Skip to main content
SpringerLink
Log in

Treatment of Functional (Psychogenic) Movement Disorders

  • Review
  • Published:
Neurotherapeutics

Abstract

Functional (psychogenic) movement disorders are a common source of disability and distress. Despite this, little systematic evidence is available to guide treatment decisions. This situation is likely to have been influenced by the “no man’s land” that such patients occupy between neurologists and psychiatrists, often with neither side feeling a clear responsibility or ability to direct management. The aim of this narrative review is to provide an overview of the current state of the evidence regarding management of functional movement disorders. This reveals that there is some evidence to support the use of specific forms of cognitive behavioral therapy and physiotherapy. Such treatments may be facilitated in selected patients with the use of antidepressant medication, and may be more effective for those with severe symptoms when given as part of inpatient multidisciplinary rehabilitation. Other treatments, for example hypnosis and transcranial magnetic stimulation, are of interest, but further evidence is required regarding mechanism of effect and long-term benefit. Though prognosis is poor in general, improvement in symptoms is possible in patients with functional movement disorders, and there is a clear challenge to clinicians and therapists involved in their care to conduct and advocate for high-quality clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Edwards MJ, Bhatia KP. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol 2012;11:250-260.

    Article  PubMed  Google Scholar 

  2. Crimlisk HL, Bhatia K, Cope H, David A, Marsden CD, Ron MA. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ 1998;316:582-586.

    Article  CAS  PubMed  Google Scholar 

  3. Feinstein A, Stergiopoulos V, Fine J, Lang AE. Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Neuropsychiatry Neuropsychol Behav Neurol 2001;14:169-76.

    CAS  PubMed  Google Scholar 

  4. Thomas M, Vuong KD, Jankovic J. Long-term prognosis of patients with psychogenic movement disorders. Parkinsonism Relat Disord 2006;12:382-387

    Article  PubMed  Google Scholar 

  5. Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2013 Sep 12 [Epub ahead of print].

  6. Espay AJ, Goldenhar LM, Voon V, et al. Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: an international survey of movement disorder society members. Mov Disord 2009;24:1366-1374.

    Article  PubMed  Google Scholar 

  7. Stone J, Edwards MJ. How “psychogenic” are psychogenic movement disorders? Mov Disord 2011; 26: 1787-1788

    Article  PubMed  Google Scholar 

  8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Arlington, VA, 2013.

  9. Edwards MJ, Stone J, Lang AE. From psychogenic movement disorder to functional movement disorder: It's time to change the name. Mov Disord 2013 Jul 10 [Epub ahead of print].

  10. Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ. A Bayesian account of 'hysteria'. Brain 2012;135:3495-3512.

    Article  PubMed  Google Scholar 

  11. Edwards MJ, Fotopoulou A, Pareés I. Neurobiology of functional (psychogenic) movement disorders. Curr Opin Neurol 2013;26:442-447.

    Article  CAS  PubMed  Google Scholar 

  12. Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry 2012;83:67-69.

    Article  PubMed  Google Scholar 

  13. Salmon P, Peters S, Stanley I. Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ 1999;318:372-376.

    Article  CAS  PubMed  Google Scholar 

  14. Stone J, Wojcik W, Durrance D, et al. What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ 2002;325:1449-1450.

    Article  PubMed  Google Scholar 

  15. Oto M, Espie CA, Duncan R. An exploratory randomized controlled trial of immediate versus delayed withdrawal of antiepileptic drugs in patients with psychogenic nonepileptic attacks (PNEAs). Epilepsia 2010;51:1994-1999.

    Article  PubMed  Google Scholar 

  16. Mayor R, Brown RJ, Cock H, et al. Short-term outcome of psychogenic non-epileptic seizures after communication of the diagnosis. Epilepsy Behav 2012;25:676-681.

    Article  CAS  PubMed  Google Scholar 

  17. Stone J, Edwards M. Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs. Neurology 2012;79:282-284.

    Article  PubMed  Google Scholar 

  18. Jankovic J, Cloninger CR, Fahn S, Hallett M, Lang AE, Williams DT. Therapeutic approaches to psychogenic movement disorders. In: Hallett M, Fahn S, Jankovic J, Lang AE, Cloninger CR, Yudofsky S (eds) Psychogenic movement disorders: neurology and neuropsychiatry. AAN Enterprises and Lippincott Williams and Wilkins, Philadelphia, PA, 2006, pp. 323-328.

    Google Scholar 

  19. Edwards MJ, Stone J, Nielsen G. Physiotherapists and patients with functional (psychogenic) motor symptoms: a survey of attitudes and interest. J Neurol Neurosurg Psychiatry 2012;83:655-658.

    Article  PubMed  Google Scholar 

  20. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: A systematic review. J Psychosom Res 2013;75:93-102.

    Article  PubMed  Google Scholar 

  21. Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR, Ahlskog JE. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Parkinsonism Relat Disord 2012;18:247-251.

    Article  PubMed  Google Scholar 

  22. Dallocchio C, Arbasino C, Klersy C, Marchioni E. The effects of physical activity on psychogenic movement disorders. Mov Disord 2010;25:421-425.

    Article  PubMed  Google Scholar 

  23. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007;69:881-888.

    Article  PubMed  Google Scholar 

  24. Speckens AE, van Hemert AM, Spinhoven P, Hawton KE, Bolk JH, Rooijmans HG. Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. BMJ 1995;311:1328-1332.

