Objective: To determine long term symptom outcome, quality of life, psychiatric co morbidity, work plus social adjustment and mortality of patients with a functional motor disorder (FMD), compared to neurological controls (NC) and healthy controls (HC).

Background: Prognosis of functional motor disorders is generally unfavorable, but prospective studies are scarce. Our previously published case-control cohort (1) of recent onset symptoms of FMD (n=107), weakness caused by neurological disease (n=46) and healthy controls (n=38) provided an unique opportunity to perform very long term follow-up.

Methods: After ethical approval, we used electronic secondary care records, wrote to primary care providers and determined mortality using the National Records of Scotland. Participants received an online questionnaire consisting of: Clinical Global Inventory (CGI) for symptom outcome, RAND-36, Hospital Anxiety and Depression Scale (HADS); Work and Social Adjustment Scale (WSAS). Some final recruitment is still ongoing.

Results: 54 FMD patients, 23 NC and 22 HC participated (follow-up rate 67%, mean follow-up duration 13,9 years). At follow-up, motor symptoms were persistent in some form in 78% of FMD patients versus 83% of NC. Symptoms improved in 29% of FMD patients versus 9% of NC (Mann Whitney U test, p<0,01). There was no difference at follow up between FMD and NC patients on scores of general health, physical functioning, energy (RAND-36), depression (HADS) and the WSAS, while HC scored significantly better than FMD patients on all these scales. Anxiety was the same in all groups. Pain was significantly worse in FMD patients versus NC (p<0,05). Ten FMD patients (9%) died, mainly of cardiovascular causes, 7 NC (15%) died, mostly as a consequence of their disorder and 1 healthy control subject (3%) died of cancer. Death rate in Scotland under the age of 75 was 7,5% accumulated in the timeframe of the study.

Conclusions: In nearly 80% of FMD patients motor disorders are a chronic problem. Health related disability and distress in FMD at long term follow-up was strikingly comparable to neurological disease. Inclusion bias is minimal, because patients were included from all neurology centers in South East Scotland. Only cases in which symptoms resolved before a neurology consultation might have been missed. 1. Stone J, et al. The symptom of functional weakness. Brain. 2010;133:1537-51.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-prognosis-of-functional-motor-disorders-a-case-control-follow-up-study/