Journal
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Volume 83, Issue 2, Pages 202-204Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jnnp-2011-300733
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Funding
- Allergan Inc
- Allon Therapeutics
- Ceregene Inc
- Chelsea Therapeutics
- Diana Helis Henry Medical Research Foundation
- EMD Serono
- Huntington's Disease Society of America
- Huntington Study Group
- Impax Pharmaceuticals
- Ipsen Ltd
- Lundbeck Inc
- Michael J Fox Foundation for Parkinson's Research
- Medtronic
- Merz Pharmaceuticals
- National Institutes of Health
- National Parkinson's Foundation
- Neurogen
- St Jude Medical
- Teva Pharmaceutical Industries Ltd
- University of Rochester
- Parkinson's Study Group
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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.
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