Alexandra E Jacob1, Darryl L Kaelin2, Abbey R Roach3, Craig H Ziegler4, Kathrin LaFaver5. 1. Department of Neurology, University of Louisville, Louisville, KY(∗). 2. Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY(†). 3. Division of Psychology and Neuropsychology, Frazier Rehab Institute, Louisville, KY(‡). 4. School of Medicine, University of Louisville, Louisville, KY(§). 5. Department of Neurology, University of Louisville, 220 Abraham Flexner Way, Suite 606, Louisville, KY, 40202(¶). Electronic address: kathrin.lafaver@louisville.edu.
Abstract
BACKGROUND: Functional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies. OBJECTIVE: To assess outcomes of FMD patients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success. DESIGN: Retrospective chart review. SETTING: University-affiliated rehabilitation institute. PATIENTS: Thirty-two consecutive FMD patients admitted to the MoRe program from July 2014-July 2016. INTERVENTION: Patients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions. MAIN OUTCOME MEASUREMENTS: Primary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program. RESULTS: Twenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes. CONCLUSIONS: The majority of FMD patients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed. LEVEL OF EVIDENCE: III.
BACKGROUND:Functional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies. OBJECTIVE: To assess outcomes of FMDpatients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success. DESIGN: Retrospective chart review. SETTING: University-affiliated rehabilitation institute. PATIENTS: Thirty-two consecutive FMDpatients admitted to the MoRe program from July 2014-July 2016. INTERVENTION: Patients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions. MAIN OUTCOME MEASUREMENTS: Primary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program. RESULTS: Twenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes. CONCLUSIONS: The majority of FMDpatients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed. LEVEL OF EVIDENCE: III.
Authors: Benjamin Stewart; Jon G Dean; Adriana Koek; Jason Chua; Rafael Wabl; Kayla Martin; Naveed Davoodian; Christopher Becker; Mai Himedan; Amanda Kim; Roger Albin; Kelvin L Chou; Vikas Kotagal Journal: Pharmacol Res Perspect Date: 2020-12