title: Psychogenic facial movement disorders: clinical features and associated conditions.
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.
authors.affiliation: Dipartimento di Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.forename: Anabela
authors.initials: A
authors.lastname: Valadas
authors.forename: Kailash P
authors.initials: KP
authors.lastname: Bhatia
authors.forename: L K
authors.initials: LK
authors.lastname: Prashanth
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.forename: Renato P
authors.initials: RP
authors.lastname: Munhoz
authors.forename: Francesca
authors.initials: F
authors.lastname: Morgante
authors.forename: Daniel
authors.initials: D
authors.lastname: Tarsy
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Duker
authors.forename: Paolo
authors.initials: P
authors.lastname: Girlanda
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Bentivoglio
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
mesh_terms: D000328:Adult; D018450:Disease Progression; D004421:Dystonia / Q000473:pathology / Q000503:physiopathology; D005145:Face / Q000503:physiopathology*; D005151:Facial Injuries / Q000150:complications*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications / Q000523:psychology*; D012189:Retrospective Studies; D013001:Somatoform Disorders / Q000150:complications / Q000523:psychology*