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Opinions and clinical practices related to diagnosing and managing functional (psychogenic) movement disorders:
K LaFaver1, A E Lang2, J Stone3
1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Background And Purpose:
There is large variability in the diagnostic approach and clinical management in functional movement disorders (FMD). This study aimed to examine whether opinions and clinical practices related to FMD have changed over the past decade.
Methods:
Adapted from a 2008 version, we repeated the survey to members of the International Parkinson and Movement Disorder Society (MDS).
Results:
In all, 864/7689 responses (denominator includes non-neurologists) were received from 92 countries. Respondents were more often male (55%), younger than 45 (65%) and from academic practices (85%). Although the likelihood of ordering neurological investigations prior to delivering a diagnosis of FMD was nearly as high as in 2008 (47% vs. 51%), the percentage of respondents communicating the diagnosis without requesting additional tests increased (27% vs. 19%; P = 0.003), with most envisioning their role as providing a diagnosis and coordinating management (57% vs. 40%; P < 0.001). Compared to patients with other disorders, 64% of respondents were more concerned about missing a diagnosis of another neurological disorder. Avoiding iatrogenic harm (58%) and educating patients about the diagnosis (53%) were again rated as the most effective therapeutic options. Frequent treatment barriers included lack of physician knowledge and training (32%), lack of treatment guidelines (39%), limited availability of referral services (48%) and cultural beliefs about psychological illnesses (50%). The preferred term for communication favored 'functional' over 'psychogenic' (P < 0.001).
Conclusions:
Attitudes and management of FMDs have changed over the past decade. Important gaps remain in access to treatment and in the education of neurologists about the inclusionary approach to FMD diagnosis.
Insights
Clinical practices for functional movement disorders (FMD) show shifts over a decade. While diagnostic approaches remain similar, physicians increasingly diagnose FMD without further tests, preferring the term "functional."
Area of Science:
- Neurology
- Movement Disorders
- Clinical Practice Research
Background:
- Functional Movement Disorders (FMD) exhibit significant variability in diagnostic methods and clinical management.
- Previous studies highlighted inconsistencies in FMD diagnosis and treatment approaches.
Purpose of the Study:
- To assess changes in clinical opinions and practices concerning FMD over the past ten years.
- To compare current FMD management strategies with those from a decade prior.
Main Methods:
- A survey adapted from a 2008 version was administered to members of the International Parkinson and Movement Disorder Society (MDS).
- The survey collected responses from 864 participants across 92 countries, detailing diagnostic and management preferences.
Main Results:
- The likelihood of ordering neurological investigations before diagnosing FMD remained consistent (47% vs. 51%).
- A significant increase was observed in diagnosing FMD without additional tests (27% vs. 19%), with a greater emphasis on the physician's role in diagnosis and management coordination (57% vs. 40%).
- Physicians expressed high concern (64%) about missing other neurological diagnoses and favored 'functional' over 'psychogenic' terminology (P < 0.001).
Conclusions:
- Attitudes and management strategies for FMD have evolved over the last decade.
- Gaps persist in treatment accessibility and neurologist education regarding an inclusive diagnostic approach for FMD.
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