Barbey Anita, Aybek Selma
Neuropsychosomatic Unit, Universitätsklinik für Neurologie, Inselspital, Bern, Switzerland.
Curr Opin Neurol. 2017 Aug;30(4):427-434. doi: 10.1097/WCO.0000000000000464.
The review highlights the clinical presentation of functional movement disorders (FMDs) and presents current evidence on bedside signs and paraclinical tests to differentiate them from other neurological disorders.
FMDs are diagnosed by the presence of positive clinical signs as emphasized in the new Diagnostic and Statistical Manual of Mental Disorders-5 classification criteria. Bedside signs are numerous, and a subset of them has been validated in controlled studies. This review summarizes evidence from the literature on specificity and sensibility of positive clinical signs for FMDs. The value of rule-in paraclinical tests to confirm the diagnosis is also presented. Recent developments in neuroscience with pathophysiological mechanisms and current treatment strategies are also discussed.
FMDs represent a field of neurology that is currently rapidly growing in terms of research. Clinicians should be aware that highly reliable signs exist for the diagnosis and that early multidisciplinary treatment should be offered.
本综述重点介绍功能性运动障碍(FMDs)的临床表现,并展示目前关于床边体征和辅助检查以将其与其他神经系统疾病相鉴别的证据。
如新版《精神疾病诊断与统计手册》第5版分类标准所强调,FMDs通过阳性临床体征来诊断。床边体征众多,其中一部分已在对照研究中得到验证。本综述总结了文献中关于FMDs阳性临床体征的特异性和敏感性的证据。还介绍了用于确诊的辅助检查的价值。同时也讨论了神经科学在病理生理机制方面的最新进展以及当前的治疗策略。
FMDs是神经病学领域目前研究正在迅速发展的一个方向。临床医生应意识到存在用于诊断的高度可靠的体征,并且应提供早期多学科治疗。