Objective: To create a novel pilot clinic for the treatment of Functional Movement Disorders (FMD).

Background: FMDs are aberrations of motor system functioning in the absence of structural neuropathology. They are highly prevalent (1,2), difficult to treat and require a disproportionate use of healthcare resources (3). Prognosis is often poor and patients suffer high rates of disability (4,5). Treatments remain lacking due to the heterogeneity of FMD, the lack of large controlled studies, and outcome measures that can capture meaningful improvement. Promising results have been shown with physiotherapy (6,7), psychotherapies (8,9), and multidisciplinary inpatient models (10). However even in these models treatment remains siloed, perpetuating the mind/body dichotomy. Patients require individualized treatment plans encompassing both psychological and physical therapies in varying combinations, and we sought to create a new model of care that reflects this in a pilot clinic format.

Method: 11 patients (3 male, 8 female) with a primary diagnosis of a FMD were enrolled in a 6-session, bi-weekly treatment program where therapy was delivered in a rehabilitation model by the Neurologist, Neuropsychiatrist and Physiotherapist simultaneously. Treatment plans were individualized and combined psychological and physical therapies based on the neurological presentation and psychiatric formulation. The primary outcome for clinical efficacy was the Clinical Global Impression-Improvement (CGI-I) scale, with secondary clinical and quality-of-life scales administered at baseline and post-program completion.

Results: The mean age was 35y +/- 12, mean FMD symptom duration was 6.4y (6m – 20y), 36% had episodic symptoms, 81% had a mixed movement disorder, and 72% had a gait disorder. All patients had self-reported pain and fatigue, pre-morbid psychiatric diagnoses were present in 36% and 54% had a history of trauma. The CGI-I post program was “much” or “very much” improved in 7/11 (64%) of patients. Those with “mild” or no improvement (4/11) had longer disease duration (mean 11.3y) and older age (mean 47y).

Conclusion: There is a profound need for novel, integrated models of treatment for FMD that go beyond multidisciplinary. This pilot model demonstrated promising clinical outcomes in an otherwise difficult to treat population over a short time period and provided innovative new treatment approaches which will be studied in a larger trial.

References: 1. Factor SA, Podskalny GD, Molho ES. Psychogenic movement disorders: frequency, clinical profile, and characteristics. J Neurol Neurosurg Psychiatry. 1995 Oct 1;59(4):406–12. 2. Stone J, Carson A, Duncan R, Roberts R, Warlow C, Hibberd C, et al. Who is referred to neurology clinics?–the diagnoses made in 3781 new patients. Clin Neurol Neurosurg. 2010 Nov;112(9):747–51. 3. Parry AM, Murray B, Hart Y, Bass C. Audit of resource use in patients with non-organic disorders admitted to a UK neurology unit. J Neurol Neurosurg Psychiatry. 2006 Oct 1;77(10):1200–1. 4. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain. 2004 Oct 1;127(10):2360–72. 5. Ibrahim NM, Martino D, van de Warrenburg BPC, Quinn NP, Bhatia KP, Brown RJ, et al. The prognosis of fixed dystonia: a follow-up study. Parkinsonism Relat Disord. 2009 Sep;15(8):592–7. 6. Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res. 2013 Aug;75(2):93–102. 7. Nielsen G, Ricciardi L, Demartini B, Hunter R, Joyce E, Edwards MJ. Outcomes of a 5-day physiotherapy programme for functional (psychogenic) motor disorders. J Neurol. 2015 Mar 1;262(3):674–81. 8. LaFrance WC, Baird GL, Barry JJ, Blum AS, Webb AF, Keitner GI, et al. Multicenter Pilot Treatment Trial for Psychogenic Nonepileptic Seizures: A Randomized Clinical Trial. JAMA Psychiatry. 2014 Sep 1;71(9):997–1005. 9. Reuber M, Burness C, Howlett S, Brazier J, Grünewald R. Tailored psychotherapy for patients with functional neurological symptoms: a pilot study. J Psychosom Res. 2007 Dec;63(6):625–32. 10. Jacob AE, Kaelin DL, Roach AR, Ziegler CH, LaFaver K. Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1-Week Multidisciplinary Rehabilitation Program. PM R. 2018 Nov;10(11):1164–72.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/integrated-therapy-for-functional-movement-disorders-results-from-a-pilot-clinic/