Evaluación del estado nutricional en la enfermedad de Alzheimer y su influencia en la progresión tras el diagnóstico / Nutritional status assessment in Alzheimer disease and its influence on disease progression

Introducción: Las deficiencias nutricionales son frecuentes en la enfermedad de Alzheimer (EA), incluso en fases iniciales. El deterioro nutricional (DN) puede asociarse con una progresión más rápida de la enfermedad. El objetivo fue describir la frecuencia y los factores de riesgo asociados a DN en el momento del diagnóstico y analizar su influencia en la evolución posterior.MétodosEstudio observacional, multicéntrico, prospectivo. Se incluyeron sujetos recién diagnosticados de EA prodrómica (EAp) o demencia por EA (EAd). Se realizaron dos evaluaciones en un periodo de 18 meses. Para estimar el estado nutricional se empleó el Mini Nutritional Assessment Test (MNA, rango 0-30; DN: MNA < 24). El criterio de progresión fue un incremento en la Clinical Dementia Rating-sum of boxes ≥ 3.ResultadosSe incluyeron 50 sujetos con EAp (edad 76,1 ± 5,3 años; 68% mujeres) y 127 con EAd (edad 80 ± 5,9 años; 72,4% mujeres); 141 (79,7%) completaron las dos evaluaciones. La prevalencia de DN fue del 28,2% (EAp 24%, EAd 29,9%; p = 0,43), la mayoría (92%) en riesgo de desnutrición. El DN se asoció con el sexo femenino (OR: 4,2; IC 95%: 1,7-10,5; p < 0,001) y mayor afectación conductual (OR: 5,8; IC 95%: 2,6-12,7; p < 0,001). Se observó mayor proporción de sujetos con progresión entre los que tenían un DN respecto a estado nutricional normal (50% vs 28,7%, p < 0,05; EAd 53,6% vs 31,8%, p < 0,05; EAp 41,7% vs 22,9%; p = 0,21). Una mayor afectación cognitiva (OR: 2,1; IC 95%: 1,03-4,4; p < 0,05) y un DN (OR: 2,4; IC 95%: 1,1-5,1; p < 0,05) fueron factores de riesgo independientes de progresión.ConclusionesLa prevalencia de DN en la EA es elevada. La evaluación del estado nutricional en el momento del diagnóstico puede permitir identificar pacientes con mayor riesgo de progresión de la enfermedad. (AU)

Introduction: Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression.MethodsWe performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18 months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, < 24) was used to estimate nutritional status. Progression was defined as an increase of ≥ 3 points on the Clinical Dementia Rating-sum of boxes test.ResultsThe sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P = .43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P < .001) and greater behavioural involvement (OR: 5.8; 95% CI: 2.6-12.7; P < .001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P < .05; ADd: 53.6% vs 31.8%, P < .05; pAD: 41.7% vs 22.9%, P = .21). Greater cognitive impairment (OR: 2.1; 95% CI: 1.03-4.4; P < .05) and NI (OR: 2.4; 95% CI: 1.1-5.1; P < .05) were independent risk factors for disease progression.ConclusionsNI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression. (AU)

Nutritional status assessment in Alzheimer disease and its influence on disease progression.

INTRODUCTION: Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression. METHODS: We performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18 months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, < 24) was used to estimate nutritional status. Progression was defined as an increase of ≥ 3 points on the Clinical Dementia Rating-sum of boxes test. RESULTS: The sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P = .43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P < .001) and greater behavioural involvement (OR: 5.8; 95% CI: 2.6-12.7; P < .001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P < .05; ADd: 53.6% vs 31.8%, P < .05; pAD: 41.7% vs 22.9%, P = .21). Greater cognitive impairment (OR: 2.1; 95% CI: 1.03-4.4; P < .05) and NI (OR: 2.4; 95% CI: 1.1-5.1; P < .05) were independent risk factors for disease progression. CONCLUSIONS: NI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression.

Nutritional status assessment in Alzheimer disease and its influence on disease progression. / Evaluación del estado nutricional en la enfermedad de Alzheimer y su influencia en la progresión tras el diagnóstico.

INTRODUCTION: Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression. METHODS: We performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, <24) was used to estimate nutritional status. Progression was defined as an increase of ≥3points on the Clinical Dementia Rating-sum of boxes test. RESULTS: The sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P=.43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P<.001) and greater behavioural involvement (OR: 5.8; 95%CI: 2.6-12.7; P<.001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P<.05; ADd: 53.6% vs 31.8%, P<.05; pAD: 41.7% vs 22.9%, P=.21). Greater cognitive impairment (OR: 2.1; 95%CI: 1.03-4.4; P<.05) and NI (OR: 2.4; 95%CI: 1.1-5.1; P<.05) were independent risk factors for disease progression. CONCLUSIONS: NI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression.

