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. 2021 Sep 10;8(7):1107-1111.
doi: 10.1002/mdc3.13322. eCollection 2021 Oct.

Sudden Onset, Fixed Dystonia and Acute Peripheral Trauma as Diagnostic Clues for Functional Dystonia

Tommaso Ercoli  1 , Giovanni Defazio  1 , Christian Geroin  2 , Enrico Marcuzzo  2 , Giovanni Fabbrini  3   4 , Francesco Bono  5 , Alessandro Mechelli  5 , Roberto Ceravolo  6 , Luigi Michele Romito  7 , Alberto Albanese  8 , Antonio Pisani  9   10 , Maurizio Zibetti  11 , Maria Concetta Altavista  12 , Luca Maderna  13 , Martina Petracca  14 , Paolo Girlanda  15 , Marcello Mario Mascia  1 , Alfredo Berardelli  3   4 , Michele Tinazzi  2 ; Italian Registry of Functional Motor Disorders Study Group; Italian Registry of Adult Dystonia Study Group
Affiliations

Sudden Onset, Fixed Dystonia and Acute Peripheral Trauma as Diagnostic Clues for Functional Dystonia

Tommaso Ercoli et al. Mov Disord Clin Pract. .

Abstract

Background: The differentiation of functional dystonia from idiopathic dystonia may be clinically challenging.

Objective: To identify clinical features suggestive of functional dystonia to guide physicians to distinguish functional dystonia from idiopathic dystonia.

Methods: Patient data were extracted from the Italian Registry of Functional Motor Disorders and the Italian Registry of Adult Dystonia. Patients with functional and idiopathic dystonia were followed up at the same clinical sites, and they were similar in age and sex.

Results: We identified 113 patients with functional dystonia and 125 with idiopathic dystonia. Sudden onset of dystonia, evidence of fixed dystonia, and acute peripheral trauma before dystonia onset were more frequent in the functional dystonia group. No study variable alone achieved satisfactory sensitivity and specificity, whereas a combination of variables yielded 85% sensitivity and 98% specificity. A diagnostic algorithm was developed to reduce the risk of misclassifying functional dystonia.

Conclusion: Our findings extend the current diagnostic approach to functional dystonia by showing that clinical information about symptom onset, fixed dystonia, and history of peripheral trauma may provide key clues in the diagnosis of functional dystonia.

Keywords: acute peripheral trauma; fixed dystonia; functional dystonia; idiopathic dystonia; sudden onset.

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Conflict of interest statement

No specific funding was received for this work and the authors declare that there are no conflicts of interest relevant to this work.

Figures

FIG. 1
FIG. 1
Diagnosing functional dystonia. FDYT, functional dystonia; IDYT, idiopathic dystonia.
See this image and copyright information in PMC

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References

    1. Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol 2009;22(4):430–436. - PubMed
    1. Stone J. Functional symptoms in neurology: management. J Neurol Neurosurg Psychiatry. 2005;76(suppl_1):i13–i21. 10.1136/jnnp.2004.061663 - DOI - PMC - PubMed
    1. Hallett M, Weiner WJ, Kompoliti K. Psychogenic movement disorders. Parkinsonism Relat Disord 2012;18(suppl 1):S155–S157. 10.1016/s1353-8020(11)70048-7. - DOI - PubMed
    1. Schwingenschuh P, Saifee TA, Katschnig‐Winter P, et al. Validation of “laboratory‐supported” criteria for functional (psychogenic) tremor. Mov Disord 2016;31(4):555–562. 10.1002/mds.26525. - DOI - PubMed
    1. Schwingenschuh P, Katschnig P, Edwards MJ, et al. The blink reflex recovery cycle differs between essential and presumed psychogenic blepharospasm. Neurology 2011;76(7):610–614. - PMC - PubMed