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3. Clinical Correlates of Functional Motor Disorders: An Italian Multicenter Study

Author

Carlo Dallocchio, Giovanni Defazio, Alessandro Tessitore, Sonia Mazzucchi, Roberto Ceravolo, Fabrizio Stocchi, Roberto Erro, Christian Geroin, Martina Petracca, Alessandro Padovani, Alessandra Nicoletti, Francesca Morgante, Antonio Pisani, Alberto Albanese, Vincenzo Di Stefano, Paolo Barone, Benedetta Demartini, Luigi Romito, Angelo Pascarella, Michele Tinazzi, Angelo Antonini, Giovanna Calandra-Buonaura, Maurizio Zibetti, Enrica Olivola, Roberto Eleopra, Marcello Esposito, Mario Coletti Moja, Orsola Gambini, Mario Zappia, Francesco Bono, Andrea Pilotto, Nicola Modugno, Enrico Marcuzzo, Paolo Manganotti, Carla Arbasino, Gina Ferrazzano, Tinazzi Michele, Morgante Francesca, Marcuzzo Enrico, Erro Roberto, Barone Paolo, Ceravolo Roberto, Mazzucchi Sonia, Pilotto Andrea, Padovani Alessandro, Romito Luigi M, Eleopra Roberto, Zappia Mario, Nicoletti Alessandra, Dallocchio Carlo, Arbasino Carla, Bono F, Pascarella A, Demartini B, Gambini O, Modugno N, Olivola E, Di Stefano V, Albanese A, Ferrazzano G, Tessitore Alessandro, Zibetti Maurizio, Calandra Buonaura Giovanna, Petracca Martina, Esposito Marcello, Pisani Antonio, Manganotti Paolo, Stocchi Fabrizio, Coletti Moja Mario, Antonini Angelo, Defazio Giovanni, Geroin Christian., Tinazzi M., Morgante F., Marcuzzo E., Erro R., Barone P., Ceravolo R., Mazzucchi S., Pilotto A., Padovani A., Romito L.M., Eleopra R., Zappia M., Nicoletti A., Dallocchio C., Arbasino C., Bono F., Pascarella A., Demartini B., Gambini O., Modugno N., Olivola E., Di Stefano V., Albanese A., Ferrazzano G., Tessitore A., Zibetti M., Calandra-Buonaura G., Petracca M., Esposito M., Pisani A., Manganotti P., Stocchi F., Coletti Moja M., Antonini A., Defazio G., Geroin C., Tinazzi, M., Morgante, F., Marcuzzo, E., Erro, R., Barone, P., Ceravolo, R., Mazzucchi, S., Pilotto, A., Padovani, A., Romito, L. M., Eleopra, R., Zappia, M., Nicoletti, A., Dallocchio, C., Arbasino, C., Bono, F., Pascarella, A., Demartini, B., Gambini, O., Modugno, N., Olivola, E., Di Stefano, V., Albanese, A., Ferrazzano, G., Tessitore, A., Zibetti, M., Calandra-Buonaura, G., Petracca, M., Esposito, M., Pisani, A., Manganotti, P., Stocchi, F., Coletti Moja, M., Antonini, A., Defazio, G., and Geroin, C.

Subjects
0301 basic medicine, Weakness, Pediatrics, medicine.medical_specialty, Movement disorders, functional neurological disorders, diagnosis, Population, functional weakne, Disease, 030105 genetics & heredity, functional weakness, 03 medical and health sciences, 0302 clinical medicine, functional neurological disorder, medicine, education, Research Articles, education.field_of_study, functional dystonia, functional tremor, business.industry, functional neurological disorders, functional dystonia, functional tremor, functional weakness, diagnosis, Functional weakness, tremor, Neurology, Multicenter study, Anxiety, Settore MED/26 - Neurologia, Observational study, dystonia, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Background\ud Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases.\ud \ud Objective\ud The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables.\ud \ud Methods\ud For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms.\ud \ud Results\ud Of 410 FMDs (71% females; mean age, 47 ± 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders neurologist. Also, FMD duration, pain, insomnia, diagnosis of somatoform disease, and treatment with antipsychotics were all significantly associated with combined FMDs.\ud \ud Conclusions\ud Our findings highlight the need for multidimensional assessments in patients with FMDs given the high frequency of nonmotor symptoms and other FNDs, especially in patients with combined FMDs.