Experiencia con toxina botulínica en la migraña crónica / Experience with botulinum toxin in chronic migraine

OBJETIVO: Describir la experiencia con la administración de toxina botulínica tipo A (OnabotA) en el tratamiento de la migraña crónica (MC) en Segovia durante 16 meses, evaluar su beneficio y buscar marcadores clínicos que sirvan para predecir una mejor respuesta al tratamiento. PACIENTES Y MÉTODOS: Estudio prospectivo de pacientes con MC que recibieron infiltraciones con OnabotA durante 16 meses. Se evaluó la eficacia de OnabotA comparando la reducción en el número de días de cefalea, en la intensidad y efectos adversos. Se comparó el efecto del tratamiento con el factor tiempo mediante un análisis de la varianza de dos vías (ANOVA). Se estudió la correlación del efecto del tratamiento con el resto de las variables mediante un modelo de regresión lineal para buscar marcadores clínicos que sirvan para predecir una mejor respuesta. RESULTADOS: Se incluyó a 69 pacientes que cumplían criterios de MC. Se les realizó una media de 2 infiltraciones. La edad media fue de 43 años, el 88,4% fueron mujeres. La frecuencia de los días de cefalea y su intensidad se redujeron de forma significativa (p < 0,005) y esta mejoría se mantuvo a lo largo del tiempo. Se encontró una correlación negativa entre la reducción de la intensidad y el número de tratamientos previos a la administración de la toxina. CONCLUSIÓN: El efecto beneficioso de la OnabotA en la MC se mantiene en el tiempo, siendo un tratamiento seguro y bien tolerado. No debe retrasarse su uso en MC refractaria, ya que su beneficio podría ser mayor cuanto antes se administre

OBJECTIVE: The purposes of this study were to describe our 16-month experience with onabotulinumtoxinA (OnabotA) for the treatment of chronic migraine (CM) in the Spanish province of Segovia, evaluate its benefits, and determine clinical markers of good response to treatment. PATIENTS AND METHODS: Prospective study of patients with CM who received OnabotA for 16 months. The effectiveness of OnabotA was evaluated based on the reduction in the number of headache days, pain intensity, and side effects. We used two-way analysis of variance (ANOVA) to assess the effects of treatment according to the time factor. We studied the correlation between treatment effects and other variables using a linear regression model to establish the clinical markers of good response to treatment. RESULTS: We included 69 patients who met the diagnostic criteria for CM. Patients underwent an average of 2 infiltrations. Mean age was 43 years; 88.4% were women. The number of headache days and pain intensity decreased significantly (P < .005); improvements remained over time. We found a negative correlation between the reduction in pain intensity and the number of treatments before OnabotA. CONCLUSION: The beneficial effects of OnabotA for CM continue over time. OnabotA is a safe and well-tolerated treatment whose use for refractory CM should not be delayed since early treatment provides greater benefits

Experience with botulinum toxin in chronic migraine. / Experiencia con toxina botulínica en la migraña crónica.

OBJECTIVE: The purposes of this study were to describe our 16-month experience with onabotulinumtoxinA (OnabotA) for the treatment of chronic migraine (CM) in the Spanish province of Segovia, evaluate its benefits, and determine clinical markers of good response to treatment. PATIENTS AND METHODS: Prospective study of patients with CM who received OnabotA for 16 months. The effectiveness of OnabotA was evaluated based on the reduction in the number of headache days, pain intensity, and side effects. We used two-way analysis of variance (ANOVA) to assess the effects of treatment according to the time factor. We studied the correlation between treatment effects and other variables using a linear regression model to establish the clinical markers of good response to treatment. RESULTS: We included 69 patients who met the diagnostic criteria for CM. Patients underwent an average of 2 infiltrations. Mean age was 43 years; 88.4% were women. The number of headache days and pain intensity decreased significantly (P < .005); improvements remained over time. We found a negative correlation between the reduction in pain intensity and the number of treatments before OnabotA. CONCLUSION: The beneficial effects of OnabotA for CM continue over time. OnabotA is a safe and well-tolerated treatment whose use for refractory CM should not be delayed since early treatment provides greater benefits.

