Objective: Movement disorders (MD) in autoimmune diseases are uncommon. However, the initial presentation required that the clinicians characterize the clinical phenomenology. Rheumatological patients’ complexity required a comprehensive approach because the physician’s reasoning is that the MD’s cause is always structural. Functional movement disorders (FMD) are a category in MD in which the diagnosis is made by exclusion and are underestimated in this type of patients.
Background: Functional tremor is the most frequent FMD, characteristically with wide Variability in amplitude, frequency, direction, and presenting at rest, action, or posture. We report the case of a 23-years-old woman patient with systemic lupus erythematosus (SLE) and acute onset tremor.
Method: A patient with renal SLE activity one-month previously arrived at the Emergency Room with an acute-onset MD after an episode of emotional stress. The clinical examination showed a hyperkinetic rhythmic movement involving the head, neck, and upper limbs classified as tremor. Other features funding were: spontaneous remission, change over time, and amplitude increased when the examiner observed the phenomena. At the distractibility testing (contralateral finger tapping), we identified a slower tremor frequency. The approach included serum labs test, toxicology urinary screen, MRI brain scan, electroencephalogram (EEG), and lumbar punction (LP).
Results: Due to the high suspicion of FMD, we used distractibility maneuvers, suggestibility, and coactivation tests, with positive signs as the reduction of tremor frequency and amplitude. The approach was negative. The patient had complete remission of tremor after one week with psychotherapy and medical treatment with antidepressants.
Conclusion: MD emergencies are common in clinical practice. However, FMD are dismiss as a differential diagnosis to be considered within the spectrum of acute hypokinetic and hyperkinetic movement disorders. Early diagnosis of FMD is essential to avoid unnecessary approaches, prolonged hospitalization, and medications’ adverse effects.
To cite this abstract in AMA style:
D. Rebolledo, J. Diestel, I. Reyes. Acute functional movement disorder in a Lupus patient [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/acute-functional-movement-disorder-in-a-lupus-patient/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2021
MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-functional-movement-disorder-in-a-lupus-patient/