Published
2020

4. Functional motor disorders associated with other neurological diseases: Beyond the boundaries of 'organic' neurology

Author

Alessandro Padovani, Alessandra Nicoletti, Angelo Pascarella, Giovanna Calandra-Buonaura, Fabrizio Stocchi, Orsola Gambini, Laura Bonanni, Marcello Esposito, Martina Petracca, Roberto Ceravolo, Sonia Mazzucchi, Sofia Cuoco, Angelo Antonini, Benedetta Demartini, Antonio Pisani, Andrea Pilotto, Elisabetta Zanolin, Roberto Eleopra, Alberto Albanese, Mario Coletti Moja, Luigi Romito, Michele Tinazzi, Elena Antelmi, Francesco Bono, Enrico Marcuzzo, Roberto Erro, Christian Geroin, Tommaso Ercoli, Mario Zappia, Nicola Modugno, Rosa De Micco, Gina Ferrazzano, Enrica Olivola, Francesca Morgante, Leonardo Lopiano, Carlo Dallocchio, Paolo Manganotti, Carla Arbasino, Tinazzi, Michele, Geroin, Christian, Erro, Roberto, Marcuzzo, Enrico, Cuoco, Sofia, Ceravolo, Roberto, Mazzucchi, Sonia, Pilotto, Andrea, Padovani, Alessandro, Romito, Luigi Michele, Eleopra, Roberto, Zappia, Mario, Nicoletti, Alessandra, Dallocchio, Carlo, Arbasino, Carla, Bono, Francesco, Pascarella, Angelo, Demartini, Benedetta, Gambini, Orsola, Modugno, Nicola, Olivola, Enrica, Bonanni, Laura, Antelmi, Elena, Zanolin, Elisabetta, Albanese, Alberto, Ferrazzano, Gina, de Micco, Rosa, Lopiano, Leonardo, Calandra-Buonaura, Giovanna, Petracca, Martina, Esposito, Marcello, Pisani, Antonio, Manganotti, Paolo, Stocchi, Fabrizio, Coletti Moja, Mario, Antonini, Angelo, Ercoli, Tommaso, Morgante, Francesca, Tinazzi, M., Geroin, C., Erro, R., Marcuzzo, E., Cuoco, S., Ceravolo, R., Mazzucchi, S., Pilotto, A., Padovani, A., Romito, L. M., Eleopra, R., Zappia, M., Nicoletti, A., Dallocchio, C., Arbasino, C., Bono, F., Pascarella, A., Demartini, B., Gambini, O., Modugno, N., Olivola, E., Bonanni, L., Antelmi, E., Zanolin, E., Albanese, A., Ferrazzano, G., de Micco, R., Lopiano, L., Calandra-Buonaura, G., Petracca, M., Esposito, M., Pisani, A., Manganotti, P., Stocchi, F., Coletti Moja, M., Antonini, A., Ercoli, T., Morgante, F., and Tinazzi M, Geroin C, Erro R, Marcuzzo E, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Pascarella A, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Antelmi E, Zanolin E, Albanese A, Ferrazzano G, de Micco R, Lopiano L, Calandra Buonaura Giovanna, Petracca M, Esposito M, Pisani A, Manganotti P, Stocchi F, Coletti Moja M, Antonini A, Ercoli T, Morgante F.

Subjects
Pediatrics, medicine.medical_specialty, Neurology, functional neurological disorders, organic, Motor Disorders, functional dystonia, functional tremor, functional weakness, neurological diseases, functional weakne, Disease, Logistic regression, 03 medical and health sciences, Humans, Tremor, Depressive Disorder, Major, Movement Disorders, 0302 clinical medicine, functional neurological disorder, medicine, 030212 general & internal medicine, neurological disease, Depressive Disorder, business.industry, Parkinsonism, Major, Functional weakness, Odds ratio, medicine.disease, Settore MED/26 - NEUROLOGIA, Migraine, Observational study, Neurology (clinical), dystonia, business, 030217 neurology & neurosurgery
Abstract

Background and purpose\ud The aims of this study were to describe the clinical manifestations of functional motor disorders (FMDs) coexisting with other neurological diseases (“comorbid FMDs”), and to compare comorbid FMDs with FMDs not overlapping with other neurological diseases (“pure FMDs”).\ud \ud Methods\ud For this multicenter observational study, we enrolled outpatients with a definite FMD diagnosis attending 25 tertiary movement disorder centers in Italy. Each patient with FMDs underwent a detailed clinical assessment including screening for other associated neurological conditions. Group comparisons (comorbid FMDs vs. pure FMDs) were performed in order to compare demographic and clinical variables. Logistic regression models were created to estimate the adjusted odds ratios (95% confidence intervals) of comorbid FMDs (dependent variable) in relation to sociodemographic and clinical characteristics (independent variables).\ud \ud Results\ud Out of 410 FMDs, 21.7% of patients (n = 89) had comorbid FMDs. The most frequent coexisting neurological diseases were migraine, cerebrovascular disease and parkinsonism. In the majority of cases (86.5%), FMDs appeared after the diagnosis of a neurological disease. Patients with comorbid FMDs were older, and more frequently had tremor, non‐neurological comorbidities, paroxysmal non‐epileptic seizures, major depressive disorders, and benzodiazepine intake. Multivariate regression analysis showed that diagnosis of comorbid FMDs was more likely associated with longer time lag until the final diagnosis of FMD, presence of tremor and non‐neurological comorbidities.\ud \ud Conclusions\ud Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non‐neurological diseases.

