Velucci Vittorio, Sandri Angela, Zappia Mario, Berardelli Alfredo, Ercoli Tommaso, Tassi Laura, Brigo Francesco, Erro Roberto, Padovani Alessandro, Fabbrini Giovanni, Defazio Giovanni, Tinazzi Michele
Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy.
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Neurol Sci. 2025 Jul 29. doi: 10.1007/s10072-025-08383-5.
Functional neurological symptom disorder (FND), including functional motor disorders (FMD) and psychogenic non-epileptic seizures (PNES), is a common yet under-recognized condition, often associated with diagnostic uncertainty. This national survey investigated how Italian neurologists apply validated clinical signs and communication strategies in FND diagnosis.
A cross-sectional survey was distributed to approximately 2,700 members of three Italian neurological societies. The questionnaire assessed demographic and professional characteristics, the frequency of use of specific clinical signs for FMD and PNES, and strategies for communicating the diagnosis. Responses were rated on a five-point frequency scale and analyzed using ordinal generalized linear models and Spearman's correlations, adjusting for demographic covariates.
A total of 245 neurologists (43.3% general neurologists, 35.9% movement disorder specialists, 20.8% epileptologists) completed the survey. Movement disorder specialists more frequently assessed tremor entrainment and fixed dystonia in FMD, while epileptologists were more likely to assess signs such as eye closure and irregular jerks in PNES. Clinicians with greater experience more frequently evaluated established signs for both FMD and PNES and employed broader communication strategies. Communication practices were largely consistent across subspecialties. Written information was rarely provided across all groups.
The application of validated clinical signs and communication strategies for FND varies by subspecialty and clinical experience. While epileptologists and movement disorder specialists demonstrate greater familiarity with signs relevant to their subspecialty, key diagnostic tools for FMD remain underutilized. These findings highlight the need for targeted educational interventions to improve diagnostic accuracy, enhance communication, and optimize care for people with FND.
功能性神经症状障碍（FND），包括功能性运动障碍（FMD）和精神性非癫痫性发作（PNES），是一种常见但未得到充分认识的疾病，常伴有诊断不确定性。这项全国性调查研究了意大利神经科医生在FND诊断中如何应用经过验证的临床体征和沟通策略。
向三个意大利神经学会的约2700名成员进行了横断面调查。问卷评估了人口统计学和专业特征、FMD和PNES特定临床体征的使用频率以及传达诊断的策略。回答按五点频率量表进行评分，并使用有序广义线性模型和Spearman相关性进行分析，同时对人口统计学协变量进行调整。
共有245名神经科医生（43.3%为普通神经科医生，35.9%为运动障碍专科医生，20.8%为癫痫专科医生）完成了调查。运动障碍专科医生在FMD中更频繁地评估震颤跟随和固定性肌张力障碍，而癫痫专科医生在PNES中更倾向于评估闭眼和不规则抽搐等体征。经验更丰富的临床医生更频繁地评估FMD和PNES的既定体征，并采用更广泛的沟通策略。各亚专业的沟通实践在很大程度上是一致的。所有组中很少提供书面信息。
FND经过验证的临床体征和沟通策略的应用因亚专业和临床经验而异。虽然癫痫专科医生和运动障碍专科医生对与其亚专业相关的体征表现出更熟悉，但FMD的关键诊断工具仍未得到充分利用。这些发现凸显了有针对性的教育干预措施的必要性，以提高诊断准确性、加强沟通并优化对FND患者 的护理。
