Positive Motor Conversion Symptoms in Multiple Sclerosis

Background:

There is a high prevalence of psychiatric disorders in patients with multiple sclerosis. Depressive disorders receive the majority of attention compared to other psychiatric illnesses in MS. Conversion disorder is characterized by neurological symptoms that are unrelated to an underlying neurological or medical disorder and can be found in up to 30% of neurology patients; it is often found more difficult to treat. To our knowledge, there is very limited data on conversion disorder in MS patients.

Objectives:

We present a case of conversion disorder in patient with MS. The objectives are to review the key points of this case, highlighting the diagnostic criteria, and discussing the differential diagnosis and treatment options of conversion disorder. We will also discuss the importance of coordination of care between multiple specialties in conversion disorder patient.

Methods:

We report a case of a 56 year old Caucasian female with a definite diagnosis of relapsing remitting multiple sclerosis who presented for a psychiatric outpatient consultation for evaluation of depression and anxiety.  She was recently seen by her neurologist for abnormal movements of her upper and lower extremities and facial muscles. “Non-physiological features” were suspected. The patient reported multiple stressors including health deterioration and psychosocial issues.  Stressors preceded the onset of abnormal movements.  She had significant symptoms of depression and anxiety.  A recent brain and spine MRI did not reveal findings explaining her presentation. Her exam was positive for several episodes of involuntary, convulsive motor symptoms mainly involving her upper extremities lasting approximately 1 minute. Movements were triggered by emotional distress during the interview and were suppressed with distraction and shifting attention.

Results:

Conversion disorder was highly suspected in this case.  A movement disorder specialist concluded that her symptoms and presentation are consistent with a psychogenic movement disorder.  We recommended a combination treatment modality including psychopharmacology and psychotherapy.

Conclusions:

Conversion disorder receives very little attention in patients with multiple sclerosis. The diagnosis and treatment are challenging and often require coordination of care between multiple specialties including neurology, psychiatry and psychology. We will review the diagnostic criteria of conversion disorder and we will discuss the differential diagnosis and treatment modalities.