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Chapter 53 - Functional Movement Disorders

from Section 4: - Dyscoordinative and Otherwise Inappropriate Motor Behaviors

Published online by Cambridge University Press:  07 January 2025

By
Heide Baumann-Vogel
Edited by
Erik Ch. Wolters  and
Christian R. Baumann
Erik Ch. Wolters
Affiliation:
Universität Zürich
Christian R. Baumann
Affiliation:
Universität Zürich
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Summary

Functional movement disorders are the most challenging movement disorders to diagnose and treat. Phenomenology and disease course are variable. This group of disorders includes tremor, dystonia, myoclonus, parkinsonism, speech and gait disturbances, and other movement disorders that are incongruent with patterns of pathophysiologic (organic) disease.

Keywords

Functional disordersconversionfactitious disordersmalingering
Type
Chapter
Information
International Compendium of Movement Disorders , pp. 665 - 682
Publisher: Cambridge University Press
Print publication year: 2025

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References

Pick, S, Anderson, DG, Asadi-Pooya, AA, et al. Outcome measurement in functional neurological disorder: a systematic review and recommendations. J Neurol Neurosurg Psychiatry 2020;91(6):638–649.CrossRefGoogle Scholar
Lehn, A, Gelauff, J, Hoeritzauer, I, et al. Functional neurological disorders: mechanisms and treatment. J Neurol 2016;263(3):611–620.CrossRefGoogle ScholarPubMed
Hallett, M. Functional (psychogenic) movement disorders – clinical presentations. Parkinsonism Relat Disord 2016;22(Suppl 1):S149–152.CrossRefGoogle ScholarPubMed
Bogousslavsky, J. The mysteries of hysteria: a historical perspective. Int Rev Psychiatry 2020;32(5–6):437–450.CrossRefGoogle ScholarPubMed
Rosebush, PI, Mazurek, MF. Treatment of conversion disorder in the 21st century: have we moved beyond the couch? Curr Treat Options Neurol 2011;13(3):255–266.CrossRefGoogle ScholarPubMed
Demartini, B, Nisticò, V, Edwards, MJ, Gambini, O, Priori, A. The pathophysiology of functional movement disorders. Neurosci Biobehav Rev 2021;120:387–400.CrossRefGoogle ScholarPubMed
Thibaut, F. The mind–body Cartesian dualism and psychiatry. Dialogues Clin Neurosci 2018;20(1):3.CrossRefGoogle ScholarPubMed
Voon, V, Gallea, C, Hattori, N, et al. The involuntary nature of conversion disorder. Neurology 2010;74(3):223–228.CrossRefGoogle ScholarPubMed
Blakemore, SJ, Frith, C. Self-awareness and action. Curr Opin Neurobiol 2003;13(2):219–224.CrossRefGoogle ScholarPubMed
Perez, DL, Edwards, MJ, Nielsen, G, et al. Decade of progress in motor functional neurological disorder: continuing the momentum. J Neurol Neurosurg Psychiatry 2021:jnnp-2020-323953. Online ahead of print.Google Scholar
Edwards, MJ, Adams, RA, Brown, H, Pareés, I, Friston, KJ. A Bayesian account of ‘hysteria’. Brain 2012;135(Pt 11):3495–3512.CrossRefGoogle ScholarPubMed
Lehn, A, Gelauff, J, Hoeritzauer, I, et al. Functional neurological disorders: mechanisms and treatment. J Neurol 2016;263(3):611–620.CrossRefGoogle ScholarPubMed
Pick, S, Goldstein, LH, Perez, DL, Nicholson, TR. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. J Neurol Neurosurg Psychiatry 2019;90(6):704–711.CrossRefGoogle ScholarPubMed
Conejero, I, Thouvenot, E, Abbar, M, et al. Neuroanatomy of conversion disorder: towards a network approach. Rev Neurosci 2018;29(4):355–368.CrossRefGoogle ScholarPubMed
Voon, V, Cavanna, AE, Coburn, K, et al. Functional neuroanatomy and neurophysiology of functional neurological disorders (conversion disorder). J Neuropsychiatry Clin Neurosci 2016;28(3):168–190.CrossRefGoogle ScholarPubMed
