• Open Access

Psychogenic facial movement disorders: Clinical features and associated conditions

Authors

  • Alfonso Fasano MD, PhD,

    1. Dipartimento di Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
    2. Department of Neuroscience AFaR-Fatebenefratelli Association for Biomedical Research “San Giovanni Calibita-Fatebenefratelli” Hospital, Isola Tiberina, Rome
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    • Dr. Fasano and Dr. Valadas contributed equally to this work.

  • Anabela Valadas MD,

    1. Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon, Portugal
    2. Sobell Department of Motor Neuroscience and Movement Disorders, UCL, Institute of Neurology, University College London, United Kingdom
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    • Dr. Fasano and Dr. Valadas contributed equally to this work.

  • Kailash P. Bhatia MD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, UCL, Institute of Neurology, University College London, United Kingdom
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  • L.K. Prashanth DM,

    1. Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Anthony E. Lang MD, FRCPC,

    1. Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Renato P. Munhoz MD,

    1. Service of Neurology, Pontifical Catholic University of Parana, Curitiba, Brazil
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  • Francesca Morgante MD, PhD,

    1. Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Messina, Italy
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  • Daniel Tarsy MD,

    1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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  • Andrew P. Duker MD,

    1. UC Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
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  • Paolo Girlanda MD,

    1. Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Messina, Italy
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  • Anna Rita Bentivoglio MD, PhD,

    1. Dipartimento di Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
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  • Alberto J. Espay MD, MSc

    Corresponding author
    1. UC Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
    • Department of Neurology, University of Cincinnati, 260 Stetson St., Suite 2300 (PO Box 670525), Cincinnati, OH 45267, USA
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  • 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.

Abstract

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

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