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Aktuelle Neurologie 2015; 42(10): 603-610
DOI: 10.1055/s-0035-1565066
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Psychogene Bewegungsstörungen – Klinik, Zusatzdiagnostik und Differenzialdiagnose

Psychogenic Movement Disorders – Clinical Features, Diagnostic Approaches and Differential Diagnosis
M. Dafotakis
1   Neurologische Klinik, Universitätsklinik der RWTH Aachen
,
D. A. Nowak
2   Neurologische Fachklinik, Helios Klinik Kipfenberg
› Author Affiliations
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Publication History

Publication Date:
07 December 2015 (online)

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Zusammenfassung

Etwa 5% aller in Spezialambulanzen gesehenen Bewegungsstörungen haben einen psychogenen Ursprung. Tremor und Dystonie stellen unter diesen die häufigsten psychogenen Bewegungsstörungen dar. In der Regel ist die Diagnosestellung zeitaufwendig und kostenintensiv, obwohl es eine Vielzahl von positiven klinischen Befunden für das Vorliegen einer psychogenen Genese der Bewegungsstörung gibt. Insofern kommt der Kenntnis dieser positiven Befunde eine große Bedeutung zu. Ein prompter Beginn der Erkrankung, die variable Ausprägung der Symptomatik, Ablenkbarkeit und spezielle klinische Provokationsmanöver können bei der Diagnosestellung helfen. Die Zusatzdiagnostik mittels Elektromyografie sowie kinematischer Aufzeichnungsverfahren können die Diagnose stützen als auch, als Verlaufsparameter eingesetzt werden. Im Gegensatz dazu dienen die bildgebenden Verfahren eher der Ausschlussdiagnostik. Die vorliegende Übersichtsarbeit widmet sich der Anamnese und Klinik, der Differenzialdiagnose und der Zusatzdiagnostik psychogener Bewegungsstörungen.

Abstract

Up to 5% of all cases presenting in specialized movement disorders clinics are of psychogenic origin. Tremor and dystonia account for up to 70% of all psychogenic movement disorders. Diagnosis is commonly made by exclusion of other causes, is time consuming and expensive. However, clinical features such as acute onset and distractibility suggest a psychogenic origin of movement disorders. In addition, there are a few supportive clinical tests and diagnostic tools that help establish the diagnosis of psychogenicity, such as electromyographic or kinematic recordings. Imaging studies are used to exclude organic pathologies. In this review, the clinical presentation of psychogenic movement disorders, diagnostic approaches and differential diagnostic aspects are discussed.

Schlüsselwörter

funktionelle Störungen - dissoziative Störungen - kinematische Bewegungsanalyse - Somatisierungsstörung - Simulation

Keywords

kinematic motion analysis - psychotherapy - somatisation - functional disorder - malingering
 

