Abstract Details

Title The Pseudodystonia: Important Pitfalls in the Diagnosis of Dystonia

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-002

Objective To identify clinical characteristics that differentiate dystonia from their dystonic mimics, or pseudodystonias, and to propose a clinical algorithm for this purpose.

Background The current classification of dystonia incorporates many phenotypes but excludes a number of diagnoses that imitate dystonias, the pseudodystonias. In the evaluation and treatment of abnormal sustained posturing that appears dystonic, identification of these pseudodystonias is critical to avoid missing alternative and potentially life-threatening diagnoses. To date, there has not yet been a systemic review of pseudodystonias.

Design/Methods A systemic literature review of pseudodystonia and dystonia mimics was completed using PubMed and Web of Science.

Results

We identified 31 case reports of pseudodystonia, which we further subdivided into 3 categories: mimics of cervical dystonia, focal hand dystonia, or generalized dystonia. Mimics of cervical dystonia included 5 cases of atlantoaxial rotatory subluxation, 4 case reviews of congenital muscular torticollis, 3 cases of neck masses, 2 cases of posterior fossa tumors, 2 cases of ocular torticollis, and 4 cases of Sandifer syndrome. Mimics of focal hand dystonia included 1 review of Dupuytren’s, 1 case of Issacs’ syndrome, 1 case of a peripheral neurogenic tumor, 2 cases of myopathy, and 1 case of multifocal motor neuropathy. Mimics of generalized dystonia included 4 cases of Stiff Person Syndrome and 1 case of Satayoshi syndrome. We discuss clinical features that distinguish dystonia from pseudodystonia, such as sensory geste, task-specificity, abnormal muscle activation and disappearance in sleep. We conversely discuss clinical features that make pseudodystonia more likely than dystonia, such as muscle weakness, fasciculations, myokymia, preceding trauma, prodromal URI, palpable mass, or abnormal eye movements.

Conclusions Pseudodystonias are alternative, not-to-miss diagnoses when evaluating an abnormal movement for possible dystonia. We have identified specific clinical characteristics and developed algorithms to aid the clinician in distinguishing specific dystonia from their pseudodystonic imitators.

Authors/Disclosures
Ling Pan, MD (Rutgers Health) PRESENTER	No disclosure on file
Steven Frucht, MD (New York University Medical Center)	Dr. Frucht has nothing to disclose.

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