Anosognosia en la enfermedad de Alzheimer: prevalencia, factores asociados e influencia en la evolución de la enfermedad / Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression

Introducción: La anosognosia es frecuente en la enfermedad de Alzheimer (EA). El objetivo fue describir su prevalencia en el momento del diagnóstico y analizar los factores predisponentes y su influencia en la evolución posterior de la EA. Métodos: Estudio observacional, multicéntrico, prospectivo, analítico, realizado en consultas de neurología general. Se incluyó a pacientes recién diagnosticados de EA (criterios NINCDS-ADRDA). Se realizaron 2 evaluaciones -cognitivas, funcionales y neuropsiquiátricas-, con un intervalo de 18 meses. Se empleó la Clinical Insight Rating scale como medida de anosognosia (CIR, rango 0-8). El criterio de progresión fue un incremento en la Clinical Dementia Rating-sum of boxes mayor a 2,5 puntos. Las variables predictoras se analizaron mediante regresión logística. Resultados: Se incluyó a 127 pacientes, 94 completaron las 2 evaluaciones. El 31,5% mostraba anosognosia grave (CIR 7-8), el 39,4% conciencia alterada (CIR 3-6) y el 29,1% conciencia normal (CIR 0-2). La mediana del CIR basal en la cohorte fue 4 (Q1-Q3: 1-7) y a los 18 meses 6 (Q1-Q3: 3-8); p < 0,001. La edad avanzada (odds ratio [OR] 2,43; IC del 95%, 1,14-5,19), menor escolaridad (OR 2,15; IC del 95%, 1,01-4,58) y mayor afectación neuropsiquiátrica (OR 2,66; IC del 95%, 1,23-5,74) fueron variables predictoras de anosognosia. El CIR basal fue similar en los grupos con y sin progresión clínica significativa. Conclusiones: La gran mayoría de los pacientes con EA en el momento del diagnóstico muestran un grado significativo de anosognosia que se asocia a mayor edad, menor escolaridad y mayor afectación conductual. No se demostró influencia de la anosognosia sobre la evolución inicial de la EA tras el diagnóstico

Introduction: Anosognosia is a frequent symptom in Alzheimer disease (AD). The objective of this article is to describe prevalence of this condition at time of diagnosis and analyse any predisposing factors and their influence on disease progression. Methods: Observational, prospective, and analytical multi-centre study in an outpatient setting. Patients recently diagnosed with AD (NINCDS-ADRDA criteria) were included. Each patient underwent two cognitive, functional, and neuropsychiatric assessments separated by an interval of 18 months. The Clinical Insight Rating Scale was employed as a measure of anosognosia (CIR, scored 0-8). Progression was defined as an increase in the Clinical Dementia Rating Scale-sum of boxes of more than 2.5 points. The predictor variables were analysed using binary logistic regression. Results: The study included 127 patients, and 94 completed both assessments. Of the total, 31.5% displayed severe anosognosia (CIR 7-8); 39.4%, altered level of consciousness (CIR 3-6); and 29.1%, normal awareness (CIR 0-2). The median baseline CIR in this cohort was 4 (Q1-Q3: 1-7), and at 18 months, 6 (Q1-Q3: 3-8), P<.001. Advanced age (odds ratio (OR) 2.43; CI 95%:1.14-5.19), lower educational level (OR 2.15; CI 95%:1.01-4.58), and more marked neuropsychiatric symptoms (OR 2.66; CI 95%:1.23-5.74) were predictor variables of anosognosia. Baseline CIR was similar in the groups with and without significant clinical progression. Conclusions: The large majority of patients with AD at the time of diagnosis showed significant anosognosia, and this condition was associated with advanced age, lower educational level, and more marked behavioural symptoms. Our results did not show that anosognosia had an effect on the initial clinical progression of AD after diagnosis

Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression. / Anosognosia en la enfermedad de Alzheimer: prevalencia, factores asociados e influencia en la evolución de la enfermedad.