  • Literatur

  • 1 Illis LS. Hysteria. Spinal Cord 2002; 40: 311-312
    CrossrefPubMedGoogle Scholar
  • 2 Freud S. Quelques considerations pour une étude comparative des paralysies motrices organiques et hystèriques. Archi Neurol (Paris) 1893; 26: 29-43
    PubMedGoogle Scholar
  • 3 Heim G. Pierre Janet (1859-1947). „Médicine-philosphe“, Psychologe und Psychotherapeut. Nervenarzt 1999; 70: 1019-1024
    CrossrefPubMedGoogle Scholar
  • 4 Tomlinson WC. Freud and psychogenic movement disorders. In: Hallett M, Fahn S, Jankovic J, et al., eds. Psychogenic Movement Disorders. Philadelphia: Lippincott Raven; 2006: 14-19
    Google Scholar
  • 5 Brown RJ, Cardeña E, Nijenhuis E et al. Should conversion disorder be reclassified as a dissociative disorder in DSM V?. Psychosomatics 2007; 48: 369-378
    CrossrefPubMedGoogle Scholar
  • 6 Vuilleumier P. Hysterical conversion and brain function. Prog Brain Res 2005; 150: 309-329
    PubMedGoogle Scholar
  • 7 Koehler K, Jakumeit U. Subacute sclerosing panencephalitis presenting as Leonhard’s speech-prompt catatonia. Br J Psychiatry 1976; 129: 29-31
    CrossrefPubMedGoogle Scholar
  • 8 Laroche C, Buge A, Escourolle R et al. „Astasia-abasia“ unilateral left-sided apraxia, and touch disorders in an astrocytoma of the corpus callosum. A clinico-pathological report. Ann Med Interne (Paris) 1976; 127: 1-10
    PubMedGoogle Scholar
  • 9 Marsden CD, Harrison MJ, Bundey S. Natural history of idiopathic torsion dystonia. Adv Neurol 1976; 14: 177-187
    PubMedGoogle Scholar
  • 10 Nowak DA, Rosenkranz K, Topka H et al. Disturbances of grip force behaviour in focal hand dystonia: evidence for a generalised impairment of sensory-motor integration?. J Neurol Neurosurg Psychiatry 2005; 76: 953-959
    CrossrefPubMedGoogle Scholar
  • 11 Connor H. The use of anaesthesia to diagnose malingering in the 19th century. J R Soc Med 2006; 99: 444-447
    CrossrefPubMedGoogle Scholar
  • 12 Slater ETO, Glithero E. A follow-up of patients diagnosed as suffering from „hysteria“. J Psychosom Res 1965; 9: 9-13
    CrossrefPubMedGoogle Scholar
  • 13 Ganos C, Aguirregomozcorta M, Batla A et al. Psychogenic paroxysmal movement disorders — clinical features and diagnostic clues. Parkinsonism Relat Disord 2014; 20: 41-46
    CrossrefPubMedGoogle Scholar
  • 14 Stone J, Smyth R, Carson A et al Systematic review of misdiagnosis of conversion symptoms and „hysteria“. BMJ 2005; 331: 989
    CrossrefPubMedGoogle Scholar
  • 15 Benaderette S, Zanotti Fregonara P, Apartis E et al. Psychogenic parkinsonism: a combination of clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations improves diagnostic accuracy. Mov Disord 2006; 21: 310-317
    CrossrefPubMedGoogle Scholar
  • 16 Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol 1995; 65: 231-257
    PubMedGoogle Scholar
  • 17 Hinson VK, Haren WB. Psychogenic movement disorders. Lancet Neurol 2006; 5: 695-700
    CrossrefPubMedGoogle Scholar
  • 18 Deuschl G, Köster B, Lücking CH et al. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord 1998; 13: 294-302
    CrossrefPubMedGoogle Scholar
  • 19 Carson AJ, Ringbauer B, Stone J et al. Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J Neurol Neurosurg Psychiatry 2000; 68: 207-210
    CrossrefPubMedGoogle Scholar
  • 20 Reuber M, Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav 2003; 4: 205-216
    CrossrefPubMedGoogle Scholar
  • 21 Thomas M, Jankovic J. Psychogenic movement disorders: diagnosis and management. CNS Drugs 2004; 18: 437-452
    CrossrefPubMedGoogle Scholar
  • 22 Block F, Dafotakis M. Drug-induced tremor. Fortschr Neurol Psychiatr 2011; 79: 570-575
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Hofmann A, Tangri N, Lafontaine AL et al. Myoclonus as an acute complication of low-dose hydromorphone in multiple system atrophy. J Neurol Neurosurg Psychiatry 2006; 77: 994-995
    CrossrefPubMedGoogle Scholar
  • 24 Dafotakis M, Fink GR, Nowak DA. Dopaminergic drug-induced tics in PARK2-positive Parkinson’s disease. Mov Disord 2008; 23: 628
    CrossrefPubMedGoogle Scholar
  • 25 Laub HN, Dwivedi AK, Revilla FJ et al. Diagnostic performance of the „Huffing and Puffing“ sign in psychogenic (functional) movement disorders. Mov Disord Clin Pract 2015; 2: 29-32
    CrossrefPubMedGoogle Scholar
  • 26 Ganos C, Pareés I, Bhatia KP. Effort-related behaviors in charcot’s lectures on hysteria. Mov Disord Clin Pract 2015; 2: 201-202
    CrossrefPubMedGoogle Scholar
