Download PDF
Klinische Neurophysiologie 2017; 48(04): 187-197
DOI: 10.1055/s-0043-119042
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Psychogene neurologische Störungen: Klinik und elektrophysiologische Diagnostik

Psychogenic Neurological Disorders: Clinical Tests und Electrophysiology
Manuel Dafotakis
,
Sebastian Paus
Further Information

Publication History

Publication Date:
21 December 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Etwa 5 % der in Ambulanzen für Bewegungsstörungen vorstelligen Patienten haben eine psychogene Erkrankung, die sich als Tremor, Myoklonus oder Dystonie präsentiert. Auch für Lähmungen und Sensibilitätsstörungen lässt sich in manchen Fällen kein organisches Korrelat nachweisen. Da die Diagnosestellung einer psychogenen Störung zeit- und kostenintensiv sein kann, sollte rationale Zusatzdiagnostik erfolgen, die sich am klinischen Syndrom orientiert. Neben klinischen Tests kommt dabei der Elektrophysiologie eine große Bedeutung zu.

Abstract

Up to 5% of all cases presenting in specialized movement disorder clinics are of psychogenic origin. Tremor, dystonia and myoclonus account for up to 70% of all psychogenic movement disorders. In emergency medicine, paralysis and sensory disturbances without any organic correlates are sometimes present. Diagnosis is commonly made by exclusion of other causes, is time consuming and expensive. However, patients suffering from psychogenic disorders may show positive clinical features, such as acute onset and distractibility. Also, there are a few supportive clinical tests and diagnostic tools, which help establish the diagnosis of psychogenicity. In this review, the significance and interpretation of clinical neurophysiology in selected pathologies of psychogenic origin and differential diagnostic aspects are discussed.

Schlüsselwörter

funktionelle Störungen - dissoziative Störungen - kinematische Bewegungsanalyse - Somatisierungsstörung - Simulation

Key words

kinematic motion analysis - psychotherapy - somatisation - functional disorder - malingering
 

