Objective: The aim of this study was to describe FMDs clinical manifestations in pediatrics, including non-motor symptoms and other functional neurological disorders (FNDs) and to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables.

Background: Functional Motor Disorders (FMDs) pose a growing diagnostic and therapeutic challenge in pediatric neurology. Despite a significant prevalence, the clinical presentation of pediatric FMDs remains poorly characterized, leading to frequent misdiagnoses and diagnostic delays in young patients.

Method: For this cross-sectional study, data were extracted from the Italian Registry of Functional Motor Disorders (n=32) and from the pediatric database of the Unit of Neuropsychiatry of Sapienza University of Rome (n=42), with consistent features, collecting 74 FMD pediatric (7-18 years) inpatients and outpatients, assessed by a complete neurological and psychiatric evaluation.

Results: Out of 74 FMDs (68.9% females; mean age at the onset of the symptoms 13.8± 2.31years) the most common phenotypes were weakness (58.1%, n=43) and gait disorders (55.4%, n=41) Among the hyperkinetic FMDs, functional tremor (35.1%; n=26) represented the highest expressed manifestations, then dystonia (14.9%, n=11); myoclonus/jerks (16.2%, n=12) and Tic (10.8%, n=8).

An isolated pattern was reported in the 45.9% (n=34), related to a significantly lower number of clinical referrals before the FMD diagnosis (p .001). Combined pattern was significantly associated with weakness (p.< 0.001), functional tic (p .006), visual and sensitive disorders (p <.001 and .039), and functional seizures (p .015).

The 75.7% of FMDs had associated at least one other functional symptom. Particularly, algic symptoms were reported in 74.4% of FMDs (n=55), including 17.6% (n=13) of headaches. Almost half of FMDs presented comorbid medical conditions, mostly represented by psychiatric diagnosis (32.4%, n=24). A history of childhood trauma (23%, n=17)) and family neurological disease (13.5%, n=10) was highlighted.

Conclusion: These data expanded the knowledge of FMDs clinical correlates in the pediatric age, mainly represented by an isolated pattern of functional gait disorders and weakness. Moreover, a need for a neuropsychiatric assessment was highlighted in pediatric FMDs patients, given the high frequency of non-motor symptoms and other FND, especially in patients with combined FMDs.

Clinical symptoms reported in patients with FMDs

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MDS Abstracts - https://www.mdsabstracts.org/abstract/functional-motor-disorders-in-pediatrics-motor-patterns-and-clinical-correlates/