Objective: (1) To examine current opinion and clinical practices related to diagnosis and management of Functional Movement Disorders (FMD); and (2) to determine if practice patterns have changed compared to a similar survey to members of the International Parkinson and Movement Disorder Society (MDS) conducted ten years ago [1].

Background: FMD present common and unique challenges to practitioners. Gaps in knowledge include variability in the diagnostic approach, clinical management, and access to treatment around the world.

Method: A 21-item survey about attitudes and clinical practices regarding FMD used in a prior survey [1], updated by the MDS FMD Study group, was sent to MDS members. The survey remained open for six weeks between August 16 and September 28, 2018.

Results: There were 864 responses from MDS members in 92 countries, for an estimated response rate in practicing clinicians of 25.5%. Respondents were predominantly male (55%), under the age of 45 (65%), and worked in an academic practice setting (85%). Similar to 2009, a majority of respondents (46.7%) chose to order standard neurological investigations before informing a patient of a FMD diagnosis. Unlike the early survey, a significantly higher number informed patients about the diagnosis based on unequivocal features on exam alone (26.5% vs 18.9%; p=0.003). 63.5% of respondents were more concerned about missing another diagnosis in FMD patients compared to other disorders they manage. Avoiding iatrogenic harm (58.1%), educating the patient about the diagnosis (53.1%), referral to rehabilitation services (40.4%) and psychotherapy (34.6%) were believed to be most effective therapeutic options. Frequent treatment barriers varied between countries and included lack of physician knowledge and training (31.8%), lack of treatment guidelines (39.1%), availability of referral services (47.9%), and cultural beliefs about psychological illnesses (50.4%). Compared to 2009, the preferred term for communication with healthcare professionals and the lay public was “functional” rather than “psychogenic” (p<0.001).

Conclusion: While practices in diagnosis and treatment of FMD are slowly changing, an exclusionary approach to the diagnosis remains the norm. Limited access to treatment resources for FMD remains a major problem.

References: 1. Espay AJ, Goldenhar LM, Voon V, Schrag A, Burton N, Lang AE. Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members. Movement disorders: official journal of the Movement Disorder Society 2009;24:1366-1374.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/opinions-and-clinical-practices-related-to-diagnosing-and-managing-patients-with-functional-psychogenic-movement-disorders-from-2009-to-2019/