Raichle, ME. The brain’s default mode network. Annu Rev Neurosci 2015;38:433–447.CrossRefGoogle ScholarPubMed
Maurer, CW, LaFaver, K, Limachia, GS, et al. Gray matter differences in patients with functional movement disorders. Neurology 2018;91(20):e1870–e1879.CrossRefGoogle ScholarPubMed
Conejero, I, Thouvenot, E, Abbar, M, et al. Neuroanatomy of conversion disorder: towards a network approach. Rev Neurosci 2018;29(4):355–368.CrossRefGoogle ScholarPubMed
Voon, V, Brezing, C, Gallea, C, et al. Emotional stimuli and motor conversion disorder. Brain 2010;133(Pt 5):1526–1536.CrossRefGoogle ScholarPubMed
Burgmer, M, Konrad, C, Jansen, A, et al. Abnormal brain activation during movement observation in patients with conversion paralysis. Neuroimage 2006;29(4):1336–1343.CrossRefGoogle ScholarPubMed
Mätzold, S, Geritz, J, Zeuner, KE, et al. Functional movement disorders in neurogeriatric inpatients: underdiagnosed, often comorbid to neurodegenerative disorders and treatable. Z Gerontol Geriatr 2019;52(4):324–329.CrossRefGoogle ScholarPubMed
Stone, J, Carson, A, Duncan, R, et al. Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain 2009;132(Pt 10):2878–2888.CrossRefGoogle ScholarPubMed
Carson, A, Lehn, A. Epidemiology. Handb Clin Neurol 2016;139:47–60.CrossRefGoogle ScholarPubMed
Baizabal-Carvallo, JF, Hallett, M, Jankovic, J. Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiol Dis 2019;127:32–44.CrossRefGoogle ScholarPubMed
Harris, SR. Psychogenic movement disorders in children and adolescents: an update. Eur J Pediatr 2019;178(4):581–585.CrossRefGoogle ScholarPubMed
McCormack, R, Moriarty, J, Mellers, JD, et al. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. J Neurol Neurosurg Psychiatry 2014;85(8):895–900.CrossRefGoogle ScholarPubMed
Park, JE. Clinical characteristics of functional movement disorders: a clinic-based study. Tremor Other Hyperkinet Mov (N Y) 2018 2;8:504.CrossRefGoogle Scholar
Batla, A, Stamelou, M, Edwards, MJ, et al. Functional movement disorders are not uncommon in the elderly. Mov Disord 2013;28(4):540–543.CrossRefGoogle Scholar
Evans, RW, Evans, RE. A survey of neurologists on the likeability of headaches and other neurological disorders. Headache 2010;50(7):1126–1129.CrossRefGoogle ScholarPubMed
Pareés, I, Kojovic, M, Pires, C, et al. Physical precipitating factors in functional movement disorders. J Neurol Sci 2014;338(1–2):174–177.CrossRefGoogle ScholarPubMed
O’Connell, N, Nicholson, TR, Wessely, S, David, AS. Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case–control study. Psychol Med 2020;50(3):446–455.CrossRefGoogle Scholar
Gelauff, JM, Rosmalen, JGM, Gardien, J, Stone, J, Tijssen, MA. Shared demographics and comorbidities in different functional motor disorders. Parkinsonism Relat Disord 2020;70:1–6.CrossRefGoogle ScholarPubMed
Defazio, G, Pastore, A, Pellicciari, R, et al. Personality disorders and somatization in functional and organic movement disorders. Psychiatry Res 2017;257:227–229.CrossRefGoogle ScholarPubMed
Věchetová, G, Slovák, M, Kemlink, D, et al. The impact of non-motor symptoms on the health-related quality of life in patients with functional movement disorders. J Psychosom Res 2018;115:32–37.CrossRefGoogle ScholarPubMed
van der Hoeven, RM, Broersma, M, Pijnenborg, GH, et al. Functional (psychogenic) movement disorders associated with normal scores in psychological questionnaires: a case control study. J Psychosom Res 2015;79(3):190–194.CrossRefGoogle ScholarPubMed
