Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh, UK.
University Medical Centre Groningen, University of Groningen, Department of Neurology, Hanzeplein 1, RB, The Netherlands.
Brain. 2019 Jul 1;142(7):2137-2148. doi: 10.1093/brain/awz138.
Reliable data on the prognosis of functional motor disorder are scarce, as existing studies of the prognosis of functional motor disorder are nearly all retrospective, small and uncontrolled. In this study we used a prospectively recruited, controlled cohort design to assess misdiagnosis, mortality and symptomatic and health outcome in patients with functional limb weakness compared to neurological disease and healthy control subjects. We also carried out an exploratory analysis for baseline factors predicting outcome. One hundred and seven patients with functional limb weakness, 46 neurological and 38 healthy control subjects from our previously studied prospective cohort were traced for follow-up after an average of 14 years. Misdiagnosis was determined in a consensus meeting using information from records, patients and their GPs. Numbers and causes of death were collected via death certificates. Outcome of limb weakness, physical and psychiatric symptoms, disability/quality of life and illness perception were recorded with self-rated questionnaires. Outcome measures were compared within and between groups. Seventy-six patients (71%) with functional limb weakness, 31 (67%) neurological and 23 (61%) healthy controls were included in follow-up. Misdiagnosis was found in one patient in the functional limb weakness group (1%) and in one neurological control (2%). Eleven patients with functional limb weakness, eight neurological control subjects and one healthy control subject had died. Weakness had completely remitted in 20% of patients in the functional limb weakness group and in 18% of the neurological controls (P = 0.785) and improved in a larger proportion of functional limb weakness patients (P = 0.011). Outcomes were comparable between patient groups, and worse than the healthy control group. No baseline factors were independent predictors of outcome, although somatization disorder, general health, pain and total symptoms at baseline were univariably correlated to outcome. This study is the largest and longest follow-up study of functional limb weakness. Misdiagnosis in functional limb weakness is rare after long-term follow-up. The disorder is associated with a higher mortality rate than expected, and symptoms are persistent and disabling. It appears difficult to predict outcome based on common baseline variables. These data should help inform clinicians to provide a more realistic outlook of the outcome and emphasize the importance of active and targeted therapy.
关于功能性运动障碍预后的确切数据十分有限，因为现有的功能性运动障碍预后研究几乎都是回顾性的、规模较小且未设对照组。在本研究中，我们使用前瞻性、对照队列设计，对功能型肢体无力患者与神经系统疾病患者和健康对照者进行比较，评估误诊、死亡率以及症状和健康结局。我们还进行了一项基线因素预测预后的探索性分析。我们先前研究的前瞻性队列中 107 例功能型肢体无力患者、46 例神经系统疾病患者和 38 例健康对照者，在平均 14 年后进行了随访。通过会议共识，根据记录、患者及其全科医生的信息来确定误诊。通过死亡证明收集死亡人数和原因。使用自我评估问卷记录肢体无力、身体和精神症状、残疾/生活质量和疾病认知的结局。比较了组内和组间的结局测量。76 例（71%）功能型肢体无力患者、31 例（67%）神经系统疾病患者和 23 例（61%）健康对照者纳入随访。在功能型肢体无力组中有 1 例（1%）和神经系统疾病对照组中有 1 例（2%）患者被误诊。功能型肢体无力组中有 11 例患者、神经系统疾病对照组中有 8 例患者和健康对照组中有 1 例患者死亡。在功能型肢体无力组中，20%的患者完全缓解，18%的神经系统对照组患者（P=0.785）也完全缓解，而功能型肢体无力患者中缓解比例更大（P=0.011）。患者组间结局相似，且比健康对照组更差。虽然基线时的躯体化障碍、一般健康状况、疼痛和总症状与结局呈单变量相关，但没有基线因素是结局的独立预测因素。本研究是最大和随访时间最长的功能性肢体无力研究。经过长期随访，功能性肢体无力的误诊罕见。该疾病的死亡率高于预期，症状持续存在且具有致残性。根据常见的基线变量预测结局似乎很困难。这些数据有助于为临床医生提供更现实的预后展望，并强调积极和有针对性治疗的重要性。