  • Literatur

  • 1 Dafotakis M, Nowak DA. Psychogene Bewegungsstörungen – Klinik, Zusatzdiagnostik und Differenzialdiagnose. Aktuelle Neurologie 2015; 10: 603-610
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Brown RJ, Cardeña E, Nijenhuis E. et al. Should conversion disorder be reclassified as a dissociative disorder in DSM V?. Psychosomatics 2007; 48: 369-378
    CrossrefPubMedGoogle Scholar
  • 3 Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol 1995; 65: 231-257
    PubMedGoogle Scholar
  • 4 Hinson VK, Haren WB. Psychogenic movement disorders. Lancet Neurol 2006; 5: 695-700
    CrossrefPubMedGoogle Scholar
  • 5 Deuschl G, Köster B, Lücking CH. et al. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord 1998; 13: 294-302
    CrossrefPubMedGoogle Scholar
  • 6 Koehler K, Jakumeit U. Subacute sclerosing panencephalitis presenting as Leonhard's speech-prompt catatonia. Br J Psychiatry 1976; 129: 29-31
    CrossrefPubMedGoogle Scholar
  • 7 Laroche C, Buge A, Escourolle R. et al. "Astasia-abasia" unilateral left-sided apraxia, and touch disorders in an astrocytoma of the corpus callosum. A clinico-pathological report. Ann Med Interne (Paris) 1976; 127: 1-10
    PubMedGoogle Scholar
  • 8 Marsden CD, Harrison MJ, Bundey S. Natural history of idiopathic torsion dystonia. Adv Neurol 1976; 14: 177-187
    PubMedGoogle Scholar
  • 9 Nowak DA, Rosenkranz K, Topka H. et al. Disturbances of grip force behaviour in focal hand dystonia: evidence for a generalised impairment of sensory-motor integration?. J Neurol Neurosurg Psychiatry 2005; 76: 953-959
    CrossrefPubMedGoogle Scholar
  • 10 Slater ETO, Glithero E. A follow-up of patients diagnosed as suffering from "hysteria”. J Psychosom Res 1965; 9: 9-13
    CrossrefPubMedGoogle Scholar
  • 11 Stone J, Smyth R, Carson A. et al. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ 2005; 29: 331 989
    PubMedGoogle Scholar
  • 12 Thomas M, Jankovic J. Psychogenic movement disorders: diagnosis and management. CNS Drugs 2004; 18: 437-452
    CrossrefPubMedGoogle Scholar
  • 13 Block F, Dafotakis M. Drug-induced tremor. Fortschr Neurol Psychiatr 2011; 79: 570-575
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Hofmann A, Tangri N, Lafontaine AL. et al. Myoclonus as an acute complication of low-dose hydromorphone in multiple system atrophy. J Neurol Neurosurg Psychiatry 2006; 77: 994-995
    CrossrefPubMedGoogle Scholar
  • 15 Dafotakis M, Fink GR, Nowak DA. Dopaminergic drug-induced tics in PARK2-positive Parkinson's disease. Mov Disord 2008; 23: 628
    CrossrefPubMedGoogle Scholar
  • 16 Laub HN, Dwivedi AK, Revilla FJ. et al. Diagnostic performance of the "Huffing and Puffing" sign in psychogenic (functional) movement disorders. Mov Disord Clin Pract (Hoboken) 2015; 2: 29-32
    CrossrefPubMedGoogle Scholar
  • 17 Kim JY, Chung EJ, Lee WY. et al. Therapeutic effect of repetitive transcranial magnetic stimulation in Parkinson's disease: analysis of [11C] raclopride PET study. Mov Disord 2008; 23: 207-211
    CrossrefPubMedGoogle Scholar
  • 18 Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain 2010; 133: 1537-1551
    CrossrefPubMedGoogle Scholar
  • 19 Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA 1908; 51: 746-747
    PubMedGoogle Scholar
  • 20 Mehndiratta MM, Kumar M, Nayak R. et al. Hoover's sign: Clinical relevance in Neurology. J Postgrad Med 2014; 6: 297-299
    PubMedGoogle Scholar
  • 21 Shams T, Ashraf F, DeGeorgia M. Charles Franklin Hoover and the Hoover Sign. Neurology 2012; 78: P04.006
    PubMedGoogle Scholar
  • 22 Dohmen C, Bösel J. Acute focal neurological deficits in the emergency room. Nervenarzt 2017; 88: 616-624
    CrossrefPubMedGoogle Scholar
  • 23 Cantello R, Boccagni C, Comi C. et al. Diagnosis of psychogenic paralysis: the role of motor evoked potentials. J Neurol 2001; 248: 889-897
    CrossrefPubMedGoogle Scholar
  • 24 Meyer BU, Britton TC, Benecke R. et al. Motor responses evoked by magnetic brain stimulation in psychogenic limb weakness: diagnostic value and limitations. J Neurol 1992; 239: 251-255
    PubMedGoogle Scholar
  • 25 Dafotakis M, Ameli M, Vitinius F. et al. Transcranial magnetic stimulation for psychogenic tremor - a pilot study. Fortschr Neurol Psychiatr 2011; 79: 226-233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Schönfeldt-Lecuona C, Lefaucheur JP, Lepping P. et al. Non-Invasive Brain Stimulation in Conversion (Functional) Weakness and Paralysis: A Systematic Review and Future Perspectives. Front Neurosci 2016; 10: 140
    CrossrefPubMedGoogle Scholar
  • 27 Stone J, Vermeulen M. Functional sensory symptoms. Handb Clin Neurol 2016; 139: 271-281
    PubMedGoogle Scholar
  • 28 Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain 2010; 133: 1537-1551
    CrossrefPubMedGoogle Scholar
  • 29 Rolak LA. Psychogenic sensory loss. J Nerv Ment Dis 1988; 176: 686-687
    CrossrefPubMedGoogle Scholar
  • 30 Daum C, Gheorghita F, Spatola M. et al. Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. J Neurol Neurosurg Psychiatry 2015; 86: 425-430
    CrossrefPubMedGoogle Scholar
  • 31 Spiegel J, Heiss C, Frühauf E. et al Polygraphic validation of distraction tasks in clinical differential tremor diagnosis. Nervenarzt 1998; 69: 886-891
    CrossrefPubMedGoogle Scholar
  • 32 Kumru H, Valls-Solé J, Valldeoriola F. et al. Transient arrest of psychogenic tremor induced by contralateral ballistic movements. Neurosci Lett 2004; 370: 135-139
    CrossrefPubMedGoogle Scholar
  • 33 O'Suilleabhain PE, Matsumoto JY. Time-frequency analysis of tremors. Brain 1998; 121: 2127-2134
    CrossrefPubMedGoogle Scholar
  • 34 Schwingenschuh P, Katschnig P, Seiler S. et al. Moving toward „laboratory-supported“ criteria for psychogenic tremor. Mov Disord 2011; 26: 2509-2515
    CrossrefPubMedGoogle Scholar
  • 35 Dafotakis M, Schönfeldt-Lecuona C, Fink GR. et al. Psychogenic tremor. Fortschr Neurol Psychiatr 2008; 76: 647-654
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Fahn S, Eldridge R. Definition of dystonia and classification of the dystonic states. Adv Neurol 1976; 14: 1-5
    PubMedGoogle Scholar
  • 37 Miyasaki JM, Sa DS, Galvez-Jimenez N. et al. Psychogenic movement disorders. Can J Neurol Sci 2003; 30 (Suppl. 01) 94-100
    CrossrefPubMedGoogle Scholar
  • 38 Diener H-C, Weimar C. (Hrsg.) Leitlinien für Diagnostik und Therapie in der Neurologie, Herausgegeben von der Kommission "Leitlinien" der Deutschen Gesellschaft für Neurologie. Stuttgart: Thieme Verlag; 2012
    Google Scholar
  • 39 Ganos C, Edwards MJ, Bhatia KP. The Phenomenology of Functional (Psychogenic) Dystonia. Movment Disords Clncl Practice 2014; 1: 36-44
    PubMedGoogle Scholar
  • 40 Deuschl G, Heinen F, Kleedorfer B. et al. Clinical and polymyographic investigation of spasmodic torticollis. J Neurol 1992; 239: 9-15
    CrossrefPubMedGoogle Scholar
  • 41 Brown P. Clinical Neurophysiology of Myoclonus. Aus: Psychogenic movement disorders. (Hrsg.) Hallet M, Fahn S, Jankovic J, Lang AE, Cloninger CR, Yudofsky SC. 2006. S 262-264
    Google Scholar
  • 42 Cassim F, Houdayer E. Neurophysiology of myoclonus. Neurophysiol Clin 2006; 36: 281-291
    CrossrefPubMedGoogle Scholar
  • 43 Lozsadi D. Myoclonus: a pragmatic approach. Pract Neurol 2012; 12: 215-224
    CrossrefPubMedGoogle Scholar
  • 44 Shibasaki H, Yamashita Y, Neshige R. et al. Pathogenesis of giant somatosensory evoked potentials in progressive myoclonic epilepsy. Brain 1985; 108: 225-240
    CrossrefPubMedGoogle Scholar
  • 45 Roze E, Bounolleau P, Ducreux D. et al. Propriospinal myoclonus revisited: Clinical, neurophysiologic, and neuroradiologic findings. Neurology 2009; 72: 1301-1309
    CrossrefPubMedGoogle Scholar