Functional Movement Disorders


Authors: T. Serranová;  E. Růžička;  J. Roth
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd, 1. LF UK a VFN v Praze
Published in: Cesk Slov Neurol N 2014; 77/110(3): 270-286
Category: Minimonography

Podpořeno Univerzitou Karlovou v Praze, PRVOUK P26/LF1/4.

Overview

Functional (psychogenic) movement disorders are frequently seen in neurology outpatient clinics. However, the underlying pathophysiology is still poorly understood and from the clinical perspective, there can be many uncertainties regarding their diagnosis and treatment. Functional movement disorders are clinically characterized by variability and inconsistency of symptoms that are incongruent with movement disorders known to be caused by an organic neurological disease. Here we review the terminology, definitions, epidemiology and typical presentations of functional movement disorders and their individual forms and clinical dia­gnostic criteria. Furthermore, we review advances in our knowledge of the pathophysiology that question the formerly emphasized causal role of psychological factors, and proposes a neurobiological model of the symptom development. Diagnosis of functional movement disorders should be based on the presence of characteristic clinical features and not on exclusion of an organic cause only. Early diagnosis and its acceptance by the patient are crucial for the prognosis. Management of functional movement disorders involves a multimodal approach with a dominant role of a neurologist, who establishes and communicates the diagnosis and determines treatment.

Key words:
functional movement disorders – psychogenic movement disorders – inconsistency – incongruence – Hoover test

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Stone J, Carson A, Duncan R, Roberts R, Warlow C, Hibberd C et al. Who is referred to neurology clinics? –  the dia­gnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112(9): 747– 751. doi: 10.1016/ j.clineuro.2010.05.011.

2. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet 1999; 354(9182): 936– 939.

3. Edwards MJ, Bhatia KP. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol 2012; 11(3): 250– 260. doi: 10.1016/ S1474- 4422(11)70310- 6.

4. Edwards MJ, Fotopoulou A, Pareés I. Neurobio­logy of functional (psychogenic) movement disorders. Curr Opin Neurol 2013; 26(4): 442– 447. doi: 10.1097/ WCO.0b013e3283633953.

5. Album D, Westin S. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Soc Sci Med 2008; 66(1): 182– 188.

6. Espay AJ, Goldenhar LM, Voon V, Schrag A, Burton N, Lang AE. 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(9): 1366– 1374. doi: 10.1002/ mds.22618.

7. Stone J, Wojcik W, Durrance D, Carson A, Lewis S, MacKenzie L et al. What should we say to patients with symptoms unexplained by disease? The “number needed to offend”. BMJ 2002; 325(7379): 1449– 1450.

8. Edwards MJ, Stone J, Lang AE. From psychogenic movement disorder to functional ovement disorder: It’s time to change the name. Mov Disord 2013. In press. doi: 10.1002/ mds.25562.

9. MKN‑ 10. Mezinárodní statistická klasifikace nemocí a přidružených zdravotních problémů. 2013 [online]. Available from: http:/ / www.uzis.cz/ cz/ mkn/ F40– F48.html.

10. American Psychiatric Association. Dia­gnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing 2013.

11. Sharpe M. Distinguishing malingering from psychiatric disorders. In: Halligan PW, Bass C, Oakley DA (eds). Malingering and Illness Deception. Oxford, UK: Oxford University Press 2003: 156– 170.

12. Stone J, Carson A, Sharpe M. Functional symptoms in neurology: management. J Neurol Neurosurg Psychiatry 2005; 76 (Suppl 1): i13– i21.

13. Hallett M. Physiology of psychogenic movement disorders. J Clin Neurosci 2010; 17(8): 959– 965. doi: 10.1016/ j.jocn.2009.11.021.

14. Halligan PW, Bass C, Oakley DA. Wilful deception as illness behaviour. In: Halligan PW, Bass C, Oakley DA (eds). Malingering and Illness Deception. Oxford, UK: Oxford University Press 2003; 3– 28.

15. Akagi H, House A. The epidemiology of hysterical conversion. In: Halligan PW, Bass C, Marshall JC (eds). Contemporary approaches to the study of hysteria: clinical and theoretical perspectives. Oxford: Oxford University Press 2001; 73– 87.

16. Factor SA, Podskalny GD, Molho ES. Psychogenic movement disorders: frequency, clinical profile and characteristics. J Neurol Neurosurg Psychiatry 1995; 59(4): 406– 412.

