Twenty-seven children and adolescents diagnosed as having conversion reaction manifested as an inability to stand or walk are reported from the Department of Pediatrics, Mayo Clinic, Rochester, MN. There were 9 males and 18 females, ages 8 to 16 years, and duration of the symptoms varied from 1 to 60 weeks. Precipitating events in 17 patients included minor illnesses, school and home related problems, and minor injuries. Onset of symptoms showed seasonal variation with maximal frequency in the winter months and none in the summer and at time of school vacation. The duration of symptoms, estimated at the time of follow-up some 5 to 22 years later, was from a few days to a maximum of 2.5 years. Twenty-two (80%) said they were healthy and the remainder had minor complaints. None had organic illnesses that might have explained the ataxia. Three had continued mental problems and one was in jail for having killed his parents. [1]

COMMENT. A prompt and firm diagnosis on the basis of positive in addition to exclusion criteria is advocated, and a neurologic examination and appropriate laboratory tests are essential as a reassurance for both patient and treating physician. Dystonia musculorum deformans can be a pitfall, a disorder frequently misdiagnosed as a conversion reaction initially. In a study of 7 children with neurological symptoms diagnosed as hysterical conversion reactions and reported from Duke University Medical Center [2] all but one had been misdiagnosed as having organic diseases. When the correct diagnosis was made, all recovered and none relapsed after 3 to 11 months follow-up.