Functional dystonia under the guise of cervical dystonia
https://doi.org/10.30629/2658-7947-2024-29-2-60-65
Abstract
Among functional neurological disorders functional dystonia (FD) is the most difficult to diagnose. We present an observation of a 44-year-old patient, who was observed for a long time with a diagnosis of cervical dystonia (CD) and received disability for this disease. The patient did not have typical manifestations of CD — repetitive stereotypical movements or postures of the head/neck, sensory trick, tonic tension of the neck muscles. For a long time, the patient experienced pain of various localizations and other manifestations of FNR. The psychiatrist regarded the condition as symptoms of a schizotypal disorder. An educational program, therapeutic exercises, and botulinum toxin management led to a decrease in the manifestations of FD. The issues of pathogenesis, diagnosis, differential diagnosis and treatment of FD are discussed.
About the Authors
V. A. Tolmacheva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Moscow
O. I. Angelicheva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Moscow
T. A. Yanakaeva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Moscow
S. A. Bochovko
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Moscow
D. V. Romanov
Sechenov First Moscow State Medical University (Sechenov University); Federal State Budgetary Scientific Institution Mental Health Research Center
Russian Federation
Russian Federation
Moscow
V. A. Parfenov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Moscow
References
1. Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013;28(7):863–73. doi: 10.1002/mds.25475
2. Jinnah HA, Neychev V, Hess EJ. The Anatomical Basis for Dystonia: The Motor Network Model. Tremor and Other Hyperkinetic Movement (New York, N.Y.). 2017;7:506. doi: 10.7916/d8v69x3s
3. Newby R, Alty J, Kempster P. Functional dystonia and the borderland between neurology and psychiatry: New concepts. Mov Disord. 2016;31(12):1777–1784. doi: 10.1002/mds.26805
4. Schmerler DA, Espay AJ. Functional dystonia. Handbook of clinical neurology. 2016;139:235–245. doi: 10.1016/B978-0-12-801772-2.00020-5
5. Espay AJ, Lang AE. Phenotype-specific diagnosis of functional (psychogenic) movement disorders. Curr Neurol Neurosci Rep. 2015;15(6):32. doi: 10.1007/s11910-015-0556-y
6. Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol. 1988;50:431–55.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Wash American Psychiatric Association; 2013.
8. Hyler SE, Sussman N. Somatoform disorders: before and after DSM-III. Hosp Community Psychiatry. 1984;35(5):469–78. doi: 10.1176/ps.35.5.469
9. Dyukova G.M., Golubev V.L. Functional neurological disorders: diagnosis and therapy. Moscow: MEDpress-inform. 2022:756 p. (In Russ.).
10. Avenali M, De Icco R, Tinazzi M, Defazio G, Tronconi L, Sandrini G, Tassorelli C. Pain in focal dystonias — A focused review to address an important component of the disease. Parkinsonism RelatDisord. 2018;54:17–24. doi: 10.1016/j.parkreldis.2018.04.030
11. Charles PD, Adler CH, Stacy M, Comella C, Jankovic J, Manack Adams A et al. Cervical dystonia and pain: characteristics and treatment patterns from CD PROBE (Cervical Dystonia Patient Registry for Observation of OnabotulinumtoxinA Efficacy). J Neurol. 2014;261(7):1309–19. doi: 10.1007/s00415-014-7343-6
12. Tolmacheva V.A., Petelin D.S., Volel B.A. Comprehensive diagnosis of cervical dystonia and the efficacy of long-term (three-year) botulinum therapy. Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):35–38. (In Russ.). https://doi.org/10.14412/2074-27112023-5-35-38
13. Nodel M.R., Salouhina N.I., Tolmacheva V.A. The impact of non-motor disorders on the quality of life of patients with cervical muscular dystonia. Neurology, Neuropsychiatry, Psychosomatics. 2022;14(3):19–25. (In Russ.). https://doi.org/10.14412/2074-2711-2022-3-19-25
14. Camargo CH, Cattai L, Teive HA. Pain Relief in Cervical Dystonia with Botulinum Toxin Treatment. Toxins (Basel). 2015;7(6):2321–35. doi: 10.3390/toxins7062321
15. Salouhina N.I., Nodel M.R., Tolmacheva V.A. Cervical dystonia: ways to achieve long-term treatment effects and improve patients’ quality of life. Russian neurological journal. 2023;28(4):16–23. (In Russ.). https://doi.org/10.30629/2658-7947-2023-28-4-16-23
16. Patel N, Hanfelt J, Marsh L, Jankovic J; members of the Dystonia Coalition. Alleviating manoeuvres (sensory tricks) in cervical dystonia. J Neurol Neurosurg Psychiatry. 2014;85(8):882–4. doi: 10.1136/jnnp-2013-307316
17. Poisson A, Krack P, Thobois S, Loiraud C, Serra G, Vial C, Broussolle E. History of the ‘gesteantagoniste’ sign in cervical dystonia. J Neurol. 2012;259(8):1580–4. doi: 10.1007/s00415-011-6380-7
18. Ramos VF, Karp BI, Hallett M. Tricks in dystonia: ordering the complexity. J Neurol Neurosurg Psychiatry. 2014;85(9):987–93. doi: 10.1136/jnnp-2013-306971
19. Pandey S, Soni G, Sarma N. Sensory tricks in primary blepharospasm and idiopathic cervical dystonia. Neurol India. 2017;65(3):532–536. doi: 10.4103/neuroindia.NI_864_16. PMID: 28488615.