17. Cubo E, Hinson VK, Goetz CG, Garcia Ruiz P, Garcia de Yebenes J, Marti MJ et al. Transcultural comparison of psychogenic movement disorders. Mov Disord 2005; 20(10): 1343– 1345.

18. Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol 1995; 65: 231– 257.

19. Schwingenschuh P, Pont‑ Sunyer C, Surtees R, Edwards MJ, Bhatia KP. Psychogenic movement disorders in children: a report of 15 cases and a review of the literature. Mov Disord 2008; 23(13): 1882– 1888. doi: 10.1002/ mds.22280.

20. Batla A, Stamelou M, Edwards MJ, Parees I, Saifee TA, Fox Z et al. Functional movement disorders are not uncommon in the elderly. Mov Disord 2013; 28(4): 540– 543. doi: 10.1002/ mds.25350.

21. Lang A. General overview of psychogenic movement disorders: epidemiology, dia­gnosis, and prognosis. In: Hallett M, Fahn S, Jankovic J, Lang AE, Cloninger CR, Yudofsky SC (eds). Psychogenic movement disorders. Philadelphia: Lippincott Williams & Wilkins 2006; 35– 41.

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

23. Sharpe D, Faye C. Non‑ epileptic seizures and child sexual abuse: a critical review of the literature. Clin Psychol Rev 2006; 26(8): 1020– 1040.

24. Roelofs K, Keijsers GP, Hoogduin KA, Naring GW, Moene FC. Childhood abuse in patients with conversion disorder. Am J Psychiatry 2002; 159(11): 1908– 1913.

25. Kranick S, Ekanayake V, Martinez V, Ameli R, Hal­lett M, Voon V. Psychopathology and psychogenic movement disorders. Mov Disord 2011; 26(10): 1844– 1850. doi: 10.1002/ mds.23830.

26. Chabrol H, Peresson G, Clanet M. Lack of specificity of the traditional criteria for conversion disorders. Eur Psychiatry 1995; 10(6): 317– 319. doi: 10.1016/ /0924- 9338(96)80314- 2.

27. Gould R, Miller BL, Goldberg MA, Benson DF. The validity of hysterical signs and symptoms. J Nerv Ment Dis 1986; 174(10): 593– 597.

28. Raskin M, Talbott JA, Meyerson AT. Dia­gnosis of conversion reactions. Predictive value of psychiatric criteria. JAMA 1966; 197(7): 530– 534.

29. Sharma P, Chaturvedi SK. Conversion disorder revisited. Acta Psychiatr Scand 1995; 92(4): 301– 304.

30. Bishop ER jr, Torch EM. Dividing “hysteria”: a preliminary investigation of conversion disorder and psychalgia. J Nerv Ment Dis 1979; 167(6): 348– 356.

31. Roelofs K, Spinhoven P, Sandijck P, Moene FC, Hoogduin KA. The impact of early trauma and recent life‑ events on symptom severity in patients with conversion disorder. J Nerv Ment Dis 2005; 193(8): 508– 514.

32. Voon V, Brezing C, Gallea C, Ameli R, Roelofs K, LaFrance WC jr et al. Emotional stimuli and motor conversion disorder. Brain 2010; 133(5): 1526– 1536. doi: 10.1093/ brain/ awq054.

33. Voon V, Brezing C, Gallea C, Hallett M. Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder. Mov Disord 2011; 26(13): 2396– 2403. doi: 10.1002/ mds.23890.

34. Voon V, Gallea C, Hattori N, Bruno M, Ekanayake V, Hallett M. The involuntary nature of conversion disorder. Neurology 2010; 74(3): 223– 228. doi: 10.1212/ WNL.0b013e3181ca00e9.

35. Browning M, Fletcher P, Sharpe M. Can neuroimaging help us to understand and classify somatoform disorders? A systematic and critical review. Psychosom Med 2011; 73(2): 173– 184. doi: 10.1097/ PSY.0b013e31820824f6.

36. Pareés I, Kassavetis P, Saifee TA, Sadnicka A, Davare M,Bhatia KP et al. Failure of explicit movement control in patients with functional motor symptoms. Mov Disord 2013; 28(4): 517– 523. doi: 10.1002/ mds.25287.

37. Roelofs K, van Galen GP, Eling P, Keijsers GP, Hoogduin CA. Endogenous and exogenous attention in patients with conversion paresis. Cogn Neuropsychol 2003; 20(8): 733– 745. doi: 10.1080/ 02643290342000069.

