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Functional Parkinsonism

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Functional Movement Disorder

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Functional parkinsonism is defined by the presence of a combination of marked slowness of movement in the absence of progressive decrement and variable resistance against passive movement, that is not caused by neurodegeneration or specific dysfunction of the dopaminergic system. Functional tremor and functional gait impairment may also be present. Functional parkinsonism is estimated to represent between 3% and 6% of patients with functional movement disorder. Functional parkinsonism should be considered if a patient exhibits sudden onset of symptoms with maximal severity at onset, and if there is no improvement with dopaminergic therapy. Clinical signs suggesting a functional neurological origin include distractibility, tremor entrainment, oppositional stiffness without cogwheel rigidity, and bradykinesia without decreased amplitude. Complementary exams, such as a DaTscan, can be used as adjunctive tools in the evaluation of functional parkinsonism, and be useful in providing evidence either for or against a comorbid neurodegenerative parkinsonism (in the case of a positive or negative scan, respectively). Treatment of functional parkinsonism should involve a multidisciplinary team including neurologists and psychiatrists and may include TMS, physical therapy, and psychotherapy.

All authors have contributed to and approved the submitted draft manuscript.

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Conflict of Interest Statements:

Marine Ambar Akkaoui and Béatrice Garcin declare no conflicts of interest. Bertrand Degos received honoraria from IPSEN and travel funding from Merz-Pharma, Elivie, Orkyn.

Author information

Authors and Affiliations

  1. Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris - Psychiatry & Neurosciences, Paris, France

    Marine Ambar Akkaoui

  2. Psychiatric Emergency, CH Delafontaine, Etablissement Publique de Santé Mentale deVille Evrard, Paris, France

    Marine Ambar Akkaoui

  3. Neurology Unit, Avicenne University Hospital, Sorbonne Paris Nord University, Bobigny, France

    Bertrand Degos & Béatrice Garcin

  4. Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241/INSERM U1050, Université PSL, Paris, France

    Bertrand Degos

  5. Faculty of Medicine of Sorbonne University, Brain and Spine Institute, INSERM U1127, CNRS UMR 7225, Paris, France

    Béatrice Garcin

Authors
  1. Marine Ambar Akkaoui
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  2. Bertrand Degos
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  3. Béatrice Garcin
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Editor information

Editors and Affiliations

  1. Movement Disorder Specialist, Saratoga Hospital Medical Group, Saratoga Springs, NY, USA

    Kathrin LaFaver

  2. Department of Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA

    Carine W. Maurer

  3. Neuropsychiatry Research and Education Group, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, UK

    Timothy R. Nicholson

  4. Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    David L. Perez

Electronic Supplementary Material

Vignette 1: In the first scene (1), there is a diminished arm swing on the right, which persists while running. There is a postural tremor of the right hand during the walk. There is no slowness of the gait and no freezing. The second sequence (2) shows tremor distractibility, with cessation of the right hand tremor when the patient concentrates on tapping with the left hand. The tremor of the right hand then tends to adopt the frequency of the left hand tapping, a phenomenon referred to as entrainability. In the third sequence (3), we see slow movements of the right hand, without gradual decrement in amplitude. In the last sequence (4), the patient exhibits choreiform-like movements of the upper and lower limbs (MP4 330846 kb)

Vignette 2: The first sequence (1) shows the evaluation of akinesia in the upper and lower limbs. Movements of both the upper and lower limbs are slow, without gradual decrement in amplitude. The second scene (2) demonstrates assessment of motor tone. Rigidity that is initially observed in the left arm is found to decrease with reinforcement maneuver. The third sequence (3) shows a Hoover’s sign of left leg, with an initial deficit of left hip extension, but normal left hip extension during right hip flexion. There is no fall on the pull test (4). The patient exhibits slow gait, without freezing. There is diminished arm swing of both arms (5) (MP4 98902 kb)

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Akkaoui, M.A., Degos, B., Garcin, B. (2022). Functional Parkinsonism. In: LaFaver, K., Maurer, C.W., Nicholson, T.R., Perez, D.L. (eds) Functional Movement Disorder. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-86495-8_8

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  • DOI: https://doi.org/10.1007/978-3-030-86495-8_8

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-86494-1

  • Online ISBN: 978-3-030-86495-8

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