Neurológia pre prax 4/2013

Psychogenní poruchy chůze

Gait disturbances are ranked among the most common manifestations of psychogenic movement disorders, a nosological area lying between neurology and psychiatry where both physicians and patients often find themselves at risk of diagnostic and therapeutic errors. The aim of this review is to show the typical manifestations, emphasize diagnostic principles and outline the therapeutic options for psychogenic movement disorders, with a special focus on disorders of gait. Typical patterns of psychogenic gait disorders include 1. balance disorders (with inadequately broad-based gait, often with paradoxical improvements in tandem walking test, spontaneous rope-walkers gait or astasia-abasia), 2. pseudoparetic gait or 3. extremely slow gait. At the same time, expressed are general features of psychogenic movement disorders such as inconsistency of symptoms over time, incongruence with typical organic movement disorders, high energy expenditure and characteristic changes in symptoms with distracted attention. The diagnosis of psychogenic movement disorders is clinical and on full responsibility of the neurologist, who should not repeat the negative auxiliary examinations to „exclude organicity“ or expect that another specialist will make the diagnosis and communicate it to the patient. Success of the treatment regimen for psychogenic movement disorders decreases with their duration and with development of their social consequences.

Keywords: movement disorders, psychogenic, functional disorders.