Michele Tinazzi1, Francesca Morgante2,3, Enrico Marcuzzo1, Roberto Erro4, Paolo Barone4, Roberto Ceravolo5, Sonia Mazzucchi5, Andrea Pilotto6,7, Alessandro Padovani6, Luigi M Romito8, Roberto Eleopra8, Mario Zappia9, Alessandra Nicoletti9, Carlo Dallocchio10, Carla Arbasino10, Francesco Bono11, Angelo Pascarella11, Benedetta Demartini12, Orsola Gambini12, Nicola Modugno13, Enrica Olivola13, Vincenzo Di Stefano14, Alberto Albanese15, Gina Ferrazzano16, Alessandro Tessitore17, Maurizio Zibetti18, Giovanna Calandra-Buonaura19,20, Martina Petracca21, Marcello Esposito22,23, Antonio Pisani24, Paolo Manganotti25, Fabrizio Stocchi26, Mario Coletti Moja27, Angelo Antonini28, Giovanni Defazio29, Christian Geroin1. 1. Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy. 2. Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London London United Kingdom. 3. Department of Experimental and Clinical Medicine University of Messina Messina Italy. 4. Center for Neurodegenerative Diseases, Department of Medicine, Surgery and Dentistry-Scuola Medica Salernitana University of Salerno Baronissi Italy. 5. Neurology Unit, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy. 6. Department of Clinical and Experimental Sciences University of Brescia Brescia Italy. 7. FERB Onlus, Ospedale S. Isidoro, Trescore Balneario Bergamo Italy. 8. Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy. 9. Department G.F. Ingrassia, Section of Neurosciences University of Catania Catania Italy. 10. Department of Medical Area Neurology Unit, ASST Pavia Pavia Italy. 11. Botulinum Toxin Center Neurology Unit A.O.U. Mater Domini Catanzaro Italy. 12. Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences University of Milan Milan Italy. 13. IRCCS Neuromed Pozzilli Italy. 14. Department of Neuroscience, Imaging and Clinical Sciences University G. d'Annunzio Chieti-Pescara Italy. 15. Department of Neurology IRCCS Humanitas Research Hospital Rozzano Italy. 16. Department of Human Neurosciences Università La Sapienza Rome Italy. 17. Department of Advanced Medical and Surgery Sciences University of Campania - Luigi Vanvitelli Naples Italy. 18. Department of Neuroscience-Rita Levi Montalcini University of Turin Turin Italy. 19. Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy. 20. IRCCS, Institute of Neurological Sciences of Bologna Bologna Italy. 21. Movement Disorder Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy. 22. Clinical Neurophysiology Unit Cardarelli Hospital Naples Italy. 23. Department of Neurosciences Reproductive and Odontostomatological Sciences, University of Naples-Federico II Naples Italy. 24. Department of Systems Medicine University of Rome Tor Vergata Rome Italy. 25. Clinical Neurology Unit, Department of Medical Surgical and Health Services, University of Trieste Trieste Italy. 26. University and Institute of Research and Medical Care San Raffaele Roma Rome Italy. 27. Mauriziano Hospital Umberto I Turin Italy. 28. Movement Disorders Unit, Department of Neuroscience University of Padua Padua Italy. 29. Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy.
Abstract
BACKGROUND: Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases. OBJECTIVE: The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables. METHODS: For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms. RESULTS: Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs. CONCLUSIONS: Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.
BACKGROUND: Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases. OBJECTIVE: The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables. METHODS: For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms. RESULTS: Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs. CONCLUSIONS: Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.
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