Physiology of psychogenic movement disorders.
Physiology of psychogenic movement disorders.
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DOI：
10.1016/j.jocn.2009.11.021
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发表时间：
2010-08
影响因子：
2
通讯作者：
Hallett, Mark
中科院分区：
文献类型：
--
作者：
Hallett, Mark
关键词：
心因性运动障碍(PMD)很常见，但其生理学很大程度上是未知的。在大多数情况下，运动是非自愿的，但在少数情况下，当障碍是伪装的或人为的时，患者在撒谎，运动是自愿的。从生理上讲，我们无法区分自愿和非自愿。Bereitschaft斑点(BP)是产生运动的某些大脑机制的指示，通常被认为是自愿运动，但其本身并不表明运动是自愿的。有很好的临床神经生理学方法可以确定肌阵挛或震颤是否是PMD。例如，心理性肌阵挛通常有血压，而心理性刺激敏感型肌阵挛具有可变的潜伏期，时间与正常反应时间相似。心理性震颤随着时间的推移会有不同的频率，在两个手臂上是同步的，很可能伴随着随意的有节奏的运动。这些事实表明，PMD共享运动生产的自愿机制。目前还没有明确的测试来区分心因性肌张力障碍和器质性肌张力障碍，尽管最近有报道。两组患者均出现相似的生理异常。问题是，如何在自愿机制下开展运动，而不是被认为是自愿的。
Psychogenic movement disorders (PMDs) are common, but their physiology is largely unknown. In most situations, the movement is involuntary, but in a minority, when the disorder is malingering or factitious, the patient is lying and the movement is voluntary. Physiologically, we cannot tell the difference between voluntary and involuntary. The Bereitschaftspotential (BP) is indicative of certain brain mechanisms for generating movement, and is seen with ordinarily voluntary movements, but by itself does not indicate that a movement is voluntary. There are good clinical neurophysiological methods available to determine whether myoclonus or tremor is a PMD. For example, psychogenic myoclonus generally has a BP, and psychogenic stimulus-sensitive myoclonus has a variable latency with times similar to normal reaction times. Psychogenic tremor will have variable frequency over time, be synchronous in the two arms, and might well be entrained with voluntary rhythmic movements. These facts suggest that PMDs share voluntary mechanisms for movement production. There are no definitive tests to differentiate psychogenic dystonia from organic dystonia, although one has been recently reported. Similar physiological abnormalities are seen in both groups. The question arises as to how a movement can be produced with voluntary mechanisms, but not be considered voluntary.
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