Psychogenic axial myoclonus: report on two cases.

Axial myoclonus (AM) is characterized by sudden muscle jerks involving axial and proximal muscles. It includes propriospinal myoclonus (PSM) which consists of trunk flexion or extension jerking with activity arising in axial muscles and spreading to caudal and rostral muscles at low velocity along propriospinal pathways. We report on two patients displaying flexion AM jerks in the absence of structural lesion of the central nervous system or electrophysiological evidence of organic origin. A conversion disorder was diagnosed. The jerks disappeared after psychoeducation with the patients remaining symptom free in 6-year long follow-up. The diagnoses of psychogenic axial (propriospinal-like) myoclonus were established. The literature on psychogenic axial (propriospinal-like myoclonus) is limited to a case report. Our cases demonstrate a good response to psychotropic medication and psychoeducation and fulfill the psychogenic movement disorder criteria. The phenomenology of psychogenic abnormal movements is diverse and PSM-like clinical picture may be a novel presentation.

The influence of vascular risk factors and white matter hyperintensities on the degree of cognitive impairment in Parkinson's disease.

BACKGROUND AND PURPOSE: Vascular risk factors may contribute to deterioration of cognitive functions in Alzheimer's disease and vascular (or mixed) dementia. Parkinson's disease (PD) is an age-related disorder and vascular risk factors potentially might be the main co-morbidity responsible for motor and cognitive impairment. However, only a few studies focused on this problem have been published. The aim of the study was to assess the contribution of vascular risk factors and white matter abnormalities in magnetic resonance imaging (MRI) on cognitive impairment in PD patients. MATERIAL AND METHODS: Sixty consecutive patients (M: 35, F: 25), mean age 68.36 years (SD: 7.25, range: 51-81) with diagnosis of idiopathic PD underwent a semi-structured questionnaire on demographics and vascular risks factors, neurological, neuropsychological and neuroimaging (MRI) examinations with quantitative assessment according to the scale by Wahlund et al. According to cognitive status they were divided into 3 groups: without cognitive disability (I, n=17), with mild cognitive impairment (II, n=25) and with dementia (III, n=18). RESULTS: There were no significant differences between groups in terms of the number of vascular risk factors (except for the ischaemic heart disease difference between group I and III) and severity of white matter hyperintensities in MRI studies. CONCLUSIONS: Vascular risk factors along with white matter vascular abnormalities probably do not contribute to cognitive impairment in patients with PD. This is in concordance with previously published studies.