INTRODUCTION: Anosognosia is a frequent symptom in Alzheimer disease (AD). The objective of this article is to describe prevalence of this condition at time of diagnosis and analyse any predisposing factors and their influence on disease progression. METHODS: Observational, prospective, and analytical multi-centre study in an outpatient setting. Patients recently diagnosed with AD (NINCDS-ADRDA criteria) were included. Each patient underwent two cognitive, functional, and neuropsychiatric assessments separated by an interval of 18 months. The Clinical Insight Rating Scale was employed as a measure of anosognosia (CIR, scored 0-8). Progression was defined as an increase in the Clinical Dementia Rating Scale-sum of boxes of more than 2.5 points. The predictor variables were analysed using binary logistic regression. RESULTS: The study included 127 patients, and 94 completed both assessments. Of the total, 31.5% displayed severe anosognosia (CIR 7-8); 39.4%, altered level of consciousness (CIR 3-6); and 29.1%, normal awareness (CIR 0-2). The median baseline CIR in this cohort was 4 (Q1-Q3: 1-7), and at 18 months, 6 (Q1-Q3: 3-8), P<.001. Advanced age (odds ratio (OR) 2.43; CI 95%:1.14-5.19), lower educational level (OR 2.15; CI 95%:1.01-4.58), and more marked neuropsychiatric symptoms (OR 2.66; CI 95%:1.23-5.74) were predictor variables of anosognosia. Baseline CIR was similar in the groups with and without significant clinical progression. CONCLUSIONS: The large majority of patients with AD at the time of diagnosis showed significant anosognosia, and this condition was associated with advanced age, lower educational level, and more marked behavioural symptoms. Our results did not show that anosognosia had an effect on the initial clinical progression of AD after diagnosis.

Síndrome de Collet-Sicard / Collet-Sicard syndrome

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El espectro clínico de las demencias frontotemporales: un caso de demencia rápidamente progresiva / The clinical spectrum of frontotemporal dementia: a case of rapidly progressive dementia

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[White cerebellum sign (reversal sign)]. / Signo del cerebelo blanco (reversal sign).

TITLE: Signo del cerebelo blanco (reversal sign).

Síndrome de Opalski: una variante del síndrome medular lateral / Opalski syndrome: a variant of lateral-medullary syndrome

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Blefarospasmo y espasmo hemifacial: tratamiento a largo plazo con toxina botulínica / Blepharospasm and hemifacial spasm: long-term treatment with botulinum toxin

Introducción: Nuestro objetivo es describir las características clínico epidemiológicas y terapéuticas de los pacientes con blefarospasmo (BS) y espasmo hemifacial (EH) en tratamiento con toxina botulínica tipo A (TBA). Pacientes y métodos: Se estudió retrospectivamente a los pacientes diagnosticados de BS y EH en tratamiento con TBA en la consulta de neurología del Complejo Asistencial de Segovia, desde marzo del 1991 hasta diciembre del 2009. Resultados: Se recogieron distintas variables de 34 pacientes con BS y 55 pacientes con EH, de los cuales el 44,1 y el 32,7%, respectivamente, llevaban más de 10 años en tratamiento con TBA. Desde el inicio de los síntomas hasta la consulta la mediana de tiempo fue de 24 meses en el grupo de BS, y de 59,7 meses en el grupo de EH, diagnosticándose en la primera visita el 76,5 y el 90,7%, respectivamente. El 34,6% de los pacientes con BS y el 77,6% de los pacientes con EH fueron derivados desde atención primaria. En ambos grupos, el preparado farmacológico de TBA más utilizado fue BOTOX®, sin hallarse resistencias primarias ni secundarias. La mediana de la dosis se incrementó progresivamente en ambas entidades, de forma significativa en los primeros años de tratamiento. La ptosis fue el efecto secundario más frecuente (el 47,1% en el BS, el 32,5% en el EH). Conclusiones: El BS y el ES constituyen los trastornos del movimiento faciales más comunes, recogiendo en esta serie diferentes parámetros epidemiológicos, clínicos y terapéuticos, confirmándose el beneficio y la seguridad del tratamiento con TBA a largo plazo (AU)

Introduction: Our purpose is to describe the demographic, clinical and therapeutic characteristics of patients with blepharospasm (BS) and hemifacial spasm (HFS) in treatment with botulinum toxin type A (BtA). Patients and methods: Retrospective analysis of patients diagnosed with BS or HFS and treated with BtA in the Neurology Department at Complejo Asistencial de Segovia between March 1991 and December 2009. Results: Different variables were collected from 34 patients with BS and 55 with HFS, of whom44.1% and 32.7% respectively had been undergoing treatment with BtA for more than 10 years. Elapsed time from symptom onset to the first visit was 24 months in the BS group and 59.7 months in the HFS group. Diagnosis was given on the first visit for 76.5% of the BS patients and90.7% of the HFS patients. Patients were referred by their primary care centres in 34.6% of the cases with BS and in 77.6% of the cases with HFS. The most commonly used BtA preparation was BOTOX® in both groups, and there were no cases of primary or secondary resistance. The median dose of BtA was raised gradually in both groups, and the increase was statistically significant during the early years of treatment. The most common side effect was ptosis (47.1% in BS, 32.5% in HFS). Conclusions: BS and HFS are the most common facial movement disorders. The demographic and clinical characteristics and therapeutic findings from this study show that treatment with BtA is both effective and safe over the long term (AU)

Blepharospasm and hemifacial spasm: long-term treatment with botulinum toxin.

