Functional (Psychogenic) Dystonia

Functional (Psychogenic) Dystonia

Functional dystonia is sometimes called psychogenic dystonia, which refers to the observation that many cases have psychological or psychiatric factors that contribute to the physical symptoms. Treating underlying emotional and mental disorders can reduce the movement symptoms, though researchers do not yet fully understand why this is the case. The human brain is a spectacularly complicated and interconnected system. Areas of the brain associated with the movement are also involved in cognition, emotion, memory, and other mental functions. Researchers are actively studying functional dystonia and functional movement disorders to better the underlying neurology and improve treatment.

What is Functional Dystonia?

Dystonia is a neurological disorder that causes intense, involuntary muscle contractions. These muscle spasms make it difficult for patients to move their bodies freely and control their body movements. There are many types of dystonia and numerous causes. In functional dystonia, there is abnormal, unintended movement or positioning of the body due to the nervous system not working properly. Functional dystonia can cause movement symptoms in the face, neck, shoulder, torso, and/or limbs. Functional dystonia is often seen in individuals with psychiatric disorders and/or exposure to psychological stressors. The start of symptoms is often preceded by an injury, illness, or emotionally stressful event.

Functional Movement Disorders?

Functional dystonia belongs to a category of disorders called functional movement disorders. Many people with functional movement disorders experience a mix of motor symptoms including dystonia, tremor, myoclonus, gait disorders, and tics. They may also experience pain, weakness, sensory symptoms, non-epileptic seizures, and other functional neurological symptoms. Functional movement disorders are common, representing up to 25% of patients treated in movement disorder clinics. Functional movement disorders affect men and women as well as children.

Symptoms 

• Sudden symptom onset
• Minor injury preceding symptom onset
• Symptoms are varying and unpredictable across time
• Symptoms contradict hallmark features of other neurological disorders
• Symptoms are lessened with distraction
• Spontaneous remission and relapse
• Abnormal movements and pain are inconsistent with extent of injury
• Psychiatric symptoms
• Exposure to psychological stressors
• Many additional medically

Cause

Many researchers believe functional movement disorders occur due to an underlying vulnerability in the brain combined with an external trigger, though the mechanism is not yet fully understood. Research suggests that the process in the brain that helps a person sense whether a movement is voluntary or involuntary becomes disordered, resulting in unintentional movements or postures. These disorders are caused by changes in how the brain functions, not damage to the structures of the nervous system.

Diagnosis

Diagnosing functional dystonia can be difficult and should be left to movement disorder neurologists and psychiatrists with expertise in diverse neurological diseases. The diagnosis of functional dystonia is made on the positive observation of the clinical signs in the neurological examination, not solely by ruling out other disorders or the presence of psychological or psychiatric factors. Although psychological and psychiatric factors often contribute to functional dystonia, these signs
are not always present.

Treatment

Many individuals with functional dystonia have complex healthcare needs, so a team of medical experts may be appropriate. The team may include a movement disorder neurologist, psychiatrist, psychotherapist, physical therapist, and additional healthcare providers.

Therapy for functional movement disorders must be tailored to the needs of the individual. The goal of treatment is to lessen symptoms and improve function by helping the brain override the mechanism that is causing the unintentional movements or postures. Treatment may require physical and/or occupational therapy, cognitive behavior therapy, and/or oral medications such as antidepressants.

Living with Functional Dystonia

Living well with a functional movement disorder is possible. In some cases, treatment can dramatically reduce or eliminate
symptoms. Individuals affected by functional dystonia are strongly encouraged to:


• Seek evaluation from a neurologist with special training in movement disorders.
• Seek expert mental health professionals to diagnose and treat possible underlying emotional or mental disorders.
• Learn about functional movement disorders and treatment options.
• Develop a support system of support groups, online resources, friends, and family.
• Explore complementary therapies for overall wellness.
• Get active within the patient advocacy community.