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Neuropsychiatric phenotypes in functional movement disorder.

Gabriela S Gilmour1,2, Laura K Langer3, Anthony E Lang1,2

  • 1Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.

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|July 10, 2023
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Summary

Functional movement disorder (FMD) is linked to non-motor symptoms, forming a broader neuropsychiatric syndrome. Identifying distinct FMD phenotypes aids in understanding and managing this complex condition.

Keywords:
conversion disorderfunctional movement disorderfunctional neurological disordernon-motor featuresphenotypespsychogenic movement disorderpsychopathology

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Movement Disorders

Background:

  • Functional movement disorder (FMD) is a subtype of functional neurological disorder, primarily defined by motor symptoms.
  • Non-motor symptoms are frequently observed in FMD patients but are not well-characterized in relation to the motor phenotype.
  • Understanding the interplay between motor and non-motor features is crucial for a comprehensive view of FMD.

Purpose of the Study:

  • To explore novel neuropsychiatric FMD phenotypes by integrating movement disorder presentations with non-motor comorbidities.
  • To identify patterns and clinical factors contributing to the development and maintenance of FMD.

Main Methods:

  • A retrospective chart review of 158 FMD patients was conducted, involving deep phenotyping across neurological and psychiatric domains.
  • Cluster analysis was used to identify patterns combining motor symptoms with somatic symptoms, psychiatric diagnoses, and psychological factors.
  • Logistic regression models were employed to test the identified neuropsychiatric FMD phenotypes.

Main Results:

  • Distinct FMD phenotypes emerged when stratified by episodic versus constant motor symptoms.
  • Episodic FMD was associated with hyperkinetic movements, hyperarousal, anxiety, and trauma history.
  • Constant FMD was linked to weakness, gait disorders, fixed dystonia, activity avoidance, and low self-agency; pain, fatigue, and health anxiety were common across phenotypes.

Conclusions:

  • FMD is part of a broader neuropsychiatric syndrome, with patterns spanning the neurological-psychiatric interface.
  • A transdisciplinary approach reveals identifiable clinical factors relevant to FMD development and maintenance.
  • Recognizing these neuropsychiatric phenotypes can inform clinical management and treatment strategies.