In a study of the clinical features of conversion disorder in 52 children admitted to the Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia, hysterical gait disturbance was the main complaint in 71%, and pain, paresthesia or anesthesia in 77%. So called classical conversion symptoms such as blindness and globus were relatively rare. The disorder was rare below 8 years of age and girls outnumbered boys three to one. Spring and summer (Sept-Nov and Jan-Mar in Australia) accounted for 75% of admissions, coinciding with the end of year exams and the beginning of the new school year. Only 6 children had organic disease before the hysterical episodes. Psychological features included a model (54%), stressful event (46%), separation or loss of relative (46%), previous hysterical symptoms (33%), la belle indifference (19%). Treatment consisted of stopping unwarranted investigation, PT and OT, and psychologic counseling. At discharge, 61% were completely recovered or had appreciably improved. A core group of 13 (21%) did not respond. [1]

COMMENT: In all but 3 of the 36 children presenting with an abnormality of gait, pain and, less frequently, anesthesia were prominent features. These associated symptoms are helpful in the differentiation from a dystonic gait, frequently misdiagnosed as hysterical in nature. The infrequent occurrence of organic disease as a prelude to conversion symptoms in this study is unusual. Gait disturbances of an hysterical nature may be preceded by minor trauma and pseudoseizures are frequently accompanied by true seizures requiring treatment with anticonvulsant drugs.