Objective: To present a patient with a functional movement disorder who was successfully treated with clinical hypnosis.

Background: Functional movement disorders (FMD), specially fixed dystonia, may be severe and disabling, with scarce therapeutic options. Clinical hypnosis has proven efficacious for certain psychosomatic conditions, but has been only anecdotally reported in FMD.

Method: Case report.

Results: A 38 year-old male presented with neck pain and rigidity, with marked worsening three months after a osteopathic procedure. It evolved to a severe fixed right anterolaterocollis, persisting during sleep, with pressure injuries in the chest. Blood tests and craniocervical magnetic resonance were non-contributory. Botulinum toxin at high doses provided only a mild relief of pain. Fifteen months after onset, a functional component of cervical dystonia was diagnosed, on the basis of clinical features, especially an early fixed posture, and minor trauma as a trigger. The diagnosis was thoroughly discussed with the patient. Basal Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS) was 68(31/35 severity,24/30 disability,13/20 pain). Exploration under sedation ruled out fixed contractures, and suggestibility traits were observed in clinical examination. Clinical hypnosis with emphasis in self-hypnosis was scheduled on videotaped 30 minute weekly sessions, and the clips were shared with the patient for feedback. A sustained improvement (TWSTRS 41.2; 18/35; 17/30; 6.2/20 at 3 months; 35.2; 12/35, 17/30, 6.2/20 at 22 months) was ascertained, maintaining botulinum toxin injections at a lower doses and autohypnosis exercises.

Conclusion: Functional overlay in neurological disorders is not uncommon, and may be diagnosed positively on clinical grounds. Early detection and management may impact prognosis. Clinical hypnosis may provide sustained and significant benefit in suggestible subjects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-hypnosis-in-functional-movement-disorders-a-potential-therapeutic-strategy/