Objective: To describe new onset psychogenic movement disorders in 2 patients who underwent Deep Brain Stimulation (DBS) for Parkinson’s disease (PD) and MR guided Focused Ultrasound (MRgFUS) for Essential tremor (ET).

Background: Psychogenic movement disorders after neurosurgical intervention are a rare and under reported complication.

Method: N/A

Results: Case 1: 65 year old male with tremor predominant PD underwent bilateral subthalamic nucleus DBS due to medication intolerance. He had marked improvement post DBS but was unable to tolerate stimulation due to dyskinesias. OFF medication Movement Disorder Society-Unified Parkinson’s Rating Scale (MDS-UPDRS) score was 44 pre-op and 16 OFF medication/ON stimulation. With chronic stimulation ballistic dyskinetic movements of the right leg and trunk that were easily distractible developed. He preferred to turn OFF DBS due to these movements. Review of pre-op neuropsychological testing (Npsych) showed history of anxiety. He had a perception that his PD was caused by antibiotics and anxiety worsened when an alternate etiology was suggested. He was confronted with the diagnosis of psychogenic dyskinesias and started psychotherapy. 7 weeks later, he now tolerates unilateral stimulation and is able to tolerate bilateral stimulation for short periods without dyskinesias.

Case 2: 49 year old male who developed psychogenic tremors after a staged bilateral ventral intermediate nucleus MRgFUS thalamotomy for ET. Right hand tremors were controlled with left thalamotomy without complication. He had right thalamotomy 11 months later. After 1 month, he complained of worsening of left hand tremors compared to baseline, recurrence of right hand tremors and mild speech and balance changes. He was found to have psychogenic tremors in bilateral hands that were irregular and easily distractible. He had notable worsening of anxiety post-op. Review of Npsych testing reported a long history of anxiety. Patient was confronted with the psychogenic etiology of tremors. Patient reported resolution of tremors and improved anxiety 6 weeks after this evaluation and attributes improvement to recreational marijuana.

Conclusion: We aim to highlight 2 cases of post-op psychogenic movement disorders. Anxiety may be a potential risk factor. Confronting the patient with the diagnosis and aggressive treatment of anxiety may potentially improve outcomes.

References: [1] Marsili L, Keeling EG, Maciel R, Contarino MF, Zutt R, Okun MS, Almeida L, Deeb W, Kern D, Macias-Garcia D, Carrillo F, Mir P, Merola A, Espay AJ, Fasano A. Functional Movement Disorders and Deep Brain Stimulation: A Multi-Center Study. Mov Disord Clin Pract. 2022 Nov 14;10(1):94-100.

[2] Alshimemeri S, Vargas-Méndez D, Chen R, Lipsman N, Schwartz ML, Lozano AM, Fasano A. Functional tremor developing after successful MRI-guided focused ultrasound thalamotomy for essential tremor. J Neurol Neurosurg Psychiatry. 2022 Apr 26:jnnp-2021-327524.

[3] Breen DP, Rohani M, Moro E, Mayberg HS, Zurowski M, Lozano AM, Fasano A. Functional movement disorders arising after successful deep brain stimulation. Neurology. 2018 May 15;90(20):931-932

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-induced-psychogenic-movement-disorders-a-case-series/