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Multicenter Study
. 2025 Dec;12(12):2128-2142.
doi: 10.1002/mdc3.70340. Epub 2025 Sep 3.

The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders

Tommaso Ercoli  1 , Christian Geroin  2   3 , Enrico Marcuzzo  3 , Angela Sandri  3 , Luigi Michele Romito  4 , Roberto Eleopra  4 , Lucia Tesolin  5 , Francesco de Bertoldi  6 , Alessandra Nicoletti  7 , Giovanni Mostile  7   8 , Alessandro Padovani  9   10   11   12   13 , Andrea Pilotto  9   10   11   12 , Nicola Modugno  14 , Enrica Olivola  14 , Benedetta Demartini  15   16 , Veronica Nisticò  17 , Roberto Erro  18 , Sofia Cuoco  18 , Alessandro Tessitore  19 , Rosa De Micco  19 , Roberto Ceravolo  20 , Eleonora Del Prete  20 , Carlo Dallocchio  21 , Carla Arbasino  21 , Francesco Bono  22 , Cataldo Mummolo  22 , Marcello Esposito  23 , Assunta Trinchillo  24 , Giovanni Fabbrini  14   25 , Gina Ferrazzano  25 , Martina Petracca  26 , Carla Piano  26   27 , Laura Bonanni  28 , Claudia Carrarini  29 , Alberto Albanese  30 , Carlo Alberto Artusi  31   32 , Giovanni Defazio  33 , Paola Caruso  34 , Giovanna Calandra-Buonaura  35   36 , Francesca Morgante  37 , Antonio Pisani  38   39 , Paolo Solla  1 , Michele Tinazzi  3 ; Italian Registry of Functional Motor Disorders (IRFMD) study group
Affiliations
Multicenter Study

The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders

Tommaso Ercoli et al. Mov Disord Clin Pract. 2025 Dec.

Abstract

Background: Functional motor disorder (FMD) is a diagnosis of inclusion based on the presence of positive signs on clinical examination, and only a few tests are validated as biomarkers for FMD identification.

Objectives: The aim of this study was to assess the relative frequency of different types of conventional instrumental investigations (such as magnetic resonance imaging/computed tomography [MRI/CT] scan, dopamine transporter single-photon emission computed tomography (DaT-SPECT), electroencephalography (EEG), neurophysiological tests, and other tests) in FMD patients before diagnosis and to identify the clinical and demographic features associated with their use.

Methods: Data were obtained from the Italian Registry of Functional Motor Disorders, a multicenter initiative involving patients with a diagnosis of clinically definite FMD. Patients were consecutively enrolled at 25 Italian centers during 2 phases. Data collection initially took place between September 2018 and August 2019, and during phase 2, between January 2020 and December 2022.

Results: Among the 853 patients included during the 2 phases of the registry, we identified 794 patients (93.1%) who underwent 1 or more categories of conventional investigations. Overall, conventional investigations were more likely to be performed in older FMD patients (Odds ratio [OR]: 1.02; P = 0.013). Interestingly, we found that more than one category of investigation was more likely to be performed in FMD patients presenting with weakness (OR: 1.85; P = 0.002) and with additional functional symptoms (OR: 1.54; P = 0.026).

Conclusions: Our findings provide novel insights into the complex diagnostic process of FMD patients. This study highlights the need to identify reliable biomarkers that may help physicians diagnose FMD earlier and carefully select the most appropriate conventional investigations.

Keywords: conventional investigations; diagnosis; functional motor disorders; functional neurological disorders.

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Conflict of interest statement

Ethical Compliance Statement: The study was conducted according to the Declaration of Helsinki and to principles of good clinical practice. Approval was obtained from the Institutional Ethics Committee of the Coordinating Centre (University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Prog. 1757CESC) and confirmed by the committees of each participating center. All patients (or their guardians) were informed about the nature of the study and gave their written consent to participate. We confirm that we have read the journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.

Funding Sources and Conflicts of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work.

Financial Disclosures for the Previous 12 Months: The authors declare that there are no additional disclosures to report.

Figures

Fig. 1
Fig. 1
Proportion of patients who underwent a type of conventional investigations before the diagnosis of functional motor disorders (FMD) based on the type of investigation: magnetic resonance imaging (MRI) scan (ie, brain, spine, and vascular imaging such as MR angiography/MR venography [MRA/MRV]), computed tomography (CT) scan (ie, brain and spine), dopamine transporter single‐photon emission computed tomography (DaT‐SPECT), electroencephalography (EEG), neurophysiological tests (such as electromyography, nerve conduction studies, and evoked potentials), and other tests (such as cerebrospinal fluid analysis, autoimmune panels, and vitamin and nutritional deficiency screening).
Fig. 2
Fig. 2
Frequency distribution of type of conventional investigations before the diagnosis of functional motor disorders (FMD) in the 290 FMD patients with isolated phenotype and without neurological comorbidities. Post hoc comparisons, P < 0.01: °vs. weakness; #vs. tremor; §vs. dystonia; *vs. jerks/facial FMD.
See this image and copyright information in PMC

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