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Semin Neurol 2017; 37(02): 228-232
DOI: 10.1055/s-0037-1601487
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Treatment of Functional (Psychogenic) Parkinsonism

Kathrin LaFaver
1   Department of Neurology, Raymond Lee Lebby Chair of Parkinson's Disease Research, University of Louisville, Louisville, Kentucky
,
Alberto J. Espay
2   Department of Neurology, James J. and Joan A. Gardner Chair of Parkinson's Disease, University of Cincinnati, Cincinnati, Ohio
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Publikationsdatum:
16. Mai 2017 (online)

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Abstract

Functional (psychogenic) parkinsonism (FP) is recognized by the mandatory combination of marked slowness without progressive decrement on repetitive manual tasks and variable resistance against passive movements in the absence of cogwheel rigidity. Other functional phenotypes, such as functional tremor and functional gait impairment, may coexist. Although neither necessary nor sufficient for the diagnosis of FP, supportive historical clues include the sudden onset of symptoms and absent or nonphysiologic response to levodopa. In selected cases where examination features remain insufficient to render a clinically definite FP diagnosis, normal dopaminergic transporter imaging (DAT scan) confirms “laboratory supported” FP. The management of FP begins with diagnostic debriefing, as the full acceptance of the diagnosis is critical in ensuring patient involvement in individualized psychoeducation, psychotherapy, and physical and occupational therapy.

Keywords

functional parkinsonism - functional movement disorders - psychogenic movement disorders - DAT scan