A Case of Chronic Functional Parkinsonism Treated Over 10 Years for the Diagnosis of Juvenile Parkinsonism.

Functional (psychogenic) movement disorders (FMD) constitute a cluster of heterogeneous diagnoses involving motor symptoms that cannot be explained by organic pathology and are often associated with underlying psychological problems. In psychiatry, patients with FMD are often placed within the scope of somatoform disorders and conversion disorders. Functional Parkinsonism (FP) is a rare form of FMD seen in 1.5% of all patients presenting with symptoms of parkinsonism. Although almost all symptoms of parkinsonism can be present in FP, clinical features such as sudden onset and a nonprogressive course, inconsistent response to pharmacotherapy, and atypical findings in neurological examination are considered as important clues of psychogenic aetiology. Limited data in the literature on FP indicate that the average age of onset is between 37-53 years of age, whereas the average onset age of Idiopathic Parkinson's Disease (IPD) is around 60; and Juvenile Parkinsonism, a rare condition presenting before the age of 21, is often familial and more closely related to genetic mutations. Here, we present the case of a female patient, who, after the diagnosis of Juvenile Parkinsonism at the age of 17, had been treated with antiparkinsonian medications for about 14 years in the neurology clinic. Even though the age of onset of this case was far earlier than expected for both IPD and FP and the symptoms became chronic despite close monitoring, it is believed that this case is a striking example for the importance of the recognition of FP and early intervention.