Objective: To assess the capacity of an outpatient-based functional movement disorders (FMD) treatment program to reduce FMD symptoms.

Background: FMDs are common, intrusive, and systemically expensive, but potentially treatable disorders for which few clinics deliver dedicated treatment (e.g., beyond diagnosis and disease education). Intensive inpatient programs combining cognitive behavioral and motor retraining therapies have successfully treated FMDs. However, this model is difficult to implement in the “real world” due to logistical and economical constraints. We emulated published inpatient FMD treatment trials with an outpatient program which was relatively easy to deliver and covered by insurance.

Method: Two movement disorders neurologists provided FMD diagnosis and education. Patients were then referred to an overlapping program of 4 continuous weeks of outpatient cognitive behavioral therapy (2-3 sessions/week with a psychologist) run simultaneously with 4 continuous weeks of outpatient motor retraining therapy (2-3 sessions/week with physical and occupational therapists). Pre- and post-treatment Movement Disorder Society “Psychogenic Movement Disorders Rating Scale” (PMDRS) scores were recorded, and patients were interviewed post-treatment about their experience.

Results: Of the FMD patients that completed the outpatient treatment program, more than 80% responded with at least a 70% reduction in their PMDRS score. Three patients reported complete symptomatic resolution. The vast majority reported that the program was valuable with regard to learning how to understand and control symptoms.

Conclusion: Outpatient treatment with combined, intensive cognitive behavioral and motor retraining therapies can reduce and, in some cases, eliminate FMD symptoms. The outpatient approach is more feasible than the inpatient with regard to “real world” logistics and insurance coverage. Although our therapeutic success rate was high, it was skewed heavily towards patients who “bought in” to and completed our treatment program. Many patients found our current approach to be too time-intensive; of those most chose not to participate, whereas others quit mid-program. Future endeavors will focus on optimizing therapeutic benefit with better time economy for both patients and clinicians.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outpatient-treatment-of-functional-movement-disorders/