Functional movement disorder: a long journey to diagnosis

Area of Science:

• Neurology
• Psychiatry
• Internal Medicine

Background:

• A 61-year-old man presented with orofacial movements and cognitive decline.
• He had a 7-year history of varied symptoms and inconclusive diagnoses across multiple specialties.
• This led to significant disability and psychosocial distress.

Observation:

• Inconsistent neurological signs and fluctuating cognition were noted.
• Significant psychosocial stressors preceded symptom onset.
• The patient's presentation mimicked other neurological conditions.

Findings:

• Diagnosis of a functional movement disorder (FMD) was established.
• Symptoms improved significantly with a multidisciplinary approach.
• Key interventions included relaxation therapy, cognitive-behavioural therapy, and physiotherapy.

Implications:

• Highlights the importance of recognizing functional movement disorders.
• Emphasizes the need for clear diagnostic criteria to avoid unnecessary investigations.
• Suggests a structured approach can minimize costly and time-consuming diagnostic processes.