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Functional (psychogenic) movement disorders: merging mind and brain
Abstract
Functional (psychogenic) movement disorders (FMD) are part of the wide spectrum of functional neurological disorders, which together account for over 16% of patients referred to neurology clinics. FMD have been described as a "crisis for neurology" and cause major challenges in terms of diagnosis and treatment. As with other functional disorders, a key issue is the absence of pathophysiological understanding. There has been an influential historical emphasis on causation by emotional trauma, which is not supported by epidemiological studies. The similarity between physical signs in functional disorders and those that occur in feigned illness has also raised important challenges for pathophysiological understanding and has challenged health professionals' attitudes toward patients with these disorders. However, physical signs and selected investigations can help clinicians to reach a positive diagnosis, and modern pathophysiological research is showing an appreciation of the importance of both physical and psychological factors in FMD.
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“The reported prevalence of PMDs varies between 2% and 20% based on the definition and clinical setting.(1) While PMDs are most common in young individuals, particularly women, the gender difference is less evident in children.”
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“It makes up 50% of all PMDs.[37] PT is characterized by the presence of rest, postural, or kinetic tremor, but most often all three types are seen in unison.”
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“The terminological heterogeneity not only mirrors the fact that such conditions often fall between specialities [8], but also reflects the lack of agreement about the conceptual basis of this phenomenon [9]-[11].”
BackgroundPsychodynamic Psychotherapy for Functional (Psychogenic) Movement Disorders
Sharma, V. D., Jones, R., & Factor, S. A. (2016) · Journal of Movement Disorders · doi:10.14802/jmd.16038 · Cited by 31
Dosanjh, M., Alty, J., Martin, C., Latchford, G. J., & Graham, C. D. (2020) · British Journal of Health Psychology · doi:10.1111/bjhp.12478 · Cited by 35
“Functional movement disorders (FMD) are a sub-category, involving tremor, dystonia, paresis, tics, and gait disorders (Edwards & Bhatia, 2012).”
BackgroundHebert, C. L., Behel, J. M., Pal, G. D., Kasi, R. E., & Kompoliti, K. (2020) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2020.11.018 · Cited by 31
Gender and Age Determinants of Psychogenic Movement Disorders: A Clinical Profile of 73 Patients
Kamble, N., Prashantha, D., Jha, M., Netravathi, M., Reddy, Y. J. J., & Pal, P. (2016) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/cjn.2015.365 · Cited by 26
“Clinically PMD can present as hyperkinetic disorders and uncommonly hypokinetic disorders.(6,7) Early diagnosis and appropriate management is essential because it is associated with significant health care cost, poor quality of life, inadvertent medication use with their side effects, and burden to the caregiver.”
BackgroundFunctional jerks, tics, and paroxysmal movement disorders
Dreissen, Y. E. M., Cath, D. C., & Tijssen, M. A. J. (2016) · Handbook of clinical neurology · doi:10.1016/b978-0-12-801772-2.00021-7 · Cited by 30
Neural activity in functional movement disorders after inpatient rehabilitation
Faul, L., Knight, L. K., Espay, A. J., Depue, B. E., & LaFaver, K. (2020) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2020.111125 · Cited by 32
Inpatient Treatment of Functional Neurological Disorder: A Scoping Review
Gilmour, G. S., & Jenkins, J. D. (2020) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/cjn.2020.159 · Cited by 29
“Functional neurological disorder (FND) is a common cause for disabling neurological symptoms, including altered awareness, motor, and sensory changes.(1) Many terms are used to describe this disorder: psychogenic, conversion, somatization, nonorganic, hysteria, shell shock, and medically unexplained.”
BackgroundThe illness-disease dichotomy and the biological-clinical splitting of medicine
Tesio, L., & Buzzoni, M. (2020) · Medical Humanities · doi:10.1136/medhum-2020-011873 · Cited by 28
Recognizing Uncommon Presentations of Psychogenic (Functional) Movement Disorders
Baizabal-Carvallo, J., & Fekete, R. (2015) · Tremor and Other Hyperkinetic Movements · doi:10.7916/d8vm4b13 · Cited by 42
EMDR to Treat Functional Neurological Disorder: A Review
Cope, S. R., Mountford, L., Smith, J. G., & Agrawal, N. (2018) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.12.3.118 · Cited by 28
“…some patients, but there are many patients who present in neurology clinics without identifiable trauma in their background (Brown & Reuber, 2016; Edwards & Bhatia, 2012), and alternative theories such as attention to and expectations regarding symptoms may be a more fitting explanation in those…”
BackgroundGalli, S., Béreau, M., Magnin, É., Moulin, T., & Aybek, S. (2019) · Revue Neurologique · doi:10.1016/j.neurol.2019.08.007 · Cited by 26
“Classically, onset of FMD is sudden and often with a precipitating trigger [28].”
