Tinazzi Michele, Morgante Francesca, Marcuzzo Enrico, Erro Roberto, Barone Paolo, Ceravolo Roberto, Mazzucchi Sonia, Pilotto Andrea, Padovani Alessandro, Romito Luigi M, Eleopra Roberto, Zappia Mario, Nicoletti Alessandra, Dallocchio Carlo, Arbasino Carla, Bono Francesco, Pascarella Angelo, Demartini Benedetta, Gambini Orsola, Modugno Nicola, Olivola Enrica, Di Stefano Vincenzo, Albanese Alberto, Ferrazzano Gina, Tessitore Alessandro, Zibetti Maurizio, Calandra-Buonaura Giovanna, Petracca Martina, Esposito Marcello, Pisani Antonio, Manganotti Paolo, Stocchi Fabrizio, Coletti Moja Mario, Antonini Angelo, Defazio Giovanni, Geroin Christian
Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy.
Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London London United Kingdom.
Mov Disord Clin Pract. 2020 Sep 22;7(8):920-929. doi: 10.1002/mdc3.13077. eCollection 2020 Nov.
Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases.
The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables.
For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms.
Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs.
Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.
功能性运动障碍（FMDs）是一类异常运动，通过分散注意力的动作可使其显著改变，且与典型神经系统疾病中的运动障碍不一致。
本文的目的是：（1）描述功能性运动障碍的临床表现，包括非运动症状以及其他功能性神经障碍（FND）的发生情况；（2）报告孤立性和合并性功能性运动障碍的发生率及其与人口统计学和临床变量的关系。
在这项多中心观察性研究中，我们纳入了意大利25个三级运动障碍中心连续就诊且确诊为功能性运动障碍的门诊患者。每位患者都接受了详细的临床评估，明确功能性运动障碍的表型和数量（孤立性、合并性），并对相关的神经和精神症状进行评估。
在410例功能性运动障碍患者中（71%为女性；平均年龄47±16.1岁），最常见的表型是无力和震颤。功能性运动障碍患者的教育水平高于一般人群，且常伴有非运动症状，尤其是焦虑、疲劳和疼痛。几乎一半的功能性运动障碍患者还患有其他功能性神经障碍，如感觉症状、非癫痫性发作和视觉症状。合并功能性运动障碍的患者非运动症状负担更重，且患其他功能性神经障碍的频率更高。多因素回归分析显示，运动障碍神经科医生更有可能诊断出合并性功能性运动障碍。此外，功能性运动障碍的病程、疼痛、失眠、躯体形式疾病的诊断以及抗精神病药物治疗均与合并性功能性运动障碍显著相关。
我们的研究结果表明，鉴于非运动症状和其他功能性神经障碍的高发生率，尤其是合并功能性运动障碍的患者，对功能性运动障碍患者进行多维度评估很有必要。
