Ganos Christos, Kassavetis Panagiotis, Cerdan Maria, Erro Roberto, Balint Bettina, Price Gary, Edwards Mark J, Bhatia Kailash P
Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology University College London London United Kingdom.
Department of Neurology University Medical Center Hamburg-Eppendorf (UKE) Hamburg Germany.
Mov Disord Clin Pract. 2015 Mar 16;2(2):163-169. doi: 10.1002/mdc3.12140. eCollection 2015 Jun.
Obsessional slowness (OS) denotes a rare condition of disablingly slow motor performance. It was originally described in patients with obsessive-compulsive disorder as a "primary" condition; however, subsequent reports have included heterogeneous clinical populations. We wished to reassess patients with this diagnosis at our own institution and also revisit the literature to provide an overview of this condition.
Clinical documentation and videos of 3 patients diagnosed with OS in the National Hospital for Neurology and Neurosurgery (London, UK) were reviewed. One of the patients was clinically reappraised. A systematic review of published articles with sufficient clinical patient information was also conducted.
Our 3 cases were male with symptom onset in adolescence or early adulthood. Motor slowness with poverty of movement and a history of obsessive-compulsive symptoms were characteristic. Poor speech production, bizarre postures, mannerisms, echophenomena, and oculogyric tics were also noted. Dopaminergic imaging was normal in 2 cases. One case had autistic features. Systematic literature review identified 77 further cases. Male preponderance with symptom onset mainly during the second decade and presence of obsessive-compulsive symptoms were noted. Additional motor and neuropsychiatric features were often present.
The existence of OS as a "primary" condition is doubtful. This diagnosis has been given to characterize different clinical presentations ranging from obsessive-compulsive disorder with motor slowness resulting from covert obsessive-compulsive symptoms to catatonia. Clinicians should be aware of this syndrome to separate it from juvenile parkinsonism and other causes of motor slowness given that diagnostic approaches and treatment strategies differ.
强迫性迟缓（OS）是一种罕见的导致运动表现极度迟缓的病症。它最初在强迫症患者中被描述为一种“原发性”病症；然而，后续报告纳入了不同的临床群体。我们希望在我们自己的机构重新评估患有此诊断的患者，并重新审视文献以概述这种病症。
回顾了英国伦敦国家神经病学和神经外科医院3例被诊断为OS的患者的临床记录和视频。其中1例患者进行了临床重新评估。还对已发表的有足够临床患者信息的文章进行了系统综述。
我们的3例患者均为男性，症状在青春期或成年早期出现。运动迟缓伴动作减少以及强迫症状史是其特征。还注意到言语表达差、怪异姿势、习惯性动作、模仿现象和动眼性抽搐。2例患者的多巴胺能成像正常。1例患者有自闭症特征。系统文献综述又确定了77例病例。注意到男性占优势，症状主要在第二个十年出现，且存在强迫症状。通常还存在其他运动和神经精神特征。
作为一种“原发性”病症的OS的存在值得怀疑。这个诊断被用于描述从伴有由隐性强迫症状导致的运动迟缓的强迫症到紧张症等不同的临床表现。鉴于诊断方法和治疗策略不同，临床医生应意识到这种综合征，以便将其与青少年帕金森病和其他运动迟缓原因区分开来。
