Objective: We did a retrospective record review to determine the proportion of patients with functional MD visiting our clinic and to characterize the phenomenology of these MD.

Background: Functional movement disorders(MD) are not uncommon in patients presenting to the movement disorder clinics. Detailed clinical evaluation along with electrophysiological tools helps in making a diagnosis of functional MD. We did a retrospective record review to determine the proportion of patients with functional MD visiting our clinic and to characterize the phenomenology of these MD.

Method: Medical records of patients visiting the movement disorder clinic over a period of one year of a tertiary referral center were screened and patients who had a diagnosis of functional Movement disorder was extracted. Patient’s records were evaluated and patients who fulfilled the diagnostic criteria of functional movement disorder were included in the study.(1) Diagnosis of functional MD was based on clinical testing and or electrophysiological study. The clinical features, phenomenology of MD, and response to treatment was recorded.

Results: Of 336 patients, 22 patients were fulfilling the criteria of functional MD. There was a female dominance with 14 patients being female. The age ranged from 14 years to 56 years and mean age was 31.54 ± 12.52 years. The most common MD phenomenology was tremor (45.4%), gait disorder (22.7%) and dystonia (22.7%). One patient could not be categorized into established phenomenology. A stressor was present in 8(36.4%) patients and depression was found as a comorbidity in 54.5% patients. Symptoms of other systemic diseases was encountered in 5(22.7%).The onset of MD was abrupt in 14 (63.6%).The most common body part involved were the limbs(14, 63.6%) with asymmetrical involvement, head(3,13.6%) ,face (2,9%), neck (2,9%) and trunk (2,9%). Ten patients had more than one body part involved on presentation. After treatment of comorbid psychiatric illness and counseling , 15 patients (68.1%)had improvement and 6 did not have significant improvement.

Conclusion: Functional MD are an important differential in patients presenting to movement disorder clinic. A large proportion patients have comorbid psychiatric illness. Tremor was the most common MD phenomenology encountered in our clinic. Treatment of comorbidity and counselling leads to improvement in a significant proportion of patients.

References: 1.Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol 2009; 22:430.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-spectrum-of-functional-movement-disorders-a-clinic-based-study-from-a-developing-country/