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. 2015 Mar 1;2(1):29-32.
doi: 10.1002/mdc3.12102.

Diagnostic performance of the "Huffing and Puffing" sign in psychogenic (functional) movement disorders

Holly N Laub  1 , Alok K Dwivedi  2 , Fredy J Revilla  1 , Andrew P Duker  1 , Cara Pecina-Jacob  1 , Alberto J Espay  1
Affiliations

Diagnostic performance of the "Huffing and Puffing" sign in psychogenic (functional) movement disorders

Holly N Laub et al. Mov Disord Clin Pract. .

Abstract

Objective: To determine the diagnostic value of effort-associated behaviors ("huffing and puffing" spectrum) in patients with psychogenic movement disorders.

Methods: Three blinded clinicians rated presence, severity, and duration of effort-associated features during standing and walking tasks on edited videos of 131 patients with psychogenic gait disorders and 37 patients with organic gait disorders.

Results: Huffing, grunting, grimacing, and breath holding were the most common effort-associated behaviors in patients with psychogenic gait disorders, with a combined prevalence of 44% and disproportionate to the severity of gait impairment compared to organic gait disorders. The presence of "huffing and puffing"-type behaviors yielded a relatively low sensitivity but high specificity for the diagnosis of psychogenic movement disorders, increasing the odds of diagnosis 13-fold (95%, CI: 4.2-43.8) compared to organic gait disorders.

Conclusions: Demonstration of effort-associated behaviors during standing and walking strongly supports the psychogenic nature of disorders when gait is involved.

Keywords: excessive effort; psychogenic movement disorders.

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Figures

Figure 1
Figure 1
Prevalence of H‐P in the PMD and organic cohorts. Five criteria for positivity were used, from least to most stringent: (A) at least mild H‐P by any one rater; (B) at least mild H‐P by any two raters; (C) at least mild H‐P by all three raters; (D) moderate H‐P by any rater; and (E) severe H‐P by any rater. The “combined” bar represents the overall H‐P prevalence without prespecified definitions. Note that mild H‐P was present in controls only by definitions A and D.
See this image and copyright information in PMC

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