Objective: This retrospective study was aimed to better-characterized FMDs in a pediatric population: 1) describing FMDs clinical manifestations 2) analyzing clinical and demographic variables 3) analyzing the short-term outcome (one year).

Background: Functional Neurological Disorders (FNDs) represent an emerging challenge also in childhood and adolescence neuropsychiatry. Literature on this topic is still spare for paediatric population. Clinical presentations are vaguely characterized and often misdiagnosed in younger ages. The main neurological features enrol Functional movement disorders (FMDs), Psychogenic non-epileptic seizures (PNES) and functional weakness.

Method: 35 FMDs children and adolescents were selected (30F: 5M; age range: 9-18 years old), referred as neurological inpatients of the urban academic neuropsychiatric department of Rome Umberto I Hospital, during a timeframe of 5 years. For each patient, FMDs diagnosis was obtained (DSM-5 criteria) by a neurological diagnostic workout.

Results: Epidemiological results highlighted a FMDs mean age onset of 11,8 years with a prevalence in female (F:M=5:1). Clinical motor symptoms were characterized by hyperkinetic manifestations (60%) with a prevalence of combined pattern with other FNDs, as: PNES (40%), sensitive disorders (45%); weakness (30%) and generalized pain (65%).
Traumatic Life Events and history of family illness were reported in the 65% and 85% of cases, respectively. The early diagnosis with a clinical workout of 2-3 months was related with a positive outcome in the 80% of patients.

Conclusion: Hyperkinetic movements, presenting in combined pattern with further comorbid FNDs, were mainly reported in the pediatric population, while in adult FMDs were previously described as isolated motor symptoms. Traumatic Life events and a family history of illness seem to represent risk factors in the FMDs onset. An early diagnosis represents a clinical challenge to avoid a negative outcome.

References: Stone J, Carson A, Duncan R, et al. Who is referred to neurology clinics?–the diagnoses made in 3781 new patients. ClinNeurolNeurosurg 2010;112:747-751. Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol 2018;75:1132-1141. Tinazzi M, Morgante F, Marcuzzo E, et al.Clinical Correlates of Functional Motor Disorders: An Italian Multicentre Study. Mov Disord Clin Pract. 2020 Sep 22;7(8):920-929. doi: 10.1002/mdc3.13077. eCollection 2020 Nov. PMID: 33163563 Canavese C, Ciano C, Zibordi F,et al. Phenomenology of psychogenic movement disorders in children.Mov Disord. 2012 Aug;27(9):1153-7. doi: 10.1002/mds.24947

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-correlates-of-functional-motor-disorders-in-childhood-and-adolescence-an-emerging-diagnostic-and-clinical-challenge/