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Semin Neurol 2023; 43(01): 106-122
DOI: 10.1055/s-0043-1763505
Review Article

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Gabriela S. Gilmour
1   Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
,
Sarah C. Lidstone 
1   Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
2   Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
3   KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Funding This work was supported by an anonymous donation to the Toronto Western Hospital Movement Disorders Clinic.
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Abstract

Functional movement disorder (FMD) is a complex neuropsychiatric syndrome, encompassing abnormal movements and weakness, and is a common cause of potentially disabling neurological symptoms. It is vital to recognize that FMD is a syndrome, with nonmotor manifestations negatively affecting a patient's quality of life. This review highlights a diagnostic algorithm, where a history suggestive of FMD is combined with the presence of positive signs on examination and appropriate investigations to make the diagnosis. Positive signs indicate internal inconsistency such as variability and distractibility, and clinical findings that are incongruent with other known neurological disease. Importantly, the clinical assessment acts as the first opportunity to allow patients to understand FMD as the cause for their symptoms. Accurate and early diagnosis of FMD is necessary given that it is a treatable and potentially reversible cause of disability, with significant risk of iatrogenic harm associated with misdiagnosis.

Keywords

functional neurological disorder - functional movement disorder - diagnosis - pathophysiology - positive signs

Note

This manuscript complies with all instructions to authors.


This manuscript is an original work and has not been published elsewhere and is not under consideration by another journal. This article does not contain clinical studies or patient data.


Ethical Standards

This article does not contain clinical studies or patient data.


Author Contributions

G.S.G.: Conceptualization; investigation; writing—original draft. S.C.L.: Conceptualization; writing—review and editing.




Publikationsverlauf

Artikel online veröffentlicht:
09. März 2023

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