BackgroundSense of agency disturbances in movement disorders: A comprehensive review
Seghezzi, S., Convertino, L., & Zapparoli, L. (2021) · Consciousness and Cognition · doi:10.1016/j.concog.2021.103228 · Cited by 28
Medically Unexplained Neurologic Symptoms: A Primer for Physicians Who Make the Initial Encounter
Evens, A., Vendetta, L., Krebs, K. A., & Herath, P. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2015.03.030 · Cited by 25
“An additional part of successful treatment is the removal of unnecessary medications and avoidance of unnecessary tests and surgical treatments.(32) If a patient believes that he or she is taken seriously, many will eventually become less defensive and open up about emotional symptoms and possible stressors.”
BackgroundMula, M. (2012) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2012.07.024 · Cited by 25
Diagnosis and management of functional neurological symptoms: The Dutch experience
de Schipper, L. J., Vermeulen, M., Eeckhout, A. M., & Foncke, E. M. J. (2014) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2014.04.020 · Cited by 24
“Communicating the diagnosis of FNS to patients is challenging for neurologists [23,24].”
BackgroundSchmidt, T., Ebersbach, G., Oelsner, H., Sprock, A., König, I. R., Bäumer, T., Münchau, A. M., & Weißbach, A. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13268 · Cited by 26
“Yet, the accumulated empirical knowledge allows for formulating testable hypotheses for the treatment of FMD. Prospective controlled protocols are warranted to compare the efficacy and cost-effectiveness of different treatment concepts, e.g., single profession versus multi-disciplinary treatment and to better understa…”
BackgroundInfluentialTroubleshooting Gait Disturbances in Parkinson’s Disease With Deep Brain Stimulation
Pozzi, N. G., Palmisano, C., Reich, M. M., Capetian, P., Pacchetti, C., Volkmann, J., & Isaias, I. U. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.806513 · Cited by 28
Functional neurological symptoms
Davenport, R., & Stone, J. (2013) · Clinical Medicine · doi:10.7861/clinmedicine.13-1-80 · Cited by 24
Psychopathological constellation in patients with PNES: A new hypothesis
Martino, I., Bruni, A., Labate, A., Vasta, R., Cerasa, A., Borzì, G. M., Fazio, P. D., & Gambardella, A. (2017) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2017.09.025 · Cited by 24
“This is mainly due to those aspects that imply a presumed causal relation between psychological factors and generation of disease [2,3].”
Polara, G. F., Fleury, V., Stone, J., Barbey, A., Burkhard, P. R., Vingerhoets, F. J. G., & Aybek, S. (2018) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2018.01.022 · Cited by 24
Speech, language and swallowing impairments in functional neurological disorder: a scoping review
Barnett, C., Armes, J., & Smith, C. H. (2018) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.12448 · Cited by 24
Mills, S. M., & Hedderly, T. J. (2014) · Europe PMC (PubMed Central) · Cited by 24
Functional Movement Disorders: Updates and Clinical Overview
Park, J. E. (2024) · Journal of Movement Disorders · doi:10.14802/jmd.24126 · Cited by 26
“2 For example, probing for the time course of the disorder and change in the nature of symptoms over time is important, as patients with FMD may often note a sudden onset of symptoms that follow a stressful incident (e.g., a car accident) that can serve as a trigger, incongruent with an organic…”
BackgroundTinazzi, M., Fiorio, M., Berardelli, A., Bonetti, B., Bonifati, D. M., Burlina, A. P., Cagnin, A., Calabria, F., Corbetta, M., Cortelli, P., et al. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10840-y · Cited by 25
Tactile and Proprioceptive Temporal Discrimination Are Impaired in Functional Tremor
Tinazzi, M., Fasano, A. A., Peretti, A., Bove, F., Conte, A., Dallocchio, C., Arbasino, C., Defazio, G., Fiorio, M., & Berardelli, A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102328 · Cited by 24
“Patients with functional movement disorders may have a range of movement abnormalities including tremor.[1,2] Although the clinical features in patients with functional movement disorders are well described, the pathophysiology of these conditions is largely”
Metadata
- Authors
- Edwards, M. J., & Bhatia, K. P.
- Affiliations
- UCL Queen Square Institute of Neurology (GB)
- Corresponding author
- Bhatia, Kailash P
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 11
- Issue
- 3
- Pages
- 250-260
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W2103595952
- Cited by
- 314
- References
- 74
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 12 · 2023: 23 · 2022: 36 · 2021: 19 · 2020: 30 · 2019: 21 · 2018: 19 · 2017: 19 · 2016: 24 · 2015: 17 · 2014: 24 · 2013: 19 · 2012: 8
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- functional movement disorders, psychogenic movement disorders, conversion disorder, pathophysiology, feigned illness, psychological trauma, diagnosis, treatment, mind-brain relationship, psychological factors
- MeSH terms
- