Dr. Fasano and Dr. Valadas contributed equally to this work.
Article first published online: 2 OCT 2012
Copyright © 2012 Movement Disorder Society
Volume 27, Issue 12, pages 1544–1551, October 2012
How to Cite
Fasano, A., Valadas, A., Bhatia, K. P., Prashanth, L.K., Lang, A. E., Munhoz, R. P., Morgante, F., Tarsy, D., Duker, A. P., Girlanda, P., Bentivoglio, A. R. and Espay, A. J. (2012), Psychogenic facial movement disorders: Clinical features and associated conditions. Mov. Disord., 27: 1544–1551. doi: 10.1002/mds.25190
Relevant conflicts of interest/financial disclosures: Nothing to report.
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 18 OCT 2012
- Article first published online: 2 OCT 2012
- Manuscript Accepted: 3 AUG 2012
- Manuscript Revised: 23 JUL 2012
- Manuscript Received: 7 FEB 2012
- facial movement disorders;
- psychogenic movement disorders;
- psychogenic facial movement disorders;
- psychogenic dystonia;
- psychogenic blepharospasm;
- facial distortion
The facial phenotype of psychogenic movement disorders has not been fully characterized. Seven tertiary-referral movement disorders centers using a standardized data collection on a computerized database performed a retrospective chart review of psychogenic movement disorders involving the face. Patients with organic forms of facial dystonia or any medical or neurological disorder known to affect facial muscles were excluded. Sixty-one patients fulfilled the inclusion criteria for psychogenic facial movement disorders (91.8% females; age: 37.0 ± 11.3 years). Phasic or tonic muscular spasms resembling dystonia were documented in all patients most commonly involving the lips (60.7%), followed by eyelids (50.8%), perinasal region (16.4%), and forehead (9.8%). The most common pattern consisted of tonic, sustained, lateral, and/or downward protrusion of one side of the lower lip with ipsilateral jaw deviation (84.3%). Ipsi- or contralateral blepharospasm and excessive platysma contraction occurred in isolation or combined with fixed lip dystonia (60.7%). Spasms were reported as painful in 24.6% of cases. Symptom onset was abrupt in most cases (80.3%), with at least 1 precipitating psychological stress or trauma identified in 57.4%. Associated body regions involved included upper limbs (29.5%), neck (16.4%), lower limbs (16.4%), and trunk (4.9%). There were fluctuations in severity and spontaneous exacerbations and remissions (60%). Prevalent comorbidities included depression (38.0%) and tension headache (26.4%). Fixed jaw and/or lip deviation is a characteristic pattern of psychogenic facial movement disorders, occurring in isolation or in combination with other psychogenic movement disorders or other psychogenic features. © 2012 Movement Disorder Society