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Alterations in Muscle Tone ll

Alterations in Muscle Tone ll

Alterations in muscle tone are common manifestations of neurological disorders and reflect dysfunction within different nervous system regions. Spasticity, paratonia, and dystonia represent distinct forms of hypertonia, each with unique mechanisms, clinical features, and diagnostic importance.CharacteristicsSpasticity happens from upper motor neuron lesions and is characterized by velocity-dependent resistance to passive movement. Clinical features include:Exaggerated deep tendon reflexesClonus...

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Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis

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Persistent Diagnostic Disagreement Among Individuals With Functional Movement Disorders.

Adriano Mollica^1,2, Nima Nahiddi³, Gabriela S Gilmour^4,5

¹Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Center, University of Toronto, Toronto.

The Journal of Neuropsychiatry and Clinical Neurosciences

|March 5, 2026

Summary

This summary is machine-generated.

Persistent diagnostic disagreement (PDD) is common in functional movement disorder (FMD) and linked to psychological factors. This study defines PDD and identifies associated elements in FMD patients, highlighting potential areas for intervention.

Keywords:

Diagnostic Agreement Functional Movement Disorder Functional Neurological Disorder Persistent Diagnostic Disagreement

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Area of Science:

Neurology
Psychiatry
Clinical Psychology

Background:

Diagnostic agreement is crucial for effective treatment outcomes in neurological disorders.
Persistent diagnostic disagreement (PDD) in functional movement disorder (FMD) has not been well-studied.
Understanding PDD is essential for improving patient care and therapeutic success in FMD.

Purpose of the Study:

To propose a definition for persistent diagnostic disagreement (PDD) in functional movement disorder (FMD).
To identify demographic and clinical factors associated with PDD in FMD patients.
To evaluate the accuracy of patient self-reports and referring clinician impressions in identifying PDD.

Main Methods:

Retrospective review of clinical data from 158 FMD patients.
Assessment of patient self-reported diagnostic agreement and specialist-determined PDD status.
Utilized logistic regression and LASSO modeling to identify factors associated with PDD.
Evaluated concordance between referring clinician impressions and patient self-reports.

Main Results:

41% of FMD patients (47 out of 116) were classified as having PDD.
PDD was associated with low agency, cluster B traits, lower readiness to change, and inability to notice symptom variability.
Low agency was the only factor retained in the LASSO analysis.
Concordance between referring physician impressions and patient self-reported disagreement was low (weighted κ=0.21).

Conclusions:

Persistent diagnostic disagreement is prevalent in functional movement disorder.
Neither patient self-reports nor initial clinical impressions accurately identify PDD.
PDD may be associated with modifiable psychological processes, suggesting potential therapeutic targets.