Sandra M A van der Salm1, Anne-Fleur van Rootselaar1, Daniëlle C Cath1, Rob J de Haan1, Johannes H T M Koelman1, Marina A J Tijssen2. 1. From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands. 2. From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands. m.a.j.de.koning-tijssen@umcg.nl.
Abstract
OBJECTIVE: Functional or psychogenic movement disorders (FMD) present a diagnostic challenge. To diagnose FMD, clinicians must have experience with signs typical of FMD and distinguishing features from other hyperkinetic disorders. The aim of this study was to clarify the decision-making process of expert clinicians while diagnosing FMD, myoclonus, and tics. METHODS: Thirty-nine movement disorders experts rated 60 patients using a standardized web-based survey resembling clinical practice. It provided 5 steps of incremental information: (1) visual first impression of the patient, (2) medical history, (3) neurologic examination on video, (4) the Bereitschaftspotential (BP), and (5) psychiatric evaluation. After full evaluation of each case, experts were asked which diagnostic step was decisive. In addition, interim switches in diagnosis after each informational step were calculated. RESULTS: After full evaluation, the experts annotated the first impression of the patients as decisive in 18.5% of cases. Medical history was considered decisive in 33.3% of cases. Neurologic examination was considered decisive in 39.7%, the BP in 8%, and the psychiatric interview in 0.5% of cases. Most diagnostic switches occurred after addition of the medical history (34.5%). Addition of the neurologic examination led to 13.8% of diagnostic switches. The BP results led to diagnostic switches in 7.2% of cases. Psychiatric evaluation resulted in the lowest number of diagnostic switches (2.7% of cases). CONCLUSIONS: Experts predominantly rely on clinical assessment to diagnose FMD. Importantly, ancillary tests do not determine the final diagnosis of this expert panel. In general, the experts infrequently changed their differential diagnosis.
OBJECTIVE: Functional or psychogenic movement disorders (FMD) present a diagnostic challenge. To diagnose FMD, clinicians must have experience with signs typical of FMD and distinguishing features from other hyperkinetic disorders. The aim of this study was to clarify the decision-making process of expert clinicians while diagnosing FMD, myoclonus, and tics. METHODS: Thirty-nine movement disorders experts rated 60 patients using a standardized web-based survey resembling clinical practice. It provided 5 steps of incremental information: (1) visual first impression of the patient, (2) medical history, (3) neurologic examination on video, (4) the Bereitschaftspotential (BP), and (5) psychiatric evaluation. After full evaluation of each case, experts were asked which diagnostic step was decisive. In addition, interim switches in diagnosis after each informational step were calculated. RESULTS: After full evaluation, the experts annotated the first impression of the patients as decisive in 18.5% of cases. Medical history was considered decisive in 33.3% of cases. Neurologic examination was considered decisive in 39.7%, the BP in 8%, and the psychiatric interview in 0.5% of cases. Most diagnostic switches occurred after addition of the medical history (34.5%). Addition of the neurologic examination led to 13.8% of diagnostic switches. The BP results led to diagnostic switches in 7.2% of cases. Psychiatric evaluation resulted in the lowest number of diagnostic switches (2.7% of cases). CONCLUSIONS: Experts predominantly rely on clinical assessment to diagnose FMD. Importantly, ancillary tests do not determine the final diagnosis of this expert panel. In general, the experts infrequently changed their differential diagnosis.
Authors: Sandra M A van der Salm; Johan N van der Meer; Daniëlle C Cath; Paul F C Groot; Ysbrand D van der Werf; Eelke Brouwers; Stella J de Wit; Joris C Coppens; Aart J Nederveen; Anne-Fleur van Rootselaar; Marina A J Tijssen Journal: Neuroimage Clin Date: 2018-09-19 Impact factor: 4.881
Authors: Stoyan Popkirov; Timothy R Nicholson; Bastiaan R Bloem; Hannah R Cock; Christopher P Derry; Roderick Duncan; Barbara A Dworetzky; Mark J Edwards; Alberto J Espay; Mark Hallett; Anthony E Lang; John Paul Leach; Alexander Lehn; Aileen McGonigal; Francesca Morgante; David L Perez; Markus Reuber; Mark P Richardson; Philip Smith; Maria Stamelou; Marina A J Tijssen; Michele Tinazzi; Alan J Carson; Jon Stone Journal: J Neuropsychiatry Clin Neurosci Date: 2019-05-23 Impact factor: 2.198