INTRODUCTION: Our purpose is to describe the demographic, clinical and therapeutic characteristics of patients with blepharospasm (BS) and hemifacial spasm (HFS) in treatment with botulinum toxin type A (BtA). PATIENTS AND METHODS: Retrospective analysis of patients diagnosed with BS or HFS and treated with BtA in the Neurology Department at Complejo Asistencial de Segovia between March 1991 and December 2009. RESULTS: Different variables were collected from 34 patients with BS and 55 with HFS, of whom 44.1% and 32.7% respectively had been undergoing treatment with BtA for more than 10 years. Elapsed time from symptom onset to the first visit was 24 months in the BS group and 59.7 months in the HFS group. Diagnosis was given on the first visit for 76.5% of the BS patients and 90.7% of the HFS patients. Patients were referred by their primary care centres in 34.6% of the cases with BS and in 77.6% of the cases with HFS. The most commonly used BtA preparation was BOTOX(®) in both groups, and there were no cases of primary or secondary resistance. The median dose of BtA was raised gradually in both groups, and the increase was statistically significant during the early years of treatment. The most common side effect was ptosis (47.1% in BS, 32.5% in HFS). CONCLUSIONS: BS and HFS are the most common facial movement disorders. The demographic and clinical characteristics and therapeutic findings from this study show that treatment with BtA is both effective and safe over the long term.

Carotidinia sintomática: dolor cervical de origen vascular / Symptomatic carotidynia: neck pain of vascular origin

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[Dopaminergic stimulation in the non-motor symptoms of Parkinson's disease]. / Estimulación dopaminérgica en los trastornos no motores de la enfermedad de Parkinson.

INTRODUCTION AND DEVELOPMENT: The non-motor symptoms of Parkinson's disease have a great impact in terms of quality of life. They are frequently underdiagnosed and clinical experience suggests that not only is dopamine therapy ineffective but that in many cases it is also responsible for the appearance of some of these symptoms. Different studies have drawn attention to the involvement of the dopaminergic pathways in the pathogenesis of some non-motor symptoms. It has been observed that they can undergo fluctuations in relation to dopaminergic stimulation, generally in wearing off states, while displaying a significant correlation with motor fluctuations and a clinical response with continuous dopaminergic therapy. CONCLUSIONS: Although recent reviews offer insufficient evidence for treatment of non-motor symptoms with dopaminergic therapy, involvement of the dopaminergic pathways in the aetiopathogenesis of some of these disorders and the clinical observation that such symptoms undergo fluctuations in relation to pulsatile dopaminergic stimulation may lead us to reconsider the possible role of dopaminergic therapy in the treatment of these symptoms.

[Psychogenic movement disorders]. / Trastornos del movimiento psicógenos.

INTRODUCTION: Psychogenic movement disorders are movement disorders that cannot be attributed to any known organic disease and which are caused by an underlying psychiatric pathology or are due to voluntary simulation. They account for 1-3% of all movement disorders. AIMS: To review the literature and to update our knowledge on psychogenic movement disorders. DEVELOPMENT: We review different aspects of psychogenic movement disorders, including their epidemiology, clinical diagnosis and diagnosis by means of complementary tests, types of psychogenic movement disorders, their treatment and prognosis. Psychogenic movement disorders must be diagnosed by a neurologist and it must not be simply a diagnosis of exclusion. The most frequent presenting symptom is tremor and this where most progress has been made, above all in the contributions made by neurophysiological tests to the diagnosis. Few studies have been conducted on specific treatment. It is necessary to treat the underlying psychiatric pathology, and psychotherapy in association with drugs is recommended if needed. The prognosis of psychogenic movement disorders continues to be insufficient, even with suitable treatment. CONCLUSIONS: Although in recent years some progress has been made in our knowledge of psychogenic movement disorders, more research is needed to determine the mechanism underlying these pathologies, as well as the techniques and complementary tests that can help reach a diagnosis. Further studies on treatment are also required.