Moving Beyond Movement: Diagnosing Functional Movement Disorder

Gilmour, Gabriela S.; Lidstone, Sarah C.

doi:10.1055/s-0043-1763505

Cited by 9 publications

(15 citation statements)

References 94 publications

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“…4,5 Taken together, these findings reinforce the concept of an FMD syndrome that is not sufficiently defined based on motor phenotype alone. 2,4,34 Our results confirm previous reports of a mean diagnostic delay of 6 years, and invalidating healthcare experiences experienced by patients. 21,35 We also identified a precipitating trigger for motor symptom onset in 83% of individuals, which is higher than other reports (48%-80%).…”

Section: Discussionsupporting

confidence: 88%

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Neuropsychiatric phenotypes in functional movement disorder

Gilmour¹,

Langer²,

Lang³

et al. 2023

CNS Spectr.

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Objective Functional movement disorder (FMD), the motor-dominant subtype of functional neurological disorder, is a complex neuropsychiatric condition. Patients with FMD also manifest non-motor symptoms. Given that patients with FMD are diagnosed based on motor phenotype, the contribution of non-motor features to the neuropsychiatric syndrome is not well characterized. The objective of this hypothesis-generating study was to explore potential novel, neuropsychiatric FMD phenotypes by combining movement disorder presentations with non-motor comorbidities including somatic symptoms, psychiatric diagnoses, and psychological traits. Methods This retrospective chart review evaluated 158 consecutive patients with a diagnosis of FMD who underwent deep phenotyping across neurological and psychiatric domains. Demographic, clinical, and self-report features were analyzed. A data-driven approach using cluster analysis was performed to detect patterns when combining the movement disorder presentation with somatic symptoms, psychiatric diagnoses, and psychological factors. These new neuropsychiatric FMD phenotypes were then tested using logistic regression models. Results Distinct neuropsychiatric FMD phenotypes emerged when stratifying by episodic vs. constant motor symptoms. Episodic FMD was associated with hyperkinetic movements, hyperarousal, anxiety, and history of trauma. In contrast, constant FMD was associated with weakness, gait disorders, fixed dystonia, activity avoidance, and low self-agency. Pain, fatigue, somatic preoccupation, and health anxiety were common across all phenotypes. Conclusion This study found patterns spanning the neurological-psychiatric interface that indicate that FMD is part of a broader neuropsychiatric syndrome. Adopting a transdisciplinary view of illness reveals readily identifiable clinical factors that are relevant for the development and maintenance of FMD.

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Section: Discussionsupporting

confidence: 88%

“…, 5 Taken together, these findings reinforce the concept of an FMD syndrome that is not sufficiently defined based on motor phenotype alone 2 4 , 34 …”

Section: Discussionsupporting

confidence: 56%

Neuropsychiatric phenotypes in functional movement disorder

Gilmour¹,

Langer²,

Lang³

et al. 2023

CNS Spectr.

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“…Functional motor symptoms were further classified as episodic or constant (Table 1). 16 FMD-relevant factors and rehabilitation-relevant factors are recurrent behavioral patterns observed in FMD drawn from the literature and subspecialist clinical experience. 10,17,18 These factors were identified based on interprofessional clinical impression at the time of the assessment, with findings explicitly documented during the history and examination.…”

Section: Data Extractionmentioning

confidence: 99%

“…9 In partnership with movement disorders clinics, specialist FMD clinics provide in-depth interprofessional patient assessments, education, triage, treatment planning, and rehabilitation, and tend to focus on aspects outside of traditional neurological or psychiatric consultation. 12 Such clinics are therefore uniquely poised to explore the various factors influencing treatment suitability and outcomes. 7 FMD is unique among neurological disorders in that it is diagnosed by neurologists, yet is often treated by other disciplines, including psychiatry and allied health.…”

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confidence: 99%

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

Gilmour,

Langer,

Bhatt

et al. 2024

Movement Disord Clin Pract

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BackgroundTreatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage.ObjectivesTo describe our approach and explore factors associated with triage to FMD rehabilitation.MethodsWe conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed.ResultsSixty‐six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self‐agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes.ConclusionsThe ability to “opt‐in” to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets.

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“…Patients who have FNDs have examination findings that demonstrate preserved neurologic function despite perceived deficits, for example, distractibility, variability, and entrainment of movements. 102 FNDs involve symptoms including tremor, paralysis, muscle cramping, dissociative symptoms, and seizure-like episodes (e.g., psychogenic nonepileptic spells or PNES). FNDs cause considerable distress and disability to those affected, and treatment is focused on rehabilitating motor function with physical and occupational therapy.…”

Section: Frequency and Ethnic Variation Of Genetic Forms Of Dystoniamentioning

confidence: 99%

Global Epidemiology of Movement Disorders: Rare or Underdiagnosed?

O’Shea

Shih

2023

Semin Neurol

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In this manuscript, we review the epidemiology of movement disorders including Parkinson's disease (PD), atypical parkinsonism, essential tremor, dystonia, functional movement disorders, tic disorders, chorea, and ataxias. We emphasize age-, sex-, and geography-based incidence and prevalence, as well as notable trends including the rising incidence and prevalence of PD. Given the growing global interest in refining clinical diagnostic skills in recognizing movement disorders, we highlight some key epidemiological findings that may be of interest to clinicians and health systems tasked with diagnosing and managing the health of patients with movement disorders.

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Moving Beyond Movement: Diagnosing Functional Movement Disorder

Cited by 9 publications

References 94 publications

Neuropsychiatric phenotypes in functional movement disorder

Neuropsychiatric phenotypes in functional movement disorder

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

Global Epidemiology of Movement Disorders: Rare or Underdiagnosed?

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