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Issue: Issue 3 (2016) – Supplement 1

Case Report

Psychogenic facial movement disorder: a case report

Eren Gozke, Boran Can Saraçoglu, Mustafa Eser, Aylin Reyhani, and Pelin Dogan Ak
Background: Psychogenic movement disorders (PMD) include a wide range of involuntary motor function disturbances that lack an organic cause. Presentation with the form of any known organic movement disorder can be seen. Psychogenic facial movement disorder (PFMD) is an interesting form of PMD and it is not yet fully characterised. 
Case report: A 44-year-old female patient was evaluated because of deviation of her mouth. She was admitted to another hospital before, in which cranial MRI had been performed and did not demonstrate any abnormality. Steroid therapy had been initiated with the diagnosis of peripheral facial paralysis (PFP). The patient was admitted to our outpatient clinic because the deviation of her mouth was not resolved completely. Neurological examination revealed flattening of the right nasolabial fold and downward retraction of the contralateral edge of the mouth, which disappeared during talking and exacerbated at rest. These findings suggested psychogenic facial dystonia and she was diagnosed as having PFMD. Her steroid therapy was discontinued and treatment with alprazolam was initiated. A prominent resolution of her complaints was observed during post-treatment follow-up control visits. 
Discussion: Although PFMD is not a rare condition, it is still under-recognized and under-treated. In patients with PFMD, phasic or tonic muscular spasms resembling dystonia can be seen. It involves most commonly the lips. A prompt diagnosis based on positive clinical signs will prevent unnecessary investigations and lessen the morbidity. 

Keywords: Psychogenic movement disorders, Facial movement disorders, Peripheral facial paralysis.

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S18 
Supplemental Material

Video 1: Pre-treatment: The patient demonstrated downward protrusion of her left lower lip with ipsilateral mouth deviation. She also had flattening of the right nasolabial fold. These findings were attenuated during talking and exacerbated at rest. She could close her eyes completely, elevate her eyebrows, show her teeth without any asymmetry, purse her lips and open her mouth.

Video 2: Post-treatment: 1 week after the treatment, her symptoms almost completely disappeared.
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