38. Schrag AE, Mehta AR, Bhatia KP, Brown RJ, Frackowiak RS, Trimble MR et al. The functional neuroimaging correlates of psychogenic versus organic dystonia. Brain 2013; 136(3): 770– 781. doi: 10.1093/ brain/ awt008.

39. Pareés I, Saifee TA, Kassavetis P, Kojovic M, Rubio­‑ Agusti I, Rothwell JC et al. Believing is perceiving: mismatch between self‑ report and actigraphy in psychogenic tremor. Brain 2012; 135(1): 117– 123. doi: 10.1093/ brain/ awr292.

40. Edwards MJ, Moretto G, Schwingenschuh P, Katschnig P, Bhatia KP, Haggard P. Abnormal sense of intention preceding voluntary movement in patients with psychogenic tremor. Neuropsychologia 2011; 49(9): 2791– 2793. doi: 10.1016/ j.neuropsychologia.2011.05.021.

41. Kranick SM, Moore JW, Yusuf N, Martinez VT, LaFaver K, Edwards MJ et al. Action‑ effect binding is decreased in motor conversion disorder: implications for sense of agency. Mov Disord 2013; 28(8): 1110– 1116. doi: 10.1002/ mds.25408.

42. Lorenz J, Hauck M, Paur RC, Nakamura Y, Zimmermann R, Bromm B et al. Cortical correlates of false expectations during pain intensity judgments –  a possible manifestation of placebo/ nocebo cognitions. Brain Behav Immun 2005; 19(4): 283– 295.

43. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004; 127(10): 2360– 2372.

44. Hotopf M, Mayou R, Wadsworth M, Wessely S.Child­hood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. Am J Psychiatry 1999; 156(11): 1796– 1800.

45. 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(7131): 582– 586.

46. Stewart DE. The changing faces of somatization. Psychosomatics 1990; 31(2): 153– 158.

47. Ismail K, Lewis G. Multi‑symptom illnesses, unexplained illness and Gulf War Syndrome. Philos Trans R Soc Lond B Biol Sci 2006; 361(1468): 543– 551.

48. Edwards MJ, Adams RA, Brown H, Parees I, Friston KJ. A Bayesian account of ‘hysteria’. Brain 2012; 135(11): 3495– 3512. doi: 10.1093/ brain/ aws129.

49. Heintz CE, van Tricht MJ, van der Salm SM, van Rootselaar AF, Cath D, Schmand B et al. Neuropsychological profile of psychogenic jerky movement disorders: importance of evaluating non‑credible cognitive performance and psychopathology. J Neurol Neurosurg Psychiatry 2013; 84(8): 862– 867. doi: 10.1136/ jnnp‑ 2012- 304397.

50. Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014; 85(2): 220– 226. doi: 10.1136/ jnnp‑ 2013- 305321.

51. Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol 2009; 22(4): 430– 436. doi: 10.1097/ WCO.0b013e32832dc169.

52. van Poppelen D, Saifee TA, Schwingenschuh P, Katschnig P, Bhatia KP, Tijssen MA et al. Attention to self in psychogenic tremor. Mov Disord 2011; 26(14): 2575– 2576. doi: 10.1002/ mds.23911.

53. Stone J, Smyth R, Carson A, Warlow C, Sharpe M. La belle indifférence in conversion symptoms and hysteria: systematic review. Br J Psychiatry 2006; 188: 204– 209.

54. Lader M, Sartorius N. Anxiety in patients with hysterical conversion symptoms. J Neurol Neurosurg Psychiatry 1968; 31(5): 490– 495.

55. Rice DG, Greenfield NS. Psychophysiological correlates of la belle indifference. Arch Gen Psychiatry 1969; 20(2): 239– 245.

56. Carson AJ, Brown R, David AS, Duncan R, Edwards MJ,Goldstein LH et al. Functional (conversion) neurological symptoms: research since the millennium. J Neurol Neurosurg Psychiatry 2012; 83(8): 842– 850. doi: 10.1136/ jnnp‑ 2011- 301860.

57. 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(3): 169– 176.

58. Kim YJ, Pakiam AS, Lang AE. Historical and clinical features of psychogenic tremor: a review of 70 cases. Can J Neurol Sci 1999; 26(3): 190– 195.

