Functional movement disorders: diagnosis, pathophysiology, and treatment.

Area of Science:

• Neurology
• Movement Disorders
• Psychiatry

Background:

• Functional movement disorders (FMD) are prevalent and potentially reversible neurological conditions.
• Despite their impact, FMD are frequently under-recognized and misdiagnosed, leading to delayed treatment.
• Existing diagnostic models are evolving towards a positive, clinical sign-based approach.

Purpose of the Study:

• To review current understanding and management strategies for functional movement disorders.
• To highlight diagnostic shifts towards positive clinical signs and supportive electrophysiology.
• To explore pathophysiological mechanisms and optimize patient-centered care.

Main Methods:

• Review of current literature on functional movement disorders diagnosis and management.
• Analysis of diagnostic shifts from exclusion to positive rule-in criteria.
• Examination of pathophysiological models including predictive coding and network connectivity.

Main Results:

• Diagnosis now emphasizes positive clinical signs like inconsistency, with electrophysiology as a supportive tool.
• Pathophysiology involves complex interactions in predictive coding, sensorimotor integration, and limbic-motor networks.
• Prognosis varies, underscoring the need for early diagnosis and intervention.
• Effective management integrates validated explanations, movement retraining, and psychotherapy, with pharmacotherapy playing an adjunctive role.

Conclusions:

• Functional movement disorders necessitate an integrated, multidisciplinary, and patient-centered approach.
• Optimizing functional recovery and long-term outcomes depends on timely and comprehensive interventions.
• Addressing cognitive, behavioral, and emotional factors is crucial for sustained improvement.