Holly N Laub1, Alok K Dwivedi2, Fredy J Revilla1, Andrew P Duker1, Cara Pecina-Jacob1, Alberto J Espay1. 1. James J. and Joan A. Gardner Center for Parkinson disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA. 2. Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Abstract
OBJECTIVE: To determine the diagnostic value of effort-associated behaviors ("huffing and puffing" spectrum) in patients with psychogenic movement disorders. METHODS: Three blinded clinicians rated presence, severity, and duration of effort-associated features during standing and walking tasks on edited videos of 131 patients with psychogenic gait disorders and 37 patients with organic gait disorders. RESULTS: Huffing, grunting, grimacing, and breath holding were the most common effort-associated behaviors in patients with psychogenic gait disorders, with a combined prevalence of 44% and disproportionate to the severity of gait impairment compared to organic gait disorders. The presence of "huffing and puffing"-type behaviors yielded a relatively low sensitivity but high specificity for the diagnosis of psychogenic movement disorders, increasing the odds of diagnosis 13-fold (95%, CI: 4.2-43.8) compared to organic gait disorders. CONCLUSIONS: Demonstration of effort-associated behaviors during standing and walking strongly supports the psychogenic nature of disorders when gait is involved.
OBJECTIVE: To determine the diagnostic value of effort-associated behaviors ("huffing and puffing" spectrum) in patients with psychogenic movement disorders. METHODS: Three blinded clinicians rated presence, severity, and duration of effort-associated features during standing and walking tasks on edited videos of 131 patients with psychogenic gait disorders and 37 patients with organic gait disorders. RESULTS: Huffing, grunting, grimacing, and breath holding were the most common effort-associated behaviors in patients with psychogenic gait disorders, with a combined prevalence of 44% and disproportionate to the severity of gait impairment compared to organic gait disorders. The presence of "huffing and puffing"-type behaviors yielded a relatively low sensitivity but high specificity for the diagnosis of psychogenic movement disorders, increasing the odds of diagnosis 13-fold (95%, CI: 4.2-43.8) compared to organic gait disorders. CONCLUSIONS: Demonstration of effort-associated behaviors during standing and walking strongly supports the psychogenic nature of disorders when gait is involved.
Entities:
Keywords:
excessive effort; psychogenic movement disorders
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