Ortega-Robles Emmanuel, Shalash Ali, Ramírez-Bermúdez Jesús, Arias-Carrión Oscar
Experimental Neurology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Mov Disord Clin Pract. 2025 May 19. doi: 10.1002/mdc3.70136.
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.
To provide an updated and integrative review of the clinical, neurobiological, and therapeutic dimensions of FMD, incorporating recent evidence across diagnostic and treatment modalities.
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.
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.
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.
功能性运动障碍（FMD）是一种神经精神疾病，其特征为非自愿性运动症状，这些症状与已知的神经系统疾病不符，且与参与运动控制、情绪调节、注意力和自我意识的脑网络功能障碍有关。
对FMD的临床、神经生物学和治疗方面进行更新和综合综述，纳入跨诊断和治疗方式的最新证据。
我们对FMD的主要研究进行了全面综述，重点关注最常见的临床表现：功能性震颤、肌张力障碍、肌阵挛、帕金森综合征、步态障碍和抽动。借鉴最新证据，我们研究了与恢复相关的因素，并将这些见解整合到结构化的诊断和治疗算法中。
FMD主要影响女性，通常表现为震颤、无力或混合性运动症状。表型异质性很常见；疼痛、疲劳和精神共病等非运动症状会导致临床复杂性增加。神经影像学和电生理研究显示显著网络、内感受网络和运动网络中断，常涉及杏仁核、感觉运动皮层和颞顶叶交界处。诊断依赖于阳性临床体征而非排除法。推荐采用五阶段诊断框架，包括神经系统检查、以患者为中心的沟通和多学科参与。治疗需要个体化方法，结合物理治疗、认知行为治疗、神经调节、药物治疗和数字工具。预后各不相同，但早期诊断、强大的治疗联盟以及患者对康复的信心可改善结局。
FMD是一种多系统疾病，需要综合、个性化和人性化的护理。神经生物学和治疗方式的进展带来了希望，但仍存在未满足的需求，尤其是诊断生物标志物、标准化结局测量和可扩展治疗模式的开发。