Demartini, B, Petrochilos, P, Ricciardi, L, et al. The role of alexithymia in the development of functional motor symptoms (conversion disorder). J Neurol Neurosurg Psychiatry 2014;85(10):1132–1137.CrossRefGoogle ScholarPubMed
Fahn, S, Williams, DT. Psychogenic dystonia. Adv Neurol 1988;50:431–455.Google ScholarPubMed
Gupta, A, Lang, AE. Psychogenic movement disorders. Curr Opin Neurol 2009;22(4):430–436.CrossRefGoogle ScholarPubMed
Stone, J, Carson, A, Sharpe, M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry 2005;76(Suppl 1):i2–12.CrossRefGoogle ScholarPubMed
Saranza, G, Vargas-Mendez, D, Lang, AE, Chen, R. Suggestibility as a valuable criterion for laboratory-supported definite functional movement disorders. Clin Neurophysiol Pract 2021;6:103–108.CrossRefGoogle ScholarPubMed
Thenganatt, MA, Jankovic, J. Psychogenic (functional) movement disorders. Continuum (Minneap Minn) 2019;25(4):1121–1140.Google ScholarPubMed
Espay, AJ, Aybek, S, Carson, A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol 2018;75(9):1132–1141.CrossRefGoogle ScholarPubMed
Barbey, A, Aybek, S. Functional movement disorders. Curr Opin Neurol 2017;30(4):427–434.CrossRefGoogle ScholarPubMed
Stone, J, Carson, A, Hallett, M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol 2016;139:543–553.CrossRefGoogle ScholarPubMed
Kamble, NL, Pal, PK. Electrophysiological evaluation of psychogenic movement disorders. Parkinsonism Relat Disord 2016;22(Suppl 1):S153–158.CrossRefGoogle ScholarPubMed
Schwingenschuh, P, Saifee, TA, Katschnig-Winter, P, et al. Validation of “laboratory-supported” criteria for functional (psychogenic) tremor. Mov Disord 2016;31(4):555–562.CrossRefGoogle ScholarPubMed
Schwingenschuh, P, Katschnig, P, Seiler, S, et al. Moving toward “laboratory-supported” criteria for psychogenic tremor. Mov Disord 2011;26(14):2509–2515.CrossRefGoogle ScholarPubMed
Llaneza Ramos, VF, Considine, E, Karp, BI, et al. Ultrasound as diagnostic tool for diaphragmatic myoclonus. Mov Disord Clin Pract 2016;3(3):282–284.CrossRefGoogle ScholarPubMed
Thomsen, BLC, Teodoro, T, Edwards, MJ. Biomarkers in functional movement disorders: a systematic review. J Neurol Neurosurg Psychiatry 2020;91(12):1261–1269.CrossRefGoogle ScholarPubMed
Kim, YJ, Pakiam, AS, Lang, AE. Historical and clinical features of psychogenic tremor: a review of 70 cases. Can J Neurol Sci 1999;26(3):190–195.CrossRefGoogle ScholarPubMed
Brown, P, Thompson, PD. Electrophysiological aids to the diagnosis of psychogenic jerks, spasms, and tremor. Mov Disord 2001;16(4):595–599.CrossRefGoogle Scholar
Deuschl, G, Köster, B, Lücking, CH, Scheidt, C. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord 1998;13(2):294–302.CrossRefGoogle ScholarPubMed
Lang, AE, Voon, V. Psychogenic movement disorders: past developments, current status, and future directions. Mov Disord 2011;26(6):1175–1186.CrossRefGoogle ScholarPubMed
Tarsy, D, Dengenhardt, A, Zadikoff, C. Psychogenic facial spasm (the smirk) presenting as hemifacial spasm. In: Hallett, M, Fahn, S,Jankovic, J, et al., eds. Psycho-genic Movement Disorders. Philadelphia: Lippincott Williams &Williams; 2006: 341–343.Google Scholar
Fasano, A, Valadas, A, Bhatia, KP, et al. Psychogenic facial movement disorders: clinical features and associated conditions. Mov Disord 2012;27(12):1544–1551.CrossRefGoogle ScholarPubMed
Stone, J, Carson, A, Sharpe, M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry 2005;76(Suppl 1):i2–12.CrossRefGoogle ScholarPubMed
Barnett, C, Armes, J, Smith, C. Speech, language and swallowing impairments in functional neurological disorder: a scoping review. Int J Lang Commun Disord 2019;54(3):309–320.CrossRefGoogle ScholarPubMed
