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Pediatric Functional Movement Disorders: Experience from a Tertiary Care Centre
Kempaiah Rakesh1, Nitish Kamble1, Ravi Yadav1
1Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, India.
Insights
Functional movement disorders (FMDs) in children often present with myoclonus and tremor, particularly in boys and girls, respectively. Identifying triggers and psychiatric links is key for better outcomes in pediatric FMD patients.
Area of Science:
- Pediatric Neurology
- Movement Disorders
- Child Psychiatry
Background:
- Functional movement disorders (FMDs) present diagnostic and management challenges in children.
- Understanding the interplay of socioeconomic, cultural, and psychopathological factors is crucial.
Purpose of the Study:
- To investigate the socioeconomic and cultural factors influencing FMDs in children.
- To explore the underlying psychopathology and phenomenology of FMDs in a pediatric cohort.
Main Methods:
- Retrospective chart review of 39 children diagnosed with FMDs.
- Data collected included demographics, socioeconomic/cultural background, and clinical presentation.
- Diagnosis confirmed using Fahn and Williams criteria.
Main Results:
- Mean age at onset was 12.69 years; most patients were from urban (56.41%) and low socioeconomic backgrounds (46.15%).
- Myoclonus (30.76%) was the most common symptom, followed by tremor (20.51%) and dystonia (17.94%).
- Precipitating factors were identified in 76.92% of cases; gender differences observed in symptom prevalence.
Conclusions:
- FMD symptoms significantly impact children's mental health and daily functioning.
- Identifying precipitating factors and psychiatric comorbidities is essential for effective management.
- Early intervention involving parents and child psychiatrists improves outcomes for pediatric FMD patients.
Objectives:
Functional movement disorders (FMDs) pose significant diagnostic and management challenges. We aimed to study the socioeconomic and cultural factors, underlying psychopathology and the phenomenology of FMDs in children.
Methods:
The study is a retrospective chart review of 39 children (16 girls and 23 boys) who attended our neurology OPD and the movement disorders clinic at the National Institute of Mental Health and Neurosciences (NIMHANS) between January 2011 and May 2020. The diagnosis of FMD was based on Fahn and Williams criteria and the patients were either diagnosed as "documented" or "clinically established". All the relevant demographic data including the ethnicity, socioeconomic and cultural background, examination findings, electrophysiological, and other investigations were retrieved from the medical records.
Results:
The mean age at onset was 12.69 ± 3.13 years. Majority of the children were from urban regions (56.41%) and belonging to low socioeconomic status (46.15%). Thirty (76.92%) were found to have a precipitating factor. Myoclonus was the most common phenomenology observed in these patients (30.76%), followed by tremor (20.51%), dystonia (17.94%), and gait abnormality (7.69%). Chorea (5.12%) and tics (2.56%) were uncommon. Tremor (37.5%) and dystonia (18.75%) were more common in girls, whereas myoclonus (39.13%) was more common in boys.
Conclusions:
The symptoms of FMD have great impact on the mental health, social, and academic functioning of children. It is important to identify the precipitating factors and associated psychiatric comorbidities in these children as prompt alleviation of these factors by engaging parents and the child psychiatrist will yield better outcomes.
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