities included depression (38.0%) and tension headache (26.4%). Fixed jaw and/or lip deviation is a characteristic pattern of psychogenic facial movement disorders, occurring in isolation or in combination with other psychogenic movement disorders or other psychogenic features. © 2012 Movement Disorder Society

Highlights

Relevant conflicts of interest/financial disclosures: Nothing to report
While some of them are recognizable, anecdotal reports have recently focused attention on atypical presentations.[2,3,4,5]. Most of these cases have been reported as representing rare phenotypes of organic focal dystonia,[3,4,5] these patients may fulfill diagnostic criteria for psychogenic movement disorders (PMDs)
Values are mean 6 SD. aOne patient with normal neuroimaging had a family history of Fahr’s disease and other a daughter with unspecified ataxia. bTaken for few weeks and several years before psychogenic facial movement disorders (PFMDs) onset. cSubacute onset for cases reaching the greatest severity in 1 month. dMRI in all but 3, who underwent computed tomography.PFMD, psychogenic facial movement disorder; MRI, magnetic resonance imaging; VEP, visual evoked evoked potentials; BAEP, brainstem auditory evoked potentials; SEP, somatosensory evoked potentials; MEP, motor evoked potentials; EEG, electroencephalogram; EMG, electromyogram; CSF, cerebrospinal fluid

Summary

Introduction

Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles may be found in the online version of this article. The majority of them are characterized by muscular spasms.[1] While some of them are recognizable, anecdotal reports have recently focused attention on atypical presentations.[2,3,4,5] most of these cases have been reported as representing rare phenotypes of organic focal dystonia,[3,4,5] these patients may fulfill diagnostic criteria for psychogenic movement disorders (PMDs). PMDs involving the face have been largely described as blepharospasm, reported in 3%6 to 7%7 of all types of PMD, and in 22% of a consecutive series of 50 patients in a botulinum toxin injection clinic.[8] the features and diagnostic clues of the wider range of psychogenic facial movement disorders (PFMDs), as well as the relationship with previously reported cases in the Movement Disorders journal[3] and others,[1] remain unknown. We sought to examine a large series of PMDs where the orofacial region was involved in order to determine the clinical features and associated disorders, and to highlight their inconsistency and incongruence with recognized organic movement disorders

Methods

Results

Conclusion