Published
2020

5. Functional gait disorders: Demographic and clinical correlations

Author

Christian Geroin, Benedetta Demartini, Alessandra Nicoletti, Gina Ferrazzano, Luigi Romito, Michele Tinazzi, Paolo Manganotti, Alessandro Padovani, Laura Bonanni, Alberto Albanese, Tommaso Ercoli, Roberto Ceravolo, Carla Arbasino, Elisabetta Zanolin, Giovanni Defazio, Leonardo Lopiano, Francesca Morgante, Roberto Erro, Nicola Modugno, Enrica Olivola, Marcello Esposito, Andrea Pilotto, Mario Zappia, Orsola Gambini, Enrico Marcuzzo, Carlo Dallocchio, Lucia Tesolin, Giuseppe Magro, Alessandro Tessitore, Sonia Mazzucchi, Fabrizio Stocchi, Francesco Bono, Martina Petracca, Sofia Cuoco, Antonio Pisani, Francesco Teatini, Roberto Eleopra, Giovanna Calandra-Buonaura, Tinazzi M., Pilotto A., Morgante F., Marcuzzo E., Cuoco S., Ceravolo R., Mazzucchi S., Padovani A., Romito L.M., Eleopra R., Nicoletti A., Dallocchio C., Arbasino C., Bono F., Magro G., Demartini B., Gambini O., Modugno N., Olivola E., Bonanni L., Zanolin E., Albanese A., Ferrazzano G., Tessitore A., Lopiano L., Calandra Buonaura G., Petracca M., Esposito M., Pisani A., Manganotti P., Tesolin L., Teatini F., Defazio G., Ercoli T., Stocchi F., Erro R., Zappia M., and Geroin C.

Subjects
Adult, Male, medicine.medical_specialty, Slow gait, Movement disorders, Motor Disorders, Internal medicine, Knee-buckling, medicine, 80 and over, Neurologic, Humans, Gait disorders, Gait Disorders, Motor Disorder, Functional gait disorder, Astasia-abasia, Gait Disorders, Neurologic, Functional gait disorders, Functional neurological disorders, Aged, Demography, Aged, 80 and over, Cross-Sectional Studie, business.industry, Cross-Sectional Studies, Female, Italy, Middle Aged, Regression Analysis, Odds ratio, Visual symptoms, Gait, Confidence interval, Neurology, Observational study, Neurology (clinical), Geriatrics and Gerontology, medicine.symptom, business, Functional neurological disorder, Human
Abstract

Objective\ud We aimed to describe the prevalence and clinical-demographical features of patients with functional gait disorders (FGDs) and to compare them to patients with functional motor disorders (FMDs) without FGDs (No-FGDs).\ud \ud Methods\ud In this multicenter observational study, we enrolled patients with a clinically definite diagnosis of FMDs in 25 tertiary movement disorders centers in Italy. Each subject with FMDs underwent a comprehensive clinical assessment, including screening for different subtypes of functional gait disorders. Multivariate regression models were implemented in order to estimate the adjusted odds ratio (OR; 95% confidence interval) of having FGDs in relation to sociodemographic and clinical characteristics.\ud \ud Results\ud Out of 410 FMDs, 26.6% (n = 109) of patients exhibited FGDs. The most frequent FGDs were slow gait (n = 43, 39.4%), astasia-abasia (n = 26, 23.8%), and knee buckling (n = 24, 22%). They exhibited single FGDs in 51.4% (n = 56) or complex FGDs (more than one type of FGDs) in 48.6% (n = 53) of cases. On multivariate regression analysis, the presence of FGDs was more likely associated with older age (OR 1.03, 95% CI 1.01–1.04), functional visual symptoms (OR 2.19, 95% CI 1.08–4.45), and the diagnosis of somatic symptoms disorder (OR 2.97, 95% CI 1.08–8.17). FGDs were also more likely to undergo physiotherapy (OR 1.81, 95% CI 1.08–3.03).\ud \ud Conclusions\ud People with FMDs may present with different and overlapping types of FGDs, which may occur in older age. The association of FGDs with functional visual symptoms and somatic symptoms disorder opens up to new avenues to the understanding of the neural mechanisms of these disorders.

