Psychogenic parkinsonism: A combination of clinical, electrophysiological, and [123I]-FP-CIT SPECT scan explorations improves diagnostic accuracy

• Published in: Movement disorders 2006-03, Vol.21 (3), p.310-317
• Main Authors: Benaderette, Sandrine, Fregonara, Paolo Zanotti, Apartis, Emmanuelle, Nguyen, Charles, Trocello, Jean-Marc, Remy, Philippe, Devaux, Jean-Yves, Askienazy, Serge, Vidailhet, Marie
• Format: Article
• Language: English
• Subjects: Adult; Aminoacid disorders; Anxiety - psychology; Biological and medical sciences; Brain - blood supply; Brain - diagnostic imaging; Cerebrovascular Circulation - drug effects; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Depression - psychology; Diagnosis, Differential; Electromyography; Errors of metabolism; Female; Humans; Ioflupane SPECT scan (DaTSCAN); Male; Medical sciences; Metabolic diseases; Middle Aged; Muscle, Skeletal - innervation; Neurology; neurophysiology; Parkinson Disease, Secondary - diagnostic imaging; Parkinson Disease, Secondary - etiology; Parkinson Disease, Secondary - therapy; Parkinson's disease; psychogenic movement disorders; psychogenic parkinsonism; psychogenic tremor; Psychotherapy; Radiopharmaceuticals - pharmacokinetics; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Tropanes - pharmacokinetics
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.20720

We evaluated the concordance between independent clinical, electrophysiological, and [123I]‐FP‐CIT SPECT scan explorations as a staged procedure for an accurate diagnosis in 9 patients referred with a diagnosis of suspected psychogenic parkinsonism. Three patients were reclassified as pure psychogenic parkinsonism (PP), 6 with a form of combined psychogenic parkinsonism and Parkinson's disease (PP + PD), and none with pure Parkinson's disease (PD). Electrophysiological recordings showed the characteristics of psychogenic tremor in 5 of 7 patients with tremor. In two of these 5, PD tremor was also recorded. SPECT scan results were abnormal in five of 9 patients. In one case of clinically suspected PP + PD, SPECT scan results were normal. Long‐term follow‐up supported the final diagnosis of PP (initial clinical misdiagnosis). Electrophysiology contributes to the clinical diagnosis of psychogenic tremor and may help confirm associated organic PD tremor. [123I]‐FP‐CIT SPECT is a robust test to ascertain dopaminergic denervation and increase the confidence of the clinical and electrophysiological diagnosis of associated PD. A combination of clinical, electrophysiological, and [123I]‐FP‐CIT SPECT scan explorations improves diagnostic accuracy in order to distinguish PP from PP + PD. © 2005 Movement Disorder Society