J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-304682
  • Editorial commentary

What a jerk: perils in the assessment of psychogenic movement disorders

  1. Thomas A Pollak
  1. Correspondence to Dr Thomas A Pollak, Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK; thomas.pollak{at}
  • Received 3 January 2013
  • Revised 9 January 2013
  • Accepted 15 January 2013
  • Published Online First 22 February 2013

In 2012, the upstate New York town of LeRoy became something of a neuropsychiatric battleground when it witnessed an outbreak of cases of sudden-onset tic-like behaviour in high-school age girls, many from a single school.1 The ‘Tourette's epidemic’, as it was dubbed by a fascinated world media, attracted different explanations: for every claim that this was ‘mass hysteria’ (ie, conversion disorder), there was an outraged counter-claim to the effect that such a diagnosis was missing a real organic cause of these tics and jerks, variously thought to be PANDAS (a rare and still controversial apparent autoimmune response to streptococcal infection), a response to human papilloma virus (HPV) vaccination or even the result of an environmental toxin.

While the dust has yet to settle on the diagnostic facts of the matter, interviews with patients, their families and many experts made abundantly clear how …

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