Objective: We aimed to examine our large series of functional movement disorder (FMD) patients where the cranial muscles were involved in order to determine their phenomenology and other clinical features.

Background: Cranial FMD affecting the face, eyes, jaw, tongue and palate have been underrecognized.¹

Method: The present study from a tertiary care teaching institute reports the clinical profile of 26 patients who fulfilled the inclusion criteria for the cranial functional movement disorders.

Results: There were 16 (61.53%) females and 10 (38.46%) male patients and the mean ± [standard deviation (SD)] age at presentation was 33.96±16.94 (Range: 11-83) years. The duration of symptoms ranged from one day to 6 years (Mean ±SD: 402.03 ± 534.97 days). Seven patients presented with abrupt onset FMD. Features suggestive of FMD were present in the form of variability in 17, distractibility in 10, and entrainment in 3 patients. According to the Fahn-Williams criteria FMD were documented in 24 patients and clinically established in two patients. Phasic or tonic muscular spasms were documented in all patients in form of orofacial dyskinesias in five patients, hemifacial spasm in four patients, tongue dystonia in two patients, and speech involvement in two patients [childlike prosody (n=1) and stuttering and effortful speech (n=1)]. Oromandibular dyskinesia, bruxism, tongue tremor, mouth opening dystonia, blepharospasm, right eye ptosis, facial dyskinesia, jaw spasm, bilateral eyelid myoclonus, palatal tremor, eyebrow dyskinesia, chin tremor, and fixed tongue protrusion were present in one patient each. Six patients also had additional craniofacial movements other than the primary facial functional movement disorders. Nine patients also had associated functional movement disorders in the extracranial regions (neck, shoulder, upper and lower limbs). Precipitating factors were present in 84.61% (22/26) of the patients and associated illnesses were present in 42.30% (11/26) of the patients.

Conclusion: Cranial FMDs are more likely to involve facial muscles. Supportive features are female sex, and associated medical conditions like neuropsychiatric disturbances and headache. A prompt diagnosis is important as it will avoid further unnecessary and extensive workup.

References: 1. Fasano A, Tinazzi M. Functional facial and tongue movement disorders. Handb Clin Neurol. 2016;139:353-365.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cranial-functional-movement-disorders-clinical-features-associated-conditions-and-precipitating-factors/