Clinical Features

Clinical features of conversion disorder are variable but can include motor and sensory symptoms as well as loss of consciousness. In 29%-54% of children with this diagnosis, symptoms begin with mimicry of a relative or person close to the family who has an actual illness (Grattan-Smith et al. 1988; Spierings et al. 1990). Motor symptoms include abnormal movements, disturbances in gait, weakness, paralysis, and tremors. Sensory symptoms include anesthesia and paresthesia, commonly in one of the extremities, as well as deafness, blindness, and tunnel vision. Patients may also present with symptoms of seizures, referred to as conversion seizures, pseudoseizures, or nonepileptic seizures/ events. Between 5% and 37% of patients presenting to neurologists for workup of seizures are experiencing nonepileptic events (Salmon et al. 2003).

The onset of conversion symptoms is generally acute. Individual symptoms are generally shortlived, remitting within 2 weeks in most hospitalized patients (American Psychiatric Association 2000). Good prognostic factors include sudden onset, presence of an easily identifiable stressor, good premorbid adjustment, and absence of comorbid medical or psychiatric disorders (Crimlisk et al. 1998; Lazare 1981; Speed 1996). Patients with conversion seizures have a poorer prognosis than those with paralysis or blindness. The recurrence of symptoms is not uncommon, occurring in 20%-25% of cases within 1 year (American Psychiatric Association 2000). Comorbid mood, separation, and other anxiety disorders are common. Stressful family events such as recent divorce, current marital conflict, or death of a close family member (Wyllie et al. 1999), as well as overbearing and conflict-prone parenting style (Salmon et al. 2003), are also frequently associated. Estimates of the presence of concomitant epilepsy in patients with conversion seizures vary widely, although recent data suggest that 10% of patients may have both diagnoses (Kotagal et al. 2002).

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