    Article  CAS  PubMed  Google Scholar 

  25. LaFrance WC, Miller IW, Ryan CE, et al. Cognitive behavioral therapy for psychogenic nonepileptic seizures. Epilepsy Behav 2009;14:591-596.

    Article  PubMed  Google Scholar 

  26. Goldstein LH, Chalder T, Chigwedere C, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology 2010;74:1986-1994.

    Article  CAS  PubMed  Google Scholar 

  27. Sharpe M, Walker J, Williams C, et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology 2011;77:564-572.

    Article  CAS  PubMed  Google Scholar 

  28. LaFrance WC Jr, Friedman JH. Cognitive behavioral therapy for psychogenic movement disorder. Mov Disord 2009;24:1856-1857.

    Article  PubMed  Google Scholar 

  29. Hinson VK, Weinstein S, Bernard B, Leurgans SE, Goetz CG. Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders. Parkinsonism Relat Disord 2006;12:177-180.

    Article  PubMed  Google Scholar 

  30. Kompoliti K, Wilson B, Stebbins G, Bernard B, Hinson V. Immediate vs. delayed treatment of psychogenic movement disorders with short term psychodynamic psychotherapy: Randomized clinical trial. Parkinsonism Relat Disord 2013 Sep 22 [Epub ahead of print].

  31. Voon V, Lang AE. Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry 2005;66:1529-1534.

    Article  CAS  PubMed  Google Scholar 

  32. Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol 1988;50:431-455.

    CAS  PubMed  Google Scholar 

  33. Rampello L, Raffaele R, Nicoletti G, Le Pira F, Malaguarnera M, Drago F. Hysterical neurosis of the conversion type: therapeutic activity of neuroleptics with different hyperprolactinemic potency. Neuropsychobiology 1996;33:186-188.

    Article  CAS  PubMed  Google Scholar 

  34. Hebert PC. Doing right: a practical guide to ethics for medical trainees and physicians. Oxford University Press, Oxford, 1995.

    Google Scholar 

  35. Shamy MC. The treatment of psychogenic movement disorders with suggestion is ethically justified. Mov Disord 2010;25:260-264.

    Article  PubMed  Google Scholar 

  36. Van Nuenen BF, Wohlgemuth M, Wong Chung RE, Abdo WF, Bloem BR. Acupuncture for psychogenic movement disorders: treatment or diagnostic tool? Mov Disord 2007;22:1353-1355

    Article  PubMed  Google Scholar 

  37. Edwards MJ, Bhatia KP, Cordivari C. Immediate response to botulinum toxin injections in patients with fixed dystonia. Mov Disord 2011;26:917-918.

    Article  PubMed  Google Scholar 

  38. Halligan PW, Athwal BS, Oakley DA, Frackowiak RS. Imaging hypnotic paralysis: implications for conversion hysteria. Lancet 2000;355:986-987.

    Article  CAS  PubMed  Google Scholar 

  39. Bell V, Oakley DA, Halligan PW, Deeley Q. Dissociation in hysteria and hypnosis: evidence from cognitive neuroscience. J Neurol Neurosurg Psychiatry 2011;82:332-339.

    Article  PubMed  Google Scholar 

  40. Voon V; Gallea C; Hattori N, et al. The involuntary nature of conversion disorder. Neurology 2010;74:223-228.

    Article  CAS  PubMed  Google Scholar 

  41. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type. Psychother Psychosom 2002;71:66-76.

    Article  PubMed  Google Scholar 

  42. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn 2003;51:29-50.

    Article  PubMed  Google Scholar 

  43. Wojtecki L, Groiss S, Scherfeld D, et al. Transient improvement of psychogenic proprio-spinal-like myoclonus to electrical nerve stimulation. Mov Disord 2009;24:2024-2025.

    Article  PubMed  Google Scholar 

  44. Ferrara J, Stamey W, Strutt AM, Adam OR, Jankovic J. Transcutaneous electrical stimulation (TENS) for psychogenic movement disorders. J Neuropsychiatry Clin Neurosci 2011;23:141-148.

    Article  PubMed  Google Scholar 

  45. Pollak TA, Nicholson TR, Edwards MJ, David AS. A systematic review of transcranial magnetic stimulation in the treatment of functional (conversion) neurological symptoms. J Neurol Neurosurg Psychiatry 2013 Jan 8 [Epub ahead of print].

  46. Garcin B, Roze E, Mesrati F, et al. Transcranial magnetic stimulation as an efficient treatment for psychogenic movement disorders. J Neurol Neurosurg Psychiatry 2013;84:1043-1046.

    Article  PubMed  Google Scholar 

  47. Saifee TA, Kassavetis P, Pareés I, et al. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol 2012;259:1958-1963.

    Article  CAS  PubMed  Google Scholar 

  48. McCormack R, Moriarty J, Mellers JD, et al. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. J Neurol Neurosurg Psychiatry 2013 Oct 23 [Epub ahead of print].

Download references

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Author information

Authors and Affiliations

  1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK

    Luciana Ricciardi & Mark J. Edwards

  2. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Luciana Ricciardi

Authors
  1. Luciana Ricciardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark J. Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark J. Edwards.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 1225 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ricciardi, L., Edwards, M.J. Treatment of Functional (Psychogenic) Movement Disorders. Neurotherapeutics 11, 201–207 (2014). https://doi.org/10.1007/s13311-013-0246-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13311-013-0246-x

Keywords

Search

Navigation