전환장애로 인한 삼킴장애 - 증례 보고

Abstract

Conversion disorder is often characterized by various neurological symptoms affecting motor and sensory functions, with unknown mechanism. Although the disease can be presented with various symptoms, persistent dysphagia due to conversion disorder is quite rare. A 42-year-old male, diagnosed with conversion disorder, suddenly developed swallowing difficulty without preceding event. Full neurologic examination and brain MRI findings were found to be normal but the symptom persisted for 10 years despite medical treatments. The patient visited our clinic for dysphagia rehabilitation program. Videofluoroscopic swallowing study (VFSS) findings revealed significant difficulty in initiation of swallowing and bolus transfer during oral phase, but no abnormal patterns were noticed during pharyngeal and esophageal phases. Initiation difficulty of swallowing by voluntary effort raised suspicion of oromotor apraxia, and limb and oral apraxia test demonstrated positive findings of apraxia. The patient underwent conventional dysphagia rehabilitation programs and rTMS treatment over supplementary motor area to modulate motor network. On follow up VFSS, some improvements in oral transit time and bolus transfer were noted. Persistent dysphagia due to conversion disorder is very uncommon and this case showed the possibility of improvement of symptom in conversion disorder with conventional dysphagia rehabilitation programs.