Objective: This study aims to assess the incidence of pediatric Functional Movement Disorders (FMD) during the COVID-19 global pandemic compared to pre-pandemic baseline.

Background: Referrals for FMD, typically constitute a small percentage of our clinic. An increase in new onset of explosive functional tic-like movements, particularly in teenage females, has been noted [1]. Similarly, the Stanford Children’s Movement Disorder program has received increased referrals for new onset of FMD during the COVID-19 pandemic.

Method: New referrals to our pediatric movement disorders clinic were reviewed for a diagnosis of FMD at two timepoints: one year prior to the onset of institution of COVID-19 restrictions in California (3/2019-2/2020), and in the year following the implementation (3/2020-2/2021). The total number of resulting new diagnoses of FMD was compared between these two timepoints.

Results: Prior to the California COVID-19 state of emergency order, 9 patients were seen for symptoms consistent with FMD, compared to 21 patients referred after the order. For both groups, roughly 1/3 of patients presented to the emergency room at the onset of their symptoms. 100% of pre-pandemic patients female, compared to 80% in the pandemic group. Age ranges were 12-19 compared to 13-17 years of age respectively.

In the lockdown group, 9 (42%) patients experienced increase in symptoms, 11 (53%) patients had new onset symptoms, and 1 patient had symptom resolution. No patient had known history of COVID-19 infection or the loss of a loved one due to the complications from the virus. Mood disorder symptoms were reported for 44% of pre-pandemic and 62% of pandemic patients.

The most common psychogenic movements during lockdown were tics (n=12,~57%) and tremor (n=9, 24%).  Interestingly, primary complaints of new disassociation/depersonalization were observed in previously diagnosed FMD (n=1) and without prior history of FMD (n=3).

Conclusion: The incidence of patients presenting to Stanford Children’s Pediatric Movement Disorders Clinic with functional neurologic complaints more than doubled during the COVID-19 pandemic compared to the year prior.  Nearly half of patients presents with sudden explosive onset of new tics. Psychogenic tremor was the second most common manifestation.  This data highlights not only the increased referral volume but also the psychological impact of the COVID-19 pandemic on children and adolescents.

References: 1. Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks [published online ahead of print, 2021 Mar 6]. Arch Dis Child. 2021;archdischild-2021-321748.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/significant-increase-of-new-pediatric-functional-movement-disorders-during-the-covid-19-global-pandemic/