Objective: This study aimed to compare patients with isolated Functional Movement Disorders [FMD-i] to those with associated co-morbid other Functional Neurological Disorders(FND) [FMD+].

Background: FMD are a subset of FND characterized by abnormal movements or postures with incongruity and inconsistency. Certain patients with FMD have co-morbid other FND in addition to the FMD. There is a gap in our understanding of how patients with FMD with comorbid other FNDs differ from patients with isolated FMDs.

Method: This cross-sectional study included 45 consecutive consenting adult patients with FMD, assessed between January 1, 2023, and February 29, 2024, in a movement disorder clinic of a rural medical teaching hospital in India. Data were collected on demographics, socioeconomic status, duration of symptoms, psychiatric comorbidities (assessed using the Mini International Neuropsychiatric Interview), stigma (by the Stigma Scale for Chronic Illness-24), well-being (by WHO Well-being Scale), and approximate costs before presentation. Patients were categorized into two groups: those with isolated FMD (n=32, FMD-i) and those with comorbid other FND (in addition to the FMD) (n=13, FMD+).

Results: FMD-i[32] included 16 functional tremors, 7 functional gait disorders, 4 functional cranial disorders, 1 each of functional myoclonus, tic-like disorder, and dystonia. The FMD+ group had co-morbid functional seizures (n=7), functional cognitive impairment (n=5), functional sensory loss (n=3), functional pain (n=3), and functional weakness (n=2) in addition to FMD. Patients with functional tremors, and cranial functional disorders had co-morbid functional seizures. Patients with functional gait disorders had comorbid functional weakness or sensory loss. Patients with multiple FNDs (FMD+ group) reported higher levels of stigma, severe anxiety, and depression compared to those with a single FMD. Additionally, the FMD+ group had higher expenditures before consultation and a prolonged duration of symptoms prior to presentation at the hospital.

Conclusion: FMD +  patients experience higher stigma, psychiatric comorbidities, financial burden, and delayed access to care compared to those with a single FMD. These findings highlight the need for early recognition and comprehensive management of patients with multiple FNDs, particularly in rural settings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-comorbidity-conundrum-in-functional-movement-disorder-how-are-fmd-patients-with-additional-other-fnd-different/