Psychogenic Dystonia in Tunisian Children

Abstract

Psychogenic dystonia in children is rare and often difficult to distinguish from organic dystonia. It is usually related to a psychological or psychiatric underlying cause. From January 2004 to November 2009, 5 children with psychogenic dystonia among 200 with dystonia were followed up in our department. Elements of history, physical examination, videotaping and management were analyzed. Mean age was 14.9 years, mean age of onset was 13 years and mean follow up period was 6 months. The dystonia onset was abrupt in 3 patients and progression resulted rapidly into fixed dystonia in 4 patients. Pain was observed in all patients. Paroxysmal dystonia was observed in one patient. An underlying psychiatric disorder was found in all patients. All patients improved with psychotherapy and anxiolytic or antidepressant drugs. Only one patient showed relapse after each familial conflicts. The small size of our series reflects this disorder is rare (1 case/year). Pain was a prominent feature in all patients. Children have acute onset, short duration of disease and improved under psychological therapy and drugs. Psychogenic dystonia in children is usually misdiagnosed. It is necessary to analyze clinical features and outcome of this disorder to reach a clear diagnosis and adequate management, which requires multifaceted approach, including psychological, physical and pharmacological therapies.