Abstract:

Objective: To summarize the clinical characteristics of children with functional neurological disorder (FND) presented with motor symptoms. Methods and Results: Total 18 children with FND mainly manifested by motor symptoms were admitted to Department of Pediatrics in Peking University Third Hospital from July 2017 to June 2023. The clinical phenotypes included 8 cases of myoclonus, 3 of tremor, 3 of myasthenia, 2 of dystonia, and 2 of psychogenic non-epileptic seizure (PNES). There was no overlap of movement disorder symptoms in all patients. Of the 8 cases with clonus, 5 showed bilateral symmetry myoclonus, and 3 involved only the right upper limb or right hand. Three cases of tremor presented with rapid tremor on one or both upper limbs or hands. Three patients with myasthenia showed weakness of both lower limbs and inability to walk. Of the 2 patients with dystonia, one had paroxysmal upper limb and trunk torsion postural abnormalities, and one had intermittent muscle tone and hip flexion of the lower limb. Two cases of PNES were characterized by gaze, neck tilt, limb extension and flexion tremors, and tapping. One case had mild abnormal EEG and repeated small chromosome fragments. Tirteen cases had mild symptoms and good prognosis after treatment. Five cases with severe symptoms combined with mental symptoms were transferred to Department of Psychiatry for further treatment. Conclusions: The most common manifestations of children with FND presented with motor symptoms are myoclonus, tremor and myasthenia, which can be traced to related causes, and may be accompanied by a variety of other physical or psychiatric symptoms. Some children need to be referred to Department of Psychiatric for further treatment.

Key words: Conversion disorder, Motor disorders, Child, Hospital, general

摘要：

目的: 总结以运动症状为主要表现的儿童功能性神经系统疾病（以下简称功能性神经疾病）的临床特征。方法与结果: 纳入北京大学第三医院儿科2017年7月至2023年6月收治的18例以运动症状为主要表现的功能性神经疾病患儿，临床表型包括功能性肌阵挛8例、功能性震颤3例、功能性肌无力3例、功能性肌张力障碍2例、心因性非癫痫性发作2例，运动障碍症状均无重叠。8例功能性肌阵挛患儿中5例表现为双侧对称性肌阵挛，3例仅右上肢或右手肌阵挛；3例功能性震颤患儿表现为单侧上肢（1例）、双侧上肢（1例）或双手（1例）小幅度快速颤抖；3例功能性肌无力患儿均表现为双下肢无力，无法行走；2例功能性肌张力障碍患儿中1例表现为阵发性上肢和躯干扭转样姿势异常，1例为下肢间断性肌张力增高并呈屈髋屈膝样；2例心因性非癫痫性发作患儿表现为凝视，颈部后仰，肢体伸屈抖动、拍打。仅1例脑电图轻度异常，染色体小片段重复。13例症状较轻微，治疗后预后良好；5例症状较严重且合并精神症状，转入精神科继续治疗。结论: 以运动症状为主要表现的儿童功能性神经疾病常见表现是肌阵挛、震颤和肌无力，多可追溯到相关诱发因素，可伴发其他多种躯体或精神症状，部分患儿需转诊至精神科。

关键词: 转换障碍, 运动障碍, 儿童, 医院，综合