Psychogenic facial movement disorders: Clinical features and associated conditions

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. Pat...

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Bibliographic Details
Published in:Movement disorders 2012-10, Vol.27 (12), p.1544-1551
Main Authors: Fasano, Alfonso, Valadas, Anabela, Bhatia, Kailash P., Prashanth, L.K., Lang, Anthony E., Munhoz, Renato P., Morgante, Francesca, Tarsy, Daniel, Duker, Andrew P., Girlanda, Paolo, Bentivoglio, Anna Rita, Espay, Alberto J.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Disease Progression
Dystonia - pathology
Dystonia - physiopathology
Face - physiopathology
facial distortion
Facial Injuries - complications
facial movement disorders
Female
Functional Laterality
Humans
Male
Medical sciences
Middle Aged
Movement disorders
Movement Disorders - complications
Movement Disorders - psychology
Nervous system (semeiology, syndromes)
Nervous system as a whole
Neurology
psychogenic blepharospasm
psychogenic dystonia
psychogenic facial movement disorders
psychogenic movement disorders
Retrospective Studies
Somatoform Disorders - complications
Somatoform Disorders - psychology
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Summary: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
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.25190