PT - JOURNAL ARTICLE AU - Robert Fekete AU - Jose Fidel Baizabal-Carvallo AU - Ainhi D Ha AU - Anthony Davidson AU - Joseph Jankovic TI - Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls AID - 10.1136/jnnp-2011-300733 DP - 2012 Feb 01 TA - Journal of Neurology, Neurosurgery & Psychiatry PG - 202--204 VI - 83 IP - 2 4099 - http://jnnp.bmj.com/content/83/2/202.short 4100 - http://jnnp.bmj.com/content/83/2/202.full SO - J Neurol Neurosurg Psychiatry2012 Feb 01; 83 AB - Background Convergence spasm refers to transient ocular convergence, miosis and accommodation associated with disconjugate gaze mimicking abducens palsy. While it may be a manifestation of brainstem pathology, this sign is often associated with conversion (somatisation) disorders and, if unrecognised as a sign of a psychogenic disorder, it may lead to unnecessary and occasionally invasive evaluation.Methods To better characterise this neuro-ophthalmologic sign, 36 subjects were studied, 13 with psychogenic movement disorders, 11 with organic movement disorders and 12 normal controls. Patients were recorded during a manoeuvre to elicit convergence spasm and the videotapes were rated by two blinded raters on a scale of 0=normal, 1=mild convergence spasm and 2=marked convergence spasm.Results Convergence spasm was present in 9/13 (69%) psychogenic movement disorders cases, 4/11 (36%) non-psychogenic movement disorders cases and 4/12 (33%) controls (p=0.049 when psychogenic vs non-psychogenic disorders or controls were compared). Inter-rater reliability analysis of the presence (rating 1 or 2) versus absence (rating 0) showed good agreement (27/36 or 75%; kappa 0.491, SE 0.141, p=0.002). Analysis for the presence of marked convergence spasm (rating 2) yielded agreement in 32/36 (88.9%) examinations (kappa 0.652, SE 0.154, p<0.001) with a specificity of 87% (sensitivity 15%).Conclusion Convergence spasm may provide benefit in the clinical examination of psychogenic movement disorders patients.