Baizabal-Carvallo, JF, Jankovic, J. Speech and voice disorders in patients with psychogenic movement disorders. J Neurol 2015;262(11):2420–2424.CrossRefGoogle ScholarPubMed
van der Salm, SM, Erro, R, Cordivari, C, et al. Propriospinal myoclonus: clinical reappraisal and review of literature. Neurology 2014;83(20):1862–1870.CrossRefGoogle ScholarPubMed
Baizabal-Carvallo, JF, Jankovic, J. Functional (psychogenic) stereotypies. J Neurol 2017;264(7):1482–1487.CrossRefGoogle ScholarPubMed
Laub, HN, Dwivedi, AK, Revilla, FJ, et al. Diagnostic performance of the “Huffing and Puffing” sign in psychogenic (functional) movement disorders. Mov Disord Clin Pract 2015;2(1):29–32.CrossRefGoogle ScholarPubMed
LaFaver, K. Treatment of functional movement disorders. Neurol Clin 2020;38(2):469–480.CrossRefGoogle ScholarPubMed
Espay, AJ, Ries, S, Maloney, T, et al. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology 2019;93(19):e1787–e1798.CrossRefGoogle ScholarPubMed
Dallocchio, C, Tinazzi, M, Bombieri, F, Arnó, N, Erro, R. Cognitive behavioural therapy and adjunctive physical activity for functional movement disorders (conversion disorder): a pilot, single-blinded, randomized study. Psychother Psychosom 2016;85(6):381–383.CrossRefGoogle ScholarPubMed
Espay, AJ, Ries, S, Maloney, T, et al. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology 2019;93(19):e1787–e1798.CrossRefGoogle ScholarPubMed
Nielsen, G, Stone, J, Edwards, MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res 2013;75(2):93–102.CrossRefGoogle ScholarPubMed
Nielsen, G, Stone, J, Buszewicz, M, et al. Physio4FMD: protocol for a multicentrerandomised controlled trial of specialistphysiotherapy for functional motor disorder. BMC Neurol 2019;19:242.CrossRefGoogle Scholar
Nielsen, G, Stone, J, Matthews, A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015;86(10):1113–1119.CrossRefGoogle ScholarPubMed
Nicholson, C, Edwards, MJ, Carson, AJ, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry 2020;91(10):1037–1045.CrossRefGoogle ScholarPubMed
Duffy, JR. Functional speech disorders: clinical manifestations, diagnosis, and management. Handb Clin Neurol 2016;139:379–388.CrossRefGoogle ScholarPubMed
Barnett, C, Armes, J, Smith, C. Speech, language and swallowing impairments in functional neurological disorder: a scoping review. Int J Lang Commun Disord 2019;54(3):309–320.CrossRefGoogle ScholarPubMed
Thomas, M, Vuong, KD, Jankovic, J. Long-term prognosis of patients with psychogenic movement disorders. Parkinsonism Relat Disord 2006;12(6):382–387.CrossRefGoogle ScholarPubMed
Gelauff, J, Stone, J, Edwards, M, Carson, A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014;85(2):220–226.CrossRefGoogle ScholarPubMed
Feinstein, A, Stergiopoulos, V, Fine, J, Lang, AE. Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Neuropsychiatry Neuropsychol Behav Neurol 2001;14(3):169–176.Google ScholarPubMed
Thomas, M, Vuong, KD, Jankovic, J. Long-term prognosis of patients with psychogenic movement disorders. Parkinsonism Relat Disord 2006;12(6):382–387.CrossRefGoogle ScholarPubMed
Pothalil, D, Vingerhoets, FJG. Tremor treatment. In: Wolters, ECh, Baumann, CR, eds. Parkinson Disease and Other Movement Disorders. Motor Behavioural Disorders and Behavioural Motor Disorders. Amsterdam: VU University Press; 2014: 501–511.Google Scholar
Parees, I, Edwards, MJ. Psychogenic (functional) movement disorders. In: Wolters, ECh, Baumann, CR, eds. Parkinson Disease and Other Movement Disorders. Motor Behavioural Disorders and Behavioural Motor Disorders. Amsterdam: VU University Press; 2014: 677–689.Google Scholar

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