Functional Movement Disorder: Evolving Mechanisms, Diagnostic Precision, and Personalized Multidisciplinary Care.

BACKGROUND

Functional movement disorder (FMD) is a neuropsychiatric condition characterized by involuntary motor symptoms that are inconsistent with known neurological diseases and linked to dysfunction in brain networks involved in motor control, emotion regulation, attention, and agency.

OBJECTIVE

To provide an updated and integrative review of the clinical, neurobiological, and therapeutic dimensions of FMD, incorporating recent evidence across diagnostic and treatment modalities.

METHODS

We conducted a comprehensive review of the leading studies on FMD, emphasizing the most common clinical presentations: functional tremor, dystonia, myoclonus, parkinsonism, gait disorder, and tics. Drawing on recent evidence, we examined recovery-associated factors and integrated these insights into a structured diagnostic and therapeutic algorithm.

RESULTS

FMD primarily affects women and typically presents with tremor, weakness, or mixed motor symptoms. Phenotypic heterogeneity is common; non-motor symptoms such as pain, fatigue, and psychiatric comorbidities contribute to clinical complexity. Neuroimaging and electrophysiological studies reveal salience, interoception, and motor network disruptions, often involving the amygdala, sensorimotor cortex, and temporoparietal junction. Diagnosis relies on positive clinical signs rather than exclusion. A five-phase diagnostic framework is recommended, including neurological examination, patient-centred communication, and multidisciplinary engagement. Treatment requires an individualized approach combining physiotherapy, cognitive behavioral therapy, neuromodulation, pharmacotherapy, and digital tools. Prognosis varies, but early diagnosis, a strong therapeutic alliance, and patient confidence in recovery improve outcomes.

CONCLUSIONS

FMD is a multisystem disorder requiring integrated, personalized, and humanized care. Advances in neurobiology and therapeutic modalities offer promise, but unmet needs remain-particularly the development of diagnostic biomarkers, standardized outcome measures, and scalable treatment models.