59. Onofrj M, Bonanni L, Manzoli L, Thomas A. Cohort study on somatoform disorders in Parkinson disease and dementia with Lewy bodies. Neurology 2010; 74(20): 1598– 1606. doi: 10.1212/ WNL.0b013e3181df09dd.

60. Pareés I, Saifee TA, Kojovic M, Kassavetis P, Rubio­‑ Agusti I, Sadnicka A et al. Functional (psychogenic) symptoms in Parkinson’s disease. Mov Disord 2013; 28(12): 1622– 1627. doi: 10.1002/ mds.25544.

61. Deuschl G, Raethjen J, Lindemann M, Krack P. The pathophysiology of tremor. Muscle Nerve 2001; 24(6): 716– 735.

62. Deuschl G, Koster B, Lucking CH, Scheidt C. Dia­gnostic and pathophysiological aspects of psychogenic tremors. Mov Disord 1998; 13(2): 294– 302.

63. Kenney C, Diamond A, Mejia N, Davidson A, Hunter C,Jankovic J. Distinguishing psychogenic and essential tremor. J Neurol Sci 2007; 263(1– 2): 94– 99.

64. Zeuner KE, Shoge RO, Goldstein SR, Dambrosia JM, Hallett M. Accelerometry to distinguish psychogenic from essential or parkinsonian tremor. Neurology 2003; 61(4): 548– 550.

65. Uhríková Z, Růzicka E, Hlavác V, Nugent CD. TremAn: a tool for measuring tremor frequency from video sequences. Mov Disord 2010; 25(4): 504– 506. doi: 10.1002/ mds.22904.

66. McAuley J, Rothwell J. Identification of psychogenic, dystonic, and other organic tremors by a coherence entrainment test. Mov Disord 2004; 19(3): 253– 267.

67. Kumru H, Begeman M, Tolosa E, Valls‑ Sole J. Dual task interference in psychogenic tremor. Mov Disord 2007; 22(14): 2077– 2082.

68. Schwingenschuh P, Katschnig P, Seiler S, Saifee TA,Aguirregomozcorta M, Cordivari C et al. Moving toward “laboratory‑ supported” criteria for psychogenic tremor. Mov Disord 2011; 26(14): 2509– 2515. doi: 10.1002/ mds.23922.

69. Fahn MC, Calne B. Classification and investigation of dystonia. In: Movement disorders. London: Butterworth 1987; 332– 358.

70. Fasano A, Valadas A, Bhatia KP, Prashanth LK, Lang AE, Munhoz RP et al. Psychogenic facial movement disorders: clinical features and associated conditions. Mov Disord 2012; 27(12): 1544– 1551. doi: 10.1002/ mds.25190.

71. Albanese A, Asmus F, Bhatia KP, Elia AE, Elibol B, Filippini G et al. EFNS guidelines on dia­gnosis and treatment of primary dystonias. Eur J Neurol 2011; 18(1): 5– 18. doi: 10.1111/ j.1468- 1331.2010.03042.x.

72. Fahn S, Marsden CD, Van Woert MH. Definition and classification of myoclonus. Adv Neurol 1986; 43: 1– 5.

73. Thompson PD, Colebatch JG, Brown P, Rothwell JC, Day BL, Obeso JA et al. Voluntary stimulus‑ sensitive jerks and jumps mimicking myoclonus or pathological startle syndromes. Mov Disord 1992; 7(3): 257– 262.

74. Brown P, Thompson PD. Electrophysiological aids to the dia­gnosis of psychogenic jerks, spasms and tremor. Mov Disord 2001; 16(4): 595– 599.

75. Terada K, Ikeda A, Van Ness PC, Nagamine T, Kaji R,Kimura J et al. Presence of Bereitschaftspotential preceding psychogenic myoclonus: clinical application of jerk‑ locked back averaging. J Neurol Neurosurg Psychiatry 1995; 58(6): 745– 747.

76. Esposito M, Edwards MJ, Bhatia KP, Brown P, Cordivari C. Idiopathic spinal myoclonus: a clinical and neurophysiological assessment of a movement disorder of uncertain origin. Mov Disord 2009; 24(16): 2344– 2349. doi: 10.1002/ mds.22812.

77. van der Salm SM, Koelman JH, Henneke S, van Rootselaar AF, Tijssen MA. Axial jerks: a clinical spectrum ranging from propriospinal to psychogenic myoclonus. J Neurol 2010; 257(8): 1349– 1355. doi: 10.1007/ s00415- 010- 5531- 6.

78. Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord 2007; 22(3): 395– 399.

79. Lempert T, Brandt T, Dieterich M, Huppert D. How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol 1991; 238(3): 140– 146.

80. Keane JR. Hysterical gait disorders: 60 cases. Neurology 1989; 39(4): 586– 589.

81. Jordbru AA, Smedstad LM, Moen VP, Martinsen EW. Identifying patterns of psychogenic gait by video‑ recording. J Rehabil Med 2012; 44(1): 31– 35.

82. Růžička E, Serranová T. Psychogenní poruchy chůze. Neurol Prax 2013; 14(4): 182– 184.

83. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical dia­gnosis of idiopathic Parkinson’s disease: a clinico‑ pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55(3): 181– 184.

84. Benaderette S, Zanotti Fregonara P, Apartis E, Nguyen C, Trocello JM, Remy P et al. Psychogenic parkinsonism: a combination of clinical, electrophysiological, and [(123)I]– FP‑ CIT SPECT scan explorations improves dia­gnostic accuracy. Mov Disord 2006; 21(3): 310– 317.

85. Bhatia KP. Paroxysmal dyskinesias. Mov Disord 2011; 26(6): 1157– 1165. doi: 10.1002/ mds.23765.

86. Ganos C, Aguirregomozcorta M, Batla A, Stamelou M,Schwingenschuh P, Münchau A et al. Psychogenic paroxysmal movement disorders –  clinical features and dia­gnostic clues. Parkinsonism Relat Disord 2014; 20(1): 41– 46. doi: 10.1016/ j.parkreldis.2013.09.012.

87. Ziv I, Djaldetti R, Zoldan Y, Avraham M, Melamed E. Dia­gnosis of “non‑organic” limb paresis by a novel objective motor assessment: the quantitative Hoover’s test. J Neurol 1998; 245(12): 797– 802.

88. Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and dia­gnosis. J Neurol Neurosurg Psychiatry 2005; 76 (Suppl 1): i2– i12.

89. Stone J, Zeman A, Sharpe M. Functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2002; 73(3): 241– 245.

90. American Psychiatric Association. Highlights of Changes from DSM‑ IV‑ TR to DSM‑ 5. American Psychiatric Association [online]. Available from: http:/ / www.psychiatry.org/ File Library/ Practice/ DSM/ DSM5/ Changes‑ from‑ DSM‑ IV‑ TR- to‑ DSM‑ 5.pdf.

91. Carton S, Thompson PJ, Duncan JS. Non‑ epileptic seizures: patients’ understanding and reaction to the dia­gnosis and impact on outcome. Seizure 2003; 12(5): 287– 294.

92. Jankovic J, Vuong KD, Thomas M. Psychogenic tremor: long‑term outcome. CNS Spectr 2006; 11(7): 501– 508.

93. Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet 2007; 369(9565): 946– 955.

94. Voon V, Lang AE. Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry 2005; 66(12): 1529– 1534.

95. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007; 69(9): 881– 888.

96. 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(6): 655– 658. doi: 10.1136/ jnnp‑ 2011- 302147.

97. 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(3): 247– 251. doi: 10.1016/ j.parkreldis.2011.10.011.

98. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res 2013; 75(2): 93– 102. doi: 10.1016/ j.jpsychores.2013.05.006.

99. Goldstein LH, Chalder T, Chigwedere C, Khondoker MR, Moriarty J, Toone BK et al. Cognitive‑ behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology 2010; 74(24): 1986– 1994. doi: 10.1212/ WNL.0b013e3181e39658.

100. 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 2014; 20(1): 60– 63. doi: 10.1016/ j.parkreldis.2013.09.018.

101. 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(2): 66– 76.

102. 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(1): 29– 50.

103. 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 2014; 85(2): 191– 197. doi: 10.1136/ jnnp‑ 2012- 304181.

104. Anderson KE, Gruber‑ Baldini AL, Vaughan CG, Reich SG, Fishman PS, Weiner WJ et al. Impact of psychogenic movement disorders versus Parkinson’s on disability, quality of life, and psychopathology. Mov Disord 2007; 22(15): 2204– 2209.

105. Carson A, Stone J, Hibberd C, Murray G, Duncan R, Coleman R et al. Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’. J Neurol Neurosurg Psychiatry 2011; 82(7): 810– 813. doi: 10.1136/ jnnp.2010.220640.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2014 Issue 3

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account