Department of Neurology, Alrijne Ziekenhuis, Leiderdorp, The Netherlands.
Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Mov Disord Clin Pract. 2024 Jan;11(1):63-68. doi: 10.1002/mdc3.13895. Epub 2023 Nov 15.
The demonstration of positive signs during neurological examination is a cornerstone of the diagnosis of functional movement disorders, however, the available data supporting the diagnostic value of some of these signs is limited.
To determine the diagnostic value (sensitivity and specificity) of the "whack-a-mole" (WAM) and "swivel chair" (SC) tests in patients with functional movement disorders (FMD).
We enrolled patients with functional and organic movements in the WAM test if they exhibited tremor, dystonia, myoclonus, chorea, or tics. For the SC test, patients with a gait disorder as their primary impairment were recruited. Two blinded movement disorder specialists rated the presence of these signs in edited videos.
Inclusion criteria were met by 42 patients with FMD and 65 patients with organic movement disorders. Both tests demonstrated high specificity (means, 78% and 96%), but their sensitivity was low (means, 52% and 37%). Interobserver agreement for the WAM sign was 0.77 in the FMD group, against 0.28 in patients with organic movement disorders, whereas Movement Disorders Clinical Practice for Review Only for the SC sign was 0.69 in both groups.
The present study indicates that physicians must be cautious in the application and interpretation of these clinical signs in the diagnosis of functional movement disorders, and they should be carefully considered and used as necessary.
在神经检查中出现阳性体征是功能性运动障碍诊断的基石，然而，支持这些体征诊断价值的现有数据有限。
确定“打地鼠”（WAM）和“旋转椅”（SC）测试在功能性运动障碍（FMD）患者中的诊断价值（灵敏度和特异性）。
我们招募了表现出震颤、肌张力障碍、肌阵挛、舞蹈症或抽动的功能性和器质性运动障碍患者进行 WAM 测试。对于 SC 测试，我们招募了以步态障碍为主要表现的患者。两位盲法运动障碍专家对这些体征在编辑后的视频中的出现情况进行评分。
42 名 FMD 患者和 65 名器质性运动障碍患者符合纳入标准。这两项测试的特异性均较高（平均值分别为 78%和 96%），但灵敏度较低（平均值分别为 52%和 37%）。在 FMD 组中，WAM 体征的观察者间一致性为 0.77，而在器质性运动障碍患者中为 0.28；在两组中，SC 体征的运动障碍临床实践仅为综述的观察者间一致性为 0.69。
本研究表明，医生在诊断功能性运动障碍时必须谨慎应用和解释这些临床体征，并应根据需要仔细考虑和使用。
