Prevalence of functional (psychogenic) parkinsonism in two Swiss movement disorders clinics and review of the literature.

Frasca Polara, Giulia; Fleury, Vanessa; Stone, Jon; Barbey, Anita; Burkhard, Pierre R; Vingerhoets, François; Aybek, Selma (2018). Prevalence of functional (psychogenic) parkinsonism in two Swiss movement disorders clinics and review of the literature. Journal of the neurological sciences, 387, pp. 37-45. Elsevier 10.1016/j.jns.2018.01.022

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BACKGROUND

Functional parkinsonism (FP) is considered rare but no studies have looked at its frequency. Case series have described high rates of comorbidity with Parkinson's disease (PD), suggesting a possible association between these conditions.

OBJECTIVES

To study the prevalence, epidemiology and clinical features of FP and its association with PD.

METHODS

We conducted a cross-sectional population-based prevalence study as well as a chart review of cases who received a diagnosis of FP over a 10-year-period in two movement disorder clinics in Switzerland. Epidemiological data regarding FP features were collected. The co-occurrence of PD, psychiatric disorders and other functional disorders were recorded. Clinical differences between FP and FP+PD groups are presented and discussed in light of a literature review.

RESULTS

The crude prevalence of FP was 0.64 per 100,000 in our population. FP represented 0.24% of patients with parkinsonism. Among 12 FP cases, female gender predominance (87%), mean age of onset of 45.5(±13.3 Standard deviation SD) years and prolonged diagnostic delay (mean 59±75 SD months) was found. Six patients had an additional diagnosis of PD, 83% of depression and 66% of other functional neurological disorder. In four patients with FP+PD, FP preceded PD by 6 to 56months.

CONCLUSIONS

These results suggest that FP should be considered in the differential diagnosis of patients presenting with parkinsonism. The high rate of co-occurrence with PD emphasizes the importance of long-term follow up of these patients. The observation that FP often precedes PD should be verified in prospective studies.

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