Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls. Issue 2 (23rd September 2011)

• Record Type: Journal Article
• Authors: Fekete, Robert; Baizabal-Carvallo, Jose Fidel; Ha, Ainhi D; Davidson, Anthony; Jankovic, Joseph
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 83:Issue 2(2012)
• Page Start: 202
• Page End: 204
• Publication Date: 2011-09-23
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2011-300733
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Convergence spasm refers to transient ocular convergence, miosis and accommodation associated with disconjugate gaze mimicking abducens palsy. While it may be a manifestation of brainstem pathology, this sign is often associated with conversion (somatisation) disorders and, if unrecognised as a sign of a psychogenic disorder, it may lead to unnecessary and occasionally invasive evaluation. Methods: To better characterise this neuro-ophthalmologic sign, 36 subjects were studied, 13 with psychogenic movement disorders, 11 with organic movement disorders and 12 normal controls. Patients were recorded during a manoeuvre to elicit convergence spasm and the videotapes were rated by two blinded raters on a scale of 0=normal, 1=mild convergence spasm and 2=marked convergence spasm. Results: Convergence spasm was present in 9/13 (69%) psychogenic movement disorders cases, 4/11 (36%) non-psychogenic movement disorders cases and 4/12 (33%) controls (p=0.049 when psychogenic vs non-psychogenic disorders or controls were compared). Inter-rater reliability analysis of the presence (rating 1 or 2) versus absence (rating 0) showed good agreement (27/36 or 75%; kappa 0.491, SE 0.141, p=0.002). Analysis for the presence of marked convergence spasm (rating 2) yielded agreement in 32/36 (88.9%) examinations (kappa 0.652, SE 0.154, p<0.001) with a specificity of 87% (sensitivity 15%). Conclusion: Convergence spasm may provide benefit in the clinical examination of psychogenic movement disorders patients.