Published
2021

6. Functional motor phenotypes: to lump or to split?

Author

Laura Bonanni, Roberto Ceravolo, Mario Zappia, Sofia Cuoco, Enrico Marcuzzo, Giovanna Calandra-Buonaura, Alberto Albanese, Martina Petracca, Gina Ferrazzano, Francesco Bono, Alessandra Nicoletti, Benedetta Demartini, Rosa De Micco, Nicola Modugno, Enrica Olivola, Roberto Eleopra, Carlo Dallocchio, Paolo Manganotti, Antonio Pisani, Lucia Tesolin, Alessandro Padovani, Christian Geroin, Carla Arbasino, Luigi Romito, Leonardo Lopiano, Sonia Mazzucchi, Francesca Morgante, Elisabetta Zanolin, Francesco Teatini, Andrea Pilotto, Tommaso Ercoli, Michele Tinazzi, Marcello Esposito, Roberto Erro, Orsola Gambini, Giuseppe Magro, Tinazzi, Michele, Geroin, Christian, Marcuzzo, Enrico, Cuoco, Sofia, Ceravolo, Roberto, Mazzucchi, Sonia, Pilotto, Andrea, Padovani, Alessandro, Romito, Luigi Michele, Eleopra, Roberto, Zappia, Mario, Nicoletti, Alessandra, Dallocchio, Carlo, Arbasino, Carla, Bono, Francesco, Magro, Giuseppe, Demartini, Benedetta, Gambini, Orsola, Modugno, Nicola, Olivola, Enrica, Bonanni, Laura, Zanolin, Elisabetta, Albanese, Alberto, Ferrazzano, Gina, De Micco, Rosa, Lopiano, Leonardo, Calandra-Buonaura, Giovanna, Petracca, Martina, Esposito, Marcello, Pisani, Antonio, Manganotti, Paolo, Tesolin, Lucia, Teatini, Francesco, Ercoli, Tommaso, Morgante, Francesca, Erro, Roberto, Tinazzi M., Geroin C., Marcuzzo E., Cuoco S., Ceravolo R., Mazzucchi S., Pilotto A., Padovani A., Romito L.M., Eleopra R., Zappia M., Nicoletti A., Dallocchio C., Arbasino C., Bono F., Magro G., Demartini B., Gambini O., Modugno N., Olivola E., Bonanni L., Zanolin E., Albanese A., Ferrazzano G., De Micco R., Lopiano L., Calandra Buonaura G., Petracca M., Esposito M., Pisani A., Manganotti P., Tesolin L., Teatini F., Ercoli T., Morgante F., and Erro R.

Subjects
Psychogenic movement disorder, medicine.medical_specialty, Weakness, Neurology, 03 medical and health sciences, 0302 clinical medicine, Acute onset, Physical medicine and rehabilitation, Functional dystonia, Functional neurological disorders, Functional tremor, Functional weakness, Non-motor features, Psychogenic movement disorders, Tremor, medicine, Humans, Gait disorders, Sensory symptoms, Neuroradiology, Dystonia, Original Communication, Movement Disorders, business.industry, Phenotype, Dystonic Disorders, Dystonic Disorder, Functional weakne, medicine.disease, 030227 psychiatry, Neurology (clinical), medicine.symptom, Functional neurological disorder, business, Non-motor feature, 030217 neurology & neurosurgery, Human
Abstract

Introduction Functional motor disorders (FMDs) are usually categorized according to the predominant phenomenology; however, it is unclear whether this phenotypic classification mirrors the underlying pathophysiologic mechanisms. Objective To compare the characteristics of patients with different FMDs phenotypes and without co-morbid neurological disorders, aiming to answer the question of whether they represent different expressions of the same disorder or reflect distinct entities. Methods Consecutive outpatients with a clinically definite diagnosis of FMDs were included in the Italian registry of functional motor disorders (IRFMD), a multicenter data collection platform gathering several clinical and demographic variables. To the aim of the current work, data of patients with isolated FMDs were extracted. Results A total of 176 patients were included: 58 with weakness, 40 with tremor, 38 with dystonia, 23 with jerks/facial FMDs, and 17 with gait disorders. Patients with tremor and gait disorders were older than the others. Patients with functional weakness had more commonly an acute onset (87.9%) than patients with tremor and gait disorders, a shorter time lag from symptoms onset and FMDs diagnosis (2.9 ± 3.5 years) than patients with dystonia, and had more frequently associated functional sensory symptoms (51.7%) than patients with tremor, dystonia and gait disorders. Patients with dystonia complained more often of associated pain (47.4%) than patients with tremor. No other differences were noted between groups in terms of other variables including associated functional neurological symptoms, psychiatric comorbidities, and predisposing or precipitating factors. Conclusions Our data support the evidence of a large overlap between FMD phenotypes.

Published
2021

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