Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology

Michele Tinazzi¹, Christian Geroin¹, Roberto Erro², Enrico Marcuzzo¹, Sofia Cuoco², Roberto Ceravolo³, Sonia Mazzucchi³, Andrea Pilotto^{4

5}, Alessandro Padovani⁴, Luigi Michele Romito⁶, Roberto Eleopra⁶, Mario Zappia⁷, Alessandra Nicoletti⁷, Carlo Dallocchio⁸, Carla Arbasino⁸, Francesco Bono⁹, Angelo Pascarella⁹, Benedetta Demartini¹⁰, Orsola Gambini¹⁰, Nicola Modugno¹¹, Enrica Olivola¹¹, Laura Bonanni¹², Elena Antelmi¹, Elisabetta Zanolin¹³, Alberto Albanese¹⁴, Gina Ferrazzano¹⁵, Rosa de Micco¹⁶, Leonardo Lopiano¹⁷, Giovanna Calandra-Buonaura^{18

19}, Martina Petracca²⁰, Marcello Esposito²¹, Antonio Pisani²², Paolo Manganotti²³, Fabrizio Stocchi²⁴, Mario Coletti Moja²⁵, Angelo Antonini²⁶, Tommaso Ercoli²⁷, Francesca Morgante^{28

29}

Affiliations

¹ Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
² Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Baronissi, SA, Italy.
³ Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁴ Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁵ FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy.
⁶ Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
⁷ Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Catania, Italy.
⁸ Neurology Unit, Department of Medical Area, ASST Pavia, Pavia, Italy.
⁹ Botulinum Toxin Center, Neurology Unit, A.O.U. Mater Domini, Catanzaro, Italy.
¹⁰ Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics - Department of Health Sciences, University of Milan, Milan, Italy.
¹¹ IRCCS Neuromed, Pozzilli, Italy.
¹² Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti-Pescara, Italy.
¹³ Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
¹⁴ Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy.
¹⁵ Department of Human Neurosciences, Università La Sapienza, Rome, Italy.
¹⁶ Department of Advanced Medical and Surgery Sciences, University of Campania - Luigi Vanvitelli, Naples, Italy.
¹⁷ Department of Neuroscience - Rita Levi Montalcini, University of Turin, Turin, Italy.
¹⁸ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
¹⁹ Institute of Neurological Sciences of Bologna, IRCCS, Bologna, Italy.
²⁰ Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²¹ Clinical Neurophysiology Unit, Cardarelli Hospital, Naples, Italy.
²² IRCCS Mondino Foundation, Pavia, Italy.
²³ Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy.
²⁴ University and Institute of Research and Medical Care San Raffaele, Roma, Italy.
²⁵ Mauriziano Hospital Umberto I, Turin, Italy.
²⁶ Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy.
²⁷ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
²⁸ Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
²⁹ Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.

PMID: 33300269
DOI: 10.1111/ene.14674

Observational Study

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology

Michele Tinazzi et al. Eur J Neurol. 2021 May.

. 2021 May;28(5):1752-1758.

doi: 10.1111/ene.14674. Epub 2021 Jan 2.

Authors

Affiliations

¹ Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
² Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Baronissi, SA, Italy.
³ Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁴ Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁵ FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy.
⁶ Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
⁷ Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Catania, Italy.
⁸ Neurology Unit, Department of Medical Area, ASST Pavia, Pavia, Italy.
⁹ Botulinum Toxin Center, Neurology Unit, A.O.U. Mater Domini, Catanzaro, Italy.
¹⁰ Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics - Department of Health Sciences, University of Milan, Milan, Italy.
¹¹ IRCCS Neuromed, Pozzilli, Italy.
¹² Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti-Pescara, Italy.
¹³ Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
¹⁴ Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy.
¹⁵ Department of Human Neurosciences, Università La Sapienza, Rome, Italy.
¹⁶ Department of Advanced Medical and Surgery Sciences, University of Campania - Luigi Vanvitelli, Naples, Italy.
¹⁷ Department of Neuroscience - Rita Levi Montalcini, University of Turin, Turin, Italy.
¹⁸ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
¹⁹ Institute of Neurological Sciences of Bologna, IRCCS, Bologna, Italy.
²⁰ Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²¹ Clinical Neurophysiology Unit, Cardarelli Hospital, Naples, Italy.
²² IRCCS Mondino Foundation, Pavia, Italy.
²³ Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy.
²⁴ University and Institute of Research and Medical Care San Raffaele, Roma, Italy.
²⁵ Mauriziano Hospital Umberto I, Turin, Italy.
²⁶ Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy.
²⁷ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
²⁸ Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
²⁹ Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.

PMID: 33300269
DOI: 10.1111/ene.14674

Abstract

Background and purpose: 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").

Methods: 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).

Results: 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.

Conclusions: Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non-neurological diseases.

Keywords: functional dystonia; functional neurological disorders; functional tremor; functional weakness; neurological diseases; organic.

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References

REFERENCES

1. Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol. 2018;75:1132-1141.
1. Teodoro T, Edwards MJ. Functional movement disorders. Curr Opin Neurol. 2016;29:519-525.
1. Yon MI, Azman F, Tezer FI, Saygi S. The coexistence of psychogenic nonepileptic and epileptic seizures in the same patient is more frequent than expected: Is there any clinical feature for defining these patients? Epilepsy Behav. 2020;105:106940.
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Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology

Affiliations

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical