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[儿童和青少年的功能性运动障碍]

[Functional movement disorders in children and adolescents].

作者信息

Tang Ya-Nan, Wei Ling

机构信息

Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2020 May;22(5):523-527. doi: 10.7499/j.issn.1008-8830.2002054.

Abstract

Functional movement disorders (FMDs), also known as psychogenic movement disorders (PMDs), should be considered a biological-psychological-social disease like other functional neurological diseases. It is not merely a psychological or mental disease. The etiology of FMDs includes neurobiological changes, such as abnormal patterns of cerebral activation and abnormal connectivity between the limbic system and the motor networks. Inheritance and epigenetic machinery, such as DNA methylation and changes in grey and white matter morphology, may influence the development of FMDs. FMDs are not rare in the outpatient service of pediatrics and are one of the most challenging movement disorders due to complex and diversified clinical manifestations. Due to a lack of clinical knowledge and unified diagnostic criteria, it is difficult for pediatricians to make a correct diagnosis of FMDs, which may be easily confused with other diseases. Pediatricians should pay more attention to children with FMDs and establish a multidisciplinary team with psychiatrists, specialists in developmental behavior, and physiotherapists, so as to provide active management and treatment for such children.

摘要

功能性运动障碍(FMDs),也被称为精神性运动障碍(PMDs),应被视为一种像其他功能性神经疾病一样的生物 - 心理 - 社会疾病。它不仅仅是一种心理或精神疾病。FMDs的病因包括神经生物学变化,如大脑激活模式异常以及边缘系统与运动网络之间的连接异常。遗传和表观遗传机制,如DNA甲基化以及灰质和白质形态的变化,可能会影响FMDs的发展。FMDs在儿科门诊并不罕见,并且由于临床表现复杂多样,是最具挑战性的运动障碍之一。由于缺乏临床知识和统一的诊断标准,儿科医生很难对FMDs做出正确诊断,FMDs可能很容易与其他疾病混淆。儿科医生应更加关注患有FMDs的儿童,并与精神科医生、发育行为专家和物理治疗师建立多学科团队,以便为这些儿童提供积极的管理和治疗。

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本文引用的文献

1
Psychogenic (Functional) Movement Disorders.心理性(功能性)运动障碍。
Continuum (Minneap Minn). 2019 Aug;25(4):1121-1140. doi: 10.1212/CON.0000000000000755.
5
Psychogenic movement disorders in children and adolescents: an update.儿童和青少年心因性运动障碍:最新进展。
Eur J Pediatr. 2019 Apr;178(4):581-585. doi: 10.1007/s00431-019-03317-8. Epub 2019 Jan 11.
10
You've made the diagnosis of functional neurological disorder: now what?你已确诊为功能性神经障碍:接下来该怎么办?
Pract Neurol. 2018 Aug;18(4):323-330. doi: 10.1136/practneurol-2017-001835. Epub 2018 May 15.

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