Psychogene neurologische Störungen: Klinik und elektrophysiologische Diagnostik

Zusammenfassung

Etwa 5 % der in Ambulanzen für Bewegungsstörungen vorstelligen Patienten haben eine psychogene Erkrankung, die sich als Tremor, Myoklonus oder Dystonie präsentiert. Auch für Lähmungen und Sensibilitätsstörungen lässt sich in manchen Fällen kein organisches Korrelat nachweisen. Da die Diagnosestellung einer psychogenen Störung zeit- und kostenintensiv sein kann, sollte rationale Zusatzdiagnostik erfolgen, die sich am klinischen Syndrom orientiert. Neben klinischen Tests kommt dabei der Elektrophysiologie eine große Bedeutung zu.

Abstract

Up to 5% of all cases presenting in specialized movement disorder clinics are of psychogenic origin. Tremor, dystonia and myoclonus account for up to 70% of all psychogenic movement disorders. In emergency medicine, paralysis and sensory disturbances without any organic correlates are sometimes present. Diagnosis is commonly made by exclusion of other causes, is time consuming and expensive. However, patients suffering from psychogenic disorders may show positive clinical features, such as acute onset and distractibility. Also, there are a few supportive clinical tests and diagnostic tools, which help establish the diagnosis of psychogenicity. In this review, the significance and interpretation of clinical neurophysiology in selected pathologies of psychogenic origin and differential diagnostic aspects are discussed.

Schlüsselwörter

funktionelle Störungen - dissoziative Störungen - kinematische Bewegungsanalyse - Somatisierungsstörung - Simulation

Key words

kinematic motion analysis - psychotherapy - somatisation - functional disorder - malingering

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