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Psychogenic movement disorders in children
Joseph Ferrara1, Joseph Jankovic
1Parkinson's Disease Center, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Childhood psychogenic movement disorders (PMDs) are often disabling, unlike previously thought. This study highlights their significant impact on children, including functional impairment and unnecessary medical interventions.
Area of Science:
- Neurology
- Pediatrics
- Psychiatry
Background:
- Psychogenic movement disorders (PMDs) are recognized in adults but less studied in children.
- Limited data exists on the characteristics and impact of childhood-onset PMDs.
Purpose of the Study:
- To characterize childhood-onset PMDs.
- To assess the clinical presentation, triggers, and outcomes of pediatric PMDs.
Main Methods:
- Retrospective review of medical records for children diagnosed with PMDs since 1988.
- Analysis of patient demographics, symptom onset, phenotypes, triggers, and associated morbidity.
Main Results:
- Identified 54 pediatric PMD cases (3.1% of pediatric movement disorders).
- Mean onset age 14.2 years; common phenotypes include tremor, dystonia, myoclonus.
- PMDs often had abrupt onset, triggered by trauma, and affected females more (except <13 years).
- Significant morbidity observed: prolonged school absence and unnecessary surgeries in over 20%.
Conclusions:
- Childhood-onset PMDs present similarly to adult forms but with significant, often underestimated, morbidity.
- These disorders cause marked disability, school absenteeism, and can lead to invasive procedures.
- Further research and awareness are crucial for timely diagnosis and management of pediatric PMDs.
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.
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