Objective: To describe three cases who presented with new-onset psychogenic movement disorders (PMD) after returning to school when the national lockdown was lifted.

Background: PMD occur in all age groups but are less well described in children. The diagnosis requires identification of characteristic positive symptoms to allow timely therapeutic interventions. PMD are usually related to psychological stressors and/or secondary gain, which in children can be related to their school. In Kenya, all schools were closed from the onset of the COVID-19 pandemic, and only reopened in January 2021.

Method: We describe sudden-onset PMD in three otherwise healthy adolescents within two weeks of schools reopening. All cases were reviewed independently by two neurologists, and pertinent investigations including MRI neuro-imaging and COVID-19 PCR were negative.

Results: Case 1: A 14-year-old developed tic-like neck movements which had rapidly progressed to myoclonic-like jerks of all limbs. Clinically she had la belle indifference and excessive startle. The movements had variable frequency, direction and body location, with distractibility, entrainability, suggestibility and dual-task interference. During psychotherapy she revealed severe anxiety due to being placed in a different class without her usual friends. Her PMD settled from day 3.

Case 2: A 14-year-old experienced her legs shaking whilst sat in class at boarding school which continued unabatedly and she then needed crutches to walk. On examination she had an adduction-abduction tremor at the hips, which changed on standing or walking and disappeared on sitting down, and distractible tremors of the hands. She also had positive Hoover’s sign in the left leg and astasia-abasia. Electromyography of the calf muscles was normal. After 10 days of physiotherapy and psychotherapy she returned to normal function. Her parents moved her to a day school.

Case 3: An 18-year-old with a history of somatisation disorder presented with a head twitch and right hand tremor for one week. Both were distractible and variable in phenomenology during examination. The PMD was found to have been precipitated by the intense workload due to imminent national final exams and resolved with psychotherapy.

Conclusion: Our cases fulfil the diagnostic criteria for PMD and highlight an indirect neurological complication of the COVID-19 pandemic.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychogenic-movement-disorders-precipitated-by-post-lockdown-return-to-school-in-adolescents-case-series-from-kenya/