Clinical Correlates of Functional Motor Disorders: An Italian Multicenter Study, 2020, Tinazzi et al

[Andy]

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.

Paywall, https://onlinelibrary.wiley.com/doi/10.1002/mdc3.13077
Sci hub, https://sci-hub.se/10.1002/mdc3.13077

 

[alktipping]

so many names put to a meaningless document when will they actually come up with some evidence to support this notion that psychiatric disorders cause symptoms .neurology seems to be heading to the bottom of the barrel for opinion based medicine it is a road that will cause maximum suffering for patients and guarantees stigmatisation of anyone given an fnd diagnosis.

 

[MFraumeni]

I have found this article in press of great benefit to my thinking as someone "diagnosed" with CD/FND by neurologists and one psychiatrist (and with parkinsonism of undetermined nature by a research geriatrician where I was assessed for a study but an exclusion criteria was parkinsonism). The author is a forensic psychologist and quite approachable via email for feedback. The journal unfortunately is not indexed in Pubmed so it seems:

Functional Neurological Disorders and Psychogenic Nonepileptic Seizures: Neurologic Disease NOT a ‘Functional Etiology’

"FND and PNES investigators remain highly invested in the ‘functional’ etiology and show confirmation bias in their interpretation of the empirical data. The ongoing misdiagnosis of neurologic disease and epilepsy as FND and PNES is the real crisis in neurology."

http://www.scienceinquest.com/open-access/fulltext/jnpd/functional-neurological-disorders-and-psychogenic-nonepileptic-seizures-neurologic-disease-not-a-functional-etiology.php

Below is a paraphrasing of the author's response to me on email when I mentioned to her I found her article very refreshing looking at CD/FND in an "organic" sense rather than how the neurologists and one psychiatrist I have seen as a pure psychiatric disorder.

Thank you for your response. It is so good to hear that you found a medical professional outside neurology to assist you!! I actually cite another article by Barnum in my article. The diagnostic practice in neurology (pushed by a powerful faction) is alarming and has incalculable consequences;, both physical and psychological. The powers that are invested in these erroneous diagnoses had my first article on PNES retracted and then removed from the International Journal of Epilepsy, a reputable journal with reputable reviewers. Suppression. I would encourage you to disseminate my article to the neurologists and the psychiatrist who insist you have psychogenic symptoms-as well as your family doctor and the geriatrician. This is a grass roots movement and every person misdiagnosed can participate to change what is happening!
Be well and Do Good.