Objective: We evaluated management practices and compared efficacy of specific interventions on remission of symptoms of functional movement disorder (FMD) in our pediatric population.

Background: Current recommendations of managing FMD revolve around a multidisciplinary approach without clear evidence for which interventions are more successful for remission.

Method: A retrospective cohort study includes patients ≤21 years old with a diagnosis of FMD (based on ICD9/10 codes and/or documentation) evaluated at Texas Children’s Hospital from 2011-2018.  Demographics, diagnostic studies, medical history, and medical reports reviewed. Patients and/or caregivers subsequently underwent phone surveys.

Results: A total of 203 charts were queried, 173 patients (73.4% female) met inclusion criteria.  Mean age of symptom onset was 13.1 years.  History and exam were adequate to make the diagnosis on initial presentation in 45 patients (26%).    A precipitating event was identified in 35.3% of patients. Pre-existing movement disorders occurred in 11% of patients; majority being Tourette/tourettism (63.1%).  The most common type of involuntary movement was tremor (46.8%).  According to clinicians, a frank discussion of the diagnosis contributed the most to improvement in 19.6% of patients that achieved symptom remission, followed by meeting with a psychologist familiar with the diagnosis (15.7%). Patients with symptom remission were more likely to have been receptive to the diagnosis (p-value 0.03).

Conclusion: Substantial practice variation exists at a single institution regarding management of FMD. Psychology referral was the most common intervention, however according to providers caring for patients with FMD, the most helpful intervention was an open discussion of the diagnosis with the family and patient.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/management-practices-and-long-term-follow-up-of-pediatric-functional-psychogenic-movement-disorder-at-a-tertiary-care-center/