  • 27 Kim JY, Chung EJ, Lee WY et al. Therapeutic effect of repetitive transcranial magnetic stimulation in Parkinson’s disease: analysis of [11C] raclopride PET study. Mov Disord 2008; 23: 207-211
    CrossrefPubMedGoogle Scholar
  • 28 de la Fuente-Fernández R, Ruth TJ, Sossi V et al. Expectation and dopamine release: mechanism of the placebo effect in Parkinson’s disease. Science 2001; 293: 1164-1166
    CrossrefPubMedGoogle Scholar
  • 29 Spiegel J, Heiss C, Frühauf E et al. Polygraphische Validierung von Ablenkmanövern in der klinischen Differentialdiagnose des Tremors. Nervenarzt 1998; 69: 886-891
    CrossrefPubMedGoogle Scholar
  • 30 Kumru H, Valls-Solé J, Valldeoriola F et al. Transient arrest of psychogenic tremor induced by contralateral ballistic movements. Neurosci Lett 2004; 370: 135-139
    CrossrefPubMedGoogle Scholar
  • 31 O’Suilleabhain PE, Matsumoto JY. Time-frequency analysis of tremors. Brain 1998; 121: 2127-2134
    CrossrefPubMedGoogle Scholar
  • 32 Schwingenschuh P, Katschnig P, Seiler S et al. Moving toward „laboratory-supported“ criteria for psychogenic tremor. Mov Disord 2011; 26: 2509-2515
    CrossrefPubMedGoogle Scholar
  • 33 Dafotakis M, Schönfeldt-Lecuona C, Fink GR et al. Psychogenic tremor. Fortschr Neurol Psychiatr 2008; 76: 647-654
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Fahn S, Eldridge R. Definition of dystonia and classification of the dystonic states. Adv Neurol 1976; 14: 1-5
    PubMedGoogle Scholar
  • 35 Miyasaki JM, Sa DS, Galvez-Jimenez N et al. Psychogenic movement disorders. Can J Neurol Sci 2003; 30: 94-100
    CrossrefPubMedGoogle Scholar
  • 36 Diener HC, Weimar C Hrsg Leitlinien für Diagnostik und Therapie in der Neurologie, Herausgegeben von der Kommission „Leitlinien“ der Deutschen Gesellschaft für Neurologie. Stuttgart: Thieme Verlag; 2012
    Google Scholar
  • 37 Ganos C, Edwards MJ, Bhatia KP. The phenomenology of functional (psychogenic) dystonia. Mov Disord Clin Pract 2014; 1: 36-44
    CrossrefPubMedGoogle Scholar
  • 38 Reichel G, Stenner A, Hermann W. Das Babinski-2-Zeichen, ein „neuer“ alter klinischer Test zur Differenzierung des Spasmus hemifacialis und des Blepharospasmus. Akt Neurol 2009; 36: 91-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Edwards MJ, Bhatia KP, Cordivari C. Immediate response to botulinum toxin injections in patients with fixed dystonia. Mov Disord 2011; 26: 917-918
    CrossrefPubMedGoogle Scholar
  • 40 Jankovic J. Post-traumatic movement disorders: central and peripheral mechanisms. Neurology 1994; 44: 2006-2014
    CrossrefPubMedGoogle Scholar
  • 41 Hawley JS, Weiner WJ. Psychogenic dystonia and peripheral trauma. Neurology 2011; 77: 496-502
    CrossrefPubMedGoogle Scholar
  • 42 Schrag A. Psychogenic Dystonia and reflex sympathetic dystrophy. In: Hallett M, Fahn S, Jankovic J, et al., eds. Psychogenic Movement Disorders. Philadelphia: Lippincott Raven; 2006: 53-61
    Google Scholar
  • 43 Deuschl G, Heinen F, Kleedorfer B et al. Clinical and polymyographic investigation of spasmodic torticollis. J Neurol 1992; 239: 9-15
    CrossrefPubMedGoogle Scholar
  • 44 Espay AJ, Lang AE. The psychogenic toe signs. Neurology 2011; 77: 508-509
    CrossrefPubMedGoogle Scholar
  • 45 Brown P. Clinical neurophysiology of myoclonus. In: Hallett M, Fahn S, Jankovic J, et al. (eds.). Psychogenic Movement Disorders. Philadelphia: Lippincott Raven; 2006: 262-264
    Google Scholar
  • 46 Lozsadi D. Myoclonus: a pragmatic approach. Pract Neurol 2012; 12: 215-224
    CrossrefPubMedGoogle Scholar
  • 47 Erro R, Bhatia KP, Edwards MJ et al. Clinical diagnosis of propriospinal myoclonus is unreliable: an electrophysiologic study. Mov Disord 2013; 28: 1868-1873
    CrossrefPubMedGoogle Scholar
  • 48 Hallett M, Khoshbin S. A physiological mechanism of bradykinesia. Brain 1980; 103: 301-314
    CrossrefPubMedGoogle Scholar
  • 49 Lang AE, Koller WC, Fahn S. Psychogenic parkinsonism. Arch Neurol 1995; 52: 802-810
    CrossrefPubMedGoogle Scholar
  • 50 Morgan JC, Sethi KD. Psychogenic Parkinson. In: Hallett M, Fahn S, Jankovic J, et al., eds. Psychogenic Movement Disorders. Philadelphia: Lippincott Raven; 2006: 62-68
    Google Scholar
  • 51 Lang AE. General overview of psychogenic movement disorders: epidemiology, diagnosis, and prognosis. In: Hallett M, Fahn S, Jankovic J, et al., eds. Psychogenic Movement Disorders. Philadelphia: Lippincott Raven; 2006: S35-S41
    Google Scholar