Functional motor disorders associated with other neurological diseases: Beyond the boundaries of “organic” neurology

Abstract

Background and purpose The aims of this study were to describe the clinical manifestations of functional motor disorders (FMDs) coexisting with other neurological diseases (“comorbid FMDs”), and to compare comorbid FMDs with FMDs not overlapping with other neurological diseases (“pure FMDs”). Methods For this multicenter observational study, we enrolled outpatients with a definite FMD diagnosis attending 25 tertiary movement disorder centers in Italy. Each patient with FMDs underwent a detailed clinical assessment including screening for other associated neurological conditions. Group comparisons (comorbid FMDs vs. pure FMDs) were performed in order to compare demographic and clinical variables. Logistic regression models were created to estimate the adjusted odds ratios (95% confidence intervals) of comorbid FMDs (dependent variable) in relation to sociodemographic and clinical characteristics (independent variables). Results Out of 410 FMDs, 21.7% of patients (n = 89) had comorbid FMDs. The most frequent coexisting neurological diseases were migraine, cerebrovascular disease and parkinsonism. In the majority of cases (86.5%), FMDs appeared after the diagnosis of a neurological disease. Patients with comorbid FMDs were older, and more frequently had tremor, non‐neurological comorbidities, paroxysmal non‐epileptic seizures, major depressive disorders, and benzodiazepine intake. Multivariate regression analysis showed that diagnosis of comorbid FMDs was more likely associated with longer time lag until the final diagnosis of FMD, presence of tremor and non‐neurological comorbidities. Conclusions Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non‐neurological diseases.

Economic Costs of Delayed Diagnosis of Functional Motor Disorders: Preliminary Results From a Cohort of Patients of a Specialized Clinic

“…Our data should be interpreted cautiously given the small sample size, also including patients with FMD with comorbid organic neurological and psychiatric disorders, which may have lengthened time to diagnosis and increased healthcare costs. However, our cohort's proportion of these comorbidities is consistent with those reported in a larger sample of FMD patients (3,9,29), thus indicating that our patient's sample is representative. Data from a larger sample of FMDs stratifying patients with and without neurological/psychiatric comorbidity would generalize the present results.…”

“…Over the past decade, despite advances in our understanding of the pathophysiology of FMDs (1,(6)(7)(8), clinical correlates (3,9), and evidence-based treatment (8,10), the illness is neither adequately diagnosed nor treated, as evidenced by the dissatisfaction expressed by neurologists (11) and by patients who feel misunderstood and abandoned by their healthcare providers (12). Such dissatisfaction reflects inadequacies within current clinical services for patients with FMDs (8,12) and the lack of early diagnosis and disease-specific, evidencebased management.…”

“…Data from the first year (2018–2019) of the Italian Registry of Functional Motor Disorders (RI-FMDS) showed that the model is not currently operational in Italy: three physicians (range 1–25) on an average evaluated 80% of patients before a correct diagnosis was established, and about 73% of patients received one or more misdiagnoses of organic neurological disease ( 3 , 9 ), with a diagnostic delay of about 6 years. Patients are often improperly referred to psychological and psychotherapy (rarely to physiotherapy) and leave their job due to an undiagnosed condition ( 3 ).…”

Qualitative smell/taste disorders as sequelae of acute COVID-19

“…Patients were examined 63.6 ± 40.8 days (range 8-151 days) after the negative nasopharyngeal swab. Exclusion criteria were history of head or neck trauma [11][12][13], cognitive impairment and psychiatric conditions interfering with study participation [14,15], chronic/acute rhinosinusitis, neurological diseases involving smell/taste function [16][17][18], and systemic diseases related to smell/taste disorders [19].…”

Sudden Onset, Fixed Dystonia and Acute Peripheral Trauma as Diagnostic Clues for Functional Dystonia

“… 7 , 8 Core assessment characterizing IRFMD and IRAD has been described in detail elsewhere 9 , 10 ; it comprises demographic, historical, and clinical information on the movement disorder and possible predisposing/precipitating factors. 11 , 12 , 13 …”