20. Stephen CD, Perez DL, Chibnik LB, Sharma N. Functional dystonia: A case-control study and risk prediction algorithm. Ann Clin Transl Neurol. 2021;8(4):732–748. doi: 10.1002/acn3.51307 Epub 2021 Mar 16.
21. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain. 2004;127(Pt 10):2360–72. doi: 10.1093/brain/awh262
22. Munhoz RP, Lang AE. Gestes antagonistes in psychogenic dystonia. Mov Disord. 2004;19:331–2. doi: 10.1002/mds.10628
23. Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537–550. doi: 10.1016/S1474-4422(21)00422-1
24. Nielsen G, Stone J, Matthews A, Brown M, Sparkes C, Farmer R et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86(10):1113–9. doi: 10.1136/jnnp-2014-309255. Epub 2014 Nov 28. PMID: 25433033; PMCID: PMC4602268.
25. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res. 2013;75(2):93–102. doi: 10.1016/j.jpsychores.2013.05.006
26. Dallocchio C, Arbasino C, Klersy C, Marchioni E. The effects of physical activity on psychogenic movement disorders. Mov Disord. 2010;25(4):421–5. doi: 10.1002/mds.22952
27. Ricciardi L, Edwards MJ. Treatment of functional (psychogenic) movement disorders. Neurotherapeutics. 2014;11(1):201–7. doi: 10.1007/s13311-013-0246-x
28. Espay AJ, Ries S, Maloney T, Vannest J, Neefus E, Dwivedi AK et al. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology. 2019;93(19):e1787–e1798. doi: 10.1212/WNL.0000000000008442
29. Voon V, Lang AE. Antidepressants in the treatment of psychosis with comorbid depression in Parkinson disease. Clin Neuropharmacol. 2004;27(2):90–2.
30. Khachane Y, Kozlowska K, Savage B, McClure G, Butler G, Gray N et al. Twisted in Pain: The Multidisciplinary Treatment Approach to Functional Dystonia. Harv Rev Psychiatry. 2019;27(6):359–381. doi: 10.1097/HRP.0000000000000237
31. LaFaver K. Treatment of Functional Movement Disorders. Neurol Clin. 2020;38(2):469–480. doi: 10.1016/j.ncl.2020.01.011. Epub 2020 Mar 9.
32. Macy E, Ho NJ. Multiple drug intolerance syndrome: prevalence, clinical characteristics, and management. Ann Allergy Asthma Immunol. 2012;108(2):88–93. doi: 10.1016/j.anai.2011.11.006
33. Hok P, Veverka T, Hluštík P, Nevrlý M, Kaňovský P. The Central Effects of Botulinum Toxin in Dystonia and Spasticity. Toxins (Basel). 2021;13(2):155. doi: 10.3390/toxins13020155
34. Dreissen YEM, Dijk JM, Gelauff JM, Zoons E, van Poppelen D, Contarino MF et al. Botulinum neurotoxin treatment in jerky and tremulous functional movement disorders: a double-blind, randomised placebo-controlled trial with an open-label extension. J Neurol Neurosurg Psychiatry. 2019;90(11):1244–1250. doi: 10.1136/jnnp-2018-320071
35. Schmerler DA, Espay AJ. Functional dystonia. Handb Clin Neurol. 2016;139:235–245. doi: 10.1016/B978-0-12-801772-2.00020-5 PMID: 27719842.
36. Tolmacheva V.A., Yuzbashyan P.G., Shishorin R.M., Volel B.A., Romanov D.V. Functional writer’s cramp as psychogenic focal dystonia. Neurology, Neuropsychiatry, Psychosomatics. 2022;14(1):115–121. (In Russ.). https://doi.org/10.14412/2074-2711-2022-1-115-121
37. Stephen CD, Fung V, Lungu CI, Espay AJ. Assessment of Emergency Department and Inpatient Use and Costs in Adult and Pediatric Functional Neurological Disorders. JAMA Neurol. 2021;78(1):88–101. doi: 10.1001/jamaneurol.2020.3753
38. Bramstedt KA, Ford PJ. Protecting human subjects in neurosurgical trials: the challenge of psychogenic dystonia. Contemp Clin Trials. 2006;27(2):161–4. doi: 10.1016/j.cct.2005.11.005
39. Shill H, Gerber P. Evaluation of clinical diagnostic criteria for psychogenic movement disorders. Mov Disord. 2006;21(8):1163–8. doi: 10.1002/mds.20921
Review
For citations:
Tolmacheva V.A., Angelicheva O.I., Yanakaeva T.A., Bochovko S.A., Romanov D.V., Parfenov V.A. Functional dystonia under the guise of cervical dystonia. Russian neurological journal. 2024;29(2):60-65. (In Russ.) https://doi.org/10.30629/2658-7947-2024-29-2-60-65
Views:
325
Email this article 