BACKGROUND: Functional ("psychogenic") gait and other movement disorders have proven very difficult to treat. OBJECTIVES: Describe the Mayo Clinic functional movement disorder motor-reprogramming protocol conducted in the Department of Physical Medicine and Rehabilitation (PMR), and assess short-term and long-term outcomes. DESIGN: Historical-cohort-study assessing non-randomized PMR intervention. SETTING: Tertiary care center. PATIENTS: Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008. CONTROL GROUP: age- and sex-matched patients with treatment-as-usual (n = 60). INTERVENTIONS: An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment. MAIN OUTCOME MEASURES: Improvement of the movement disorder by the end of the week-long program (patient- and physician-rated), plus the long-term outcome (patient-rated). RESULTS: Patient demographics: median symptom duration, 17 months (range, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). Physician-rated outcomes after the one-week treatment program documented 73.5% were markedly improved, nearly normal or in remission, similar to the patient-ratings (68.8%). Long-term treatment outcomes (patient-rated; median follow-up, 25 months) revealed 60.4% were markedly improved or almost completely normal/in remission, compared to 21.9% of controls (p < 0.001). CONCLUSIONS: Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial.
BACKGROUND: Functional ("psychogenic") gait and other movement disorders have proven very difficult to treat. OBJECTIVES: Describe the Mayo Clinic functional movement disorder motor-reprogramming protocol conducted in the Department of Physical Medicine and Rehabilitation (PMR), and assess short-term and long-term outcomes. DESIGN: Historical-cohort-study assessing non-randomized PMR intervention. SETTING: Tertiary care center. PATIENTS: Interventional group: 60 consecutive patients with a chronic functional movement disorder that underwent the PMR protocol between January 2005 and December 2008. CONTROL GROUP: age- and sex-matched patients with treatment-as-usual (n = 60). INTERVENTIONS: An outpatient, one-week intensive rehabilitation program based on the concept of motor-reprogramming following a comprehensive diagnostic neurological evaluation, including psychiatric/psychological assessment. MAIN OUTCOME MEASURES: Improvement of the movement disorder by the end of the week-long program (patient- and physician-rated), plus the long-term outcome (patient-rated). RESULTS:Patient demographics: median symptom duration, 17 months (range, 1-276); female predominance (76.7%); mean age 45 years (range, 17-79). Physician-rated outcomes after the one-week treatment program documented 73.5% were markedly improved, nearly normal or in remission, similar to the patient-ratings (68.8%). Long-term treatment outcomes (patient-rated; median follow-up, 25 months) revealed 60.4% were markedly improved or almost completely normal/in remission, compared to 21.9% of controls (p < 0.001). CONCLUSIONS: Short-term and long-term successful outcomes were documented in the treatment of patients with functional movement disorders by a rehabilitative, goal-oriented program with intense physical and occupational therapy. The rapid benefit, which was sustained in most patients, suggests substantial efficacy that should be further assessed in a prospective, controlled, clinical trial.
Authors: T A Saifee; P Kassavetis; I Pareés; M Kojovic; L Fisher; L Morton; J Foong; G Price; E M Joyce; M J Edwards Journal: J Neurol Date: 2012-05-15 Impact factor: 4.849
Authors: Jeannette M Gelauff; Yasmine E M Dreissen; Marina A J Tijssen; Jon Stone Journal: Curr Treat Options Neurol Date: 2014-04 Impact factor: 3.598