A Musician Presents with Unusual Facial Movements, Insomnia, and Depression

Abstract

RB, a relatively healthy 68-year-old musician, is referred for psychiatric treatment after reporting several months of distressing episodic movements. His partner described the sudden-onset episodes as spasm-like flexing of one arm and hand, accompanied by bizarre facial grimaces. The episodes, which occurred day and night and lasted 1–2 s, had been increasing in frequency over the few months prior to evaluation. Nocturnal episodes could approach 45 per night, severely disrupting his sleep. Episodes were associated with speech arrest but preserved consciousness and “weird, intrusive thoughts and images,” such as thinking of the letter “X.”