A Case of Chronic Functional Parkinsonism Treated Over 10 Years for the Diagnosis of Juvenile Parkinsonism

2021 32(4): 286-290
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Functional (psychogenic) movement disorders (FMD) constitute a
cluster of heterogeneous diagnoses involving motor symptoms that
cannot be explained by organic pathology and are often associated
with underlying psychological problems. In psychiatry, patients with
FMD are often placed within the scope of somatoform disorders and
conversion disorders. Functional Parkinsonism (FP) is a rare form
of FMD seen in 1.5% of all patients presenting with symptoms of
parkinsonism. Although almost all symptoms of parkinsonism can
be present in FP, clinical features such as sudden onset and a nonprogressive
course, inconsistent response to pharmacotherapy, and
atypical findings in neurological examination are considered as
important clues of psychogenic aetiology. Limited data in the literature
on FP indicate that the average age of onset is between 37-53 years of
age, whereas the average onset age of Idiopathic Parkinson’s Disease
(IPD) is around 60; and Juvenile Parkinsonism, a rare condition
presenting before the age of 21, is often familial and more closely
related to genetic mutations.
Here, we present the case of a female patient, who, after the diagnosis
of Juvenile Parkinsonism at the age of 17, had been treated with
antiparkinsonian medications for about 14 years in the neurology clinic.
Even though the age of onset of this case was far earlier than expected
for both IPD and FP and the symptoms became chronic despite close
monitoring, it is believed that this case is a striking example for the
importance of the recognition of FP and early intervention.