Summary
Thirty-seven patients with psychogenic disorders of stance and gait were clinically evaluated, recorded on video, and analysed with regard to clinical phenomenology. Characteristic, suggestive and unspecific features were identified. Six characteristic features proved most valuable for diagnosis of psychogenesis, as they occurred alone or in combination in 97% of patients: (1) momentary fluctuations of stance and gait, often in response to suggestion; (2) excessive slowness or hesitation of locomotion incompatible with neurological disease; (3) “psychogenic” Romberg test with a build-up of sway amplitudes after a silent latency or with improvement by distraction; (4) uneconomic postures with wastage of muscular energy; (5) the “walking on ice” gait pattern, which is characterized by small cautious steps with fixed ankle joints; (6) sudden buckling of the knees, usually without falls. Seventy-three percent of patients had additional suggestive features. Classification into characteristic subtypes was not found useful because predominant features varied from patient to patient and occurred in various combinations. Factitious impairment of stance and gait was studied in 13 healthy drama students. Simulated gait dysfunction appeared less conspicuous and more difficult to diagnose than the clinical psychogenic disorders.
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References
Bing R (1924) Lehrbuch der Nervenkrankheiten, 3rd edn. Urban & Schwarzenberg, Berlin, pp 663–667
Dejerine J (1914) Semiologie des affections du système nerveux. Masson, Paris, pp 541–549
Desai BT, Porter RJ, Penry JK (1982) Psychogenic seizures. Arch Neurol 39:202–209
Fahn S, Williams DT (1988) Psychogenic dystonia. Adv Neurol 50:431–455
Gates JR, Ramani V, Whalen S, Loewenson R (1985) Ictal characteristics of pseudoseizures. Arch Neurol 42:1183–1187
Gullick TA, Spinks IP, King DW (1982) Pseudoseizures: ictal phenomena. Neurology 32:24–30
Janet P (1920) The major symptoms of hysteria, 2nd edn. Macmillan, New York
Keane JR (1989) Hysterical gait disorders: 60 cases. Neurology 39:586–589
Koller WC, Trimble J (1985) The gait abnormality of Huntington's disease. Neurology 35:1450–1454
Lempert T, Dieterich M, Huppert D, Brandt T (1990) Psychogenic disorders in neurology. Frequency and clinical spectrum. Acta Neurol Scand 82:335–340
Luther JS, McNamara JO, Carwile S, Miller P, Hope V (1982) Pseudoepileptic seizures: methods and video analysis to aid diagnosis. Ann Neurol 12:458–462
Papa SM, Gershanik OS (1988) Orthostatic tremor: an essential tremor variant? Mov Disord 2:97–108
Simopoulos AM, Hildegard H (1969) Progressive hysterical tetraplegia with contractures. A case study. Johns Hopkins Med J 125:14–18
Solberg Sorensen P, Jansen EC, Gjerris F (1986) Motor disturbance in normal pressure hydrocephalus. Arch Neurol 43:34–38
Strümpell A (1899) Lehrbuch der speziellen Pathologie und Therapie der inneren Kankheiten, vol 3, 12th edn. Vogel, Leipzig, pp 614–616
Sudarski L, Sheldon S (1987) Gait disorder in late-life hydrocephalus. Arch Neurol 263–267
Thompson APJ, Sills JA (1988) Diagnosis of functional illness presenting with gait disorder. Arch Dis Child 63:148–153
Thompson CE (1982) Hysterical paralysis. J Fam Pract 15:1169–1173
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Lempert, T., Brandt, T., Dieterich, M. et al. How to identify psychogenic disorders of stance and gait. J Neurol 238, 140–146 (1991). https://doi.org/10.1007/BF00319680
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DOI: https://doi.org/10.1007/BF00319680