Functional Movement Disorder: Evolving Mechanisms, Diagnostic Precision, and Personalized Multidisciplinary Care.

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Functional movement disorder (FMD) is a neuropsychiatric condition with involuntary motor symptoms inconsistent with established neurological diseases.
• It is associated with disruptions in brain networks controlling motor function, emotion, attention, and agency.

Purpose of the Study:

• To present an updated and integrated review of FMD, covering clinical, neurobiological, and therapeutic aspects.
• To incorporate recent evidence on diagnostic and treatment strategies for FMD.

Main Methods:

• A comprehensive review of key FMD studies, focusing on common presentations like tremor, dystonia, and gait disorders.
• Analysis of recovery factors and integration into a diagnostic and therapeutic algorithm.

Main Results:

• FMD predominantly affects women, often presenting with tremor, weakness, or mixed symptoms, alongside non-motor symptoms like pain and fatigue.
• Neuroimaging reveals disruptions in salience, interoception, and motor networks (amygdala, sensorimotor cortex, temporoparietal junction).
• Diagnosis relies on positive clinical signs; a five-phase framework involving communication and multidisciplinary input is recommended. Treatment is individualized, combining physiotherapy, CBT, neuromodulation, and pharmacotherapy.

Conclusions:

• FMD is a multisystem disorder necessitating integrated, personalized care.
• Advances in neurobiology and therapy are promising, yet challenges remain in developing biomarkers, standardized outcomes, and scalable treatments.