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儿童功能性运动障碍病例系列——现象学与临床特征

A case series of functional movement disorders in paediatric population-phenomenology and clinical characteristics.

作者信息

Cherian Ajith, Kalikavil Puthanveedu Divya, R Amod, Sundaram Soumya

机构信息

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India.

出版信息

Acta Neurol Belg. 2025 Jul 7. doi: 10.1007/s13760-025-02836-6.

Abstract

BACKGROUND

Literature on functional movement disorders (FMD) in paediatric age group is scarce.

OBJECTIVES

To study the phenomenology and characteristics of FMDs in paediatric age group.

METHODS

The study included 13 children (8 girls and 5 boys) from a tertiary-care centre. Assessment of FMD was based on Fahn and Williams criteria. Data included phenomenology, socioeconomic background, electrophysiological, and imaging investigations.

RESULTS

Mean age of onset was 12.1 ± 2.3 years. Sudden onset and triggers like minor injuries and stressors were common precipitants. 68% of the children were from urban areas, 61% belonged to low socioeconomic status and 61.5% had intellectual disability. 72% had a precipitating factor. The most common phenomenology was myoclonus (38%), followed by tremor (30%), dystonia (23%), and abnormal gait (15%). Clues to suggest a functional etiology were, isolated or predominant involvement of the dominant upper limb, distractibility, and entrainment in the case of tremor. Significant variability in frequency, amplitude, and distribution of the FMD by distracting manoeuvres were helpful in establishing the diagnosis. Tremor and dystonia predominated in girls, while myoclonus manifested more often in boys. Ten subjects (76%) presented with an isolated movement disorder, while 3 patients (24%) had a combination of ≥ 2. Nine patients had other sensory symptoms most commonly headache.

CONCLUSIONS

FMDs were more common in children with intellectual disability than in those with normal IQ. Myoclonus was the most observed phenomenology. Among other comorbidities headache was the most common and depression followed by generalised anxiety were the most common psychiatric associations. Complete recovery is often possible with early intervention.

摘要

背景

关于儿童年龄组功能性运动障碍(FMD)的文献稀少。

目的

研究儿童年龄组FMD的现象学和特征。

方法

该研究纳入了一家三级医疗中心的13名儿童(8名女孩和5名男孩)。FMD的评估基于法恩和威廉姆斯标准。数据包括现象学、社会经济背景、电生理和影像学检查。

结果

平均发病年龄为12.1±2.3岁。突然发病以及轻伤和应激源等诱因是常见的促发因素。68%的儿童来自城市地区,61%属于社会经济地位低下,61.5%有智力残疾。72%有促发因素。最常见的现象学是肌阵挛(38%),其次是震颤(30%)、肌张力障碍(23%)和异常步态(15%)。提示功能性病因的线索包括,优势上肢孤立或主要受累、易分散注意力以及震颤时的同步化。通过分散注意力动作,FMD在频率、幅度和分布上的显著变化有助于确立诊断。震颤和肌张力障碍在女孩中占主导,而肌阵挛在男孩中更常见。10名受试者(76%)表现为孤立性运动障碍,而3名患者(24%)有≥2种运动障碍的组合。9名患者有其他感觉症状,最常见的是头痛。

结论

FMD在智力残疾儿童中比智商正常的儿童更常见。肌阵挛是最常见的现象学表现。在其他合并症中,头痛最常见,其次是抑郁症和广泛性焦虑症是最常见的精神科关联疾病。早期干预通常有可能实现完全康复。

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