To the Editor:

Oaklander’s report¹ of a patient with complex regional pain syndrome (CRPS) in addition to a movement disorder is an excellent example of the value of videotape publications.

The patient is described as having progressive right lower extremity dystonia and tremor in the contralateral foot. That the movements began abruptly after vein stripping is stated as evidence that neither psychological factors nor disuse could have caused the movements, hence their organic nature as part of CRPS.

Psychogenic movement disorders can be difficult to diagnose and neurologists and other physicians are often reluctant to make the diagnosis despite well-established criteria.^2–4 In contrast to Oaklander’s claim, the abrupt onset of a movement disorder is a clue about a psychogenic etiology, as is adult-onset dystonia beginning in the lower extremity. Another clue is the presence of more than one movement disorder. Furthermore, there is controversy about the organic etiology of posttraumatic movement disorders, such as following vein stripping. The videotape provides additional evidence: the patient exhibits a fixed dystonic posture of the right foot (another feature suggestive of psychogenic dystonia) with an atypical low amplitude, high frequency tremor of the involved foot (not typical of dystonic tremor) and an equally atypical “bouncy” whole-leg tremor of the contralateral lower extremity.

The historical and physical features of this patient support a psychogenic movement disorder. This report should not be used as evidence that movement disorders are an accepted part of the complex regional pain syndrome.