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Published on: January 12, 2019
Clinical Correlates of Functional Motor Disorders: An Italian Multicenter Study
Michele Tinazzi1, Francesca Morgante2,3, Enrico Marcuzzo1
1Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy.
Background:
Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases.
Objective:
The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables.
Methods:
For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms.
Results:
Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs.
Conclusions:
Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.
Insights
Functional motor disorders (FMDs) often present with nonmotor symptoms and other functional neurological disorders (FNDs). Multidimensional assessments are crucial for effectively managing FMDs, particularly combined forms.
Area of Science:
- Neurology
- Neuroscience
- Psychiatry
Background:
- Functional motor disorders (FMDs) are characterized by abnormal movements influenced by distraction, differing from typical neurological movement disorders.
- FMDs encompass a range of motor symptoms incongruent with established neurological conditions.
Purpose of the Study:
- To detail the clinical features of FMDs, including nonmotor symptoms and co-occurring functional neurological disorders (FNDs).
- To determine the prevalence of isolated and combined FMDs and their associations with patient demographics and clinical factors.
Main Methods:
- A multicenter, observational study involving 410 outpatients diagnosed with FMDs across 25 Italian tertiary movement disorders centers.
- Detailed clinical evaluations assessed FMD phenotypes, presence of isolated or combined FMDs, and associated neurological and psychiatric symptoms.
Main Results:
- Weakness and tremor were the most common FMD phenotypes among 410 patients (71% female; mean age 47).
- Patients exhibited higher education, frequent nonmotor symptoms (anxiety, fatigue, pain), and nearly half had other FNDs (e.g., sensory symptoms, seizures).
- Combined FMDs were linked to a greater nonmotor symptom burden, more FNDs, and were more often diagnosed by movement disorder specialists.
Conclusions:
- The high frequency of nonmotor symptoms and FNDs in FMD patients necessitates comprehensive, multidimensional assessments.
- Special attention to combined FMDs is warranted due to their association with increased symptom burden and comorbidities.
