Challenges in the diagnosis and management of functional movement disorders in a developing nation: insights from the...

Functional movement disorders (FMDs) are common but often misdiagnosed among functional neurological disorders. Key findings from this study include frequent diagnostic delays, a predominance of women (70% of cases), and frequent comorbidity with anxiety and mood disorders. Tremor and dystonia were the most common FMD phenotypes. Delayed recognition, high psychiatric comorbidity, and fragmented care emerged as major challenges. Lack of structured psychiatric assessment and low adherence to psychiatric follow-up, especially among those with lower education and in certain occupations, were noted, highlighting important gaps in care. These findings are based on data from a tertiary clinic in the Philippines, an underrepresented setting in the literature. We conducted a cross-sectional review of individual patient data from a Movement Disorders Clinic, including 37 patients diagnosed with FMDs according to established diagnostic criteria. Women accounted for 70% of cases (female-to-male ratio 2.3:1), with a mean age at symptom onset in the late twenties. Tremor (35%) and dystonia (32%) were the most frequent phenotypes, often coexisting. The mean delay from symptom onset to first consultation exceeded three years. There was a significant positive correlation between delay to consultation and total symptom duration (r = 0.497, p < 0.002), suggesting that later presentation is associated with longer symptom duration. Anxiety and mood disorders were the most common psychiatric comorbidities, yet many patients lack formal, structured psychiatric evaluation, indicating gaps in mental health assessment. Only 46% of those referred to psychiatry attended follow-up, with poorer adherence observed among patients with lower educational attainment and in specific occupational groups. These results underscore the major clinical and systemic burdens associated with FMDs in resource-limited healthcare settings. The study emphasizes three key findings: persistent diagnostic delays, the frequent co-occurrence of psychiatric issues, and substantial gaps in integrated care, especially relating to psychiatrically informed follow-up. Early identification of FMDs, integration of neurological and psychiatric services, and efforts to reduce stigma and bolster access, particularly for underserved groups, are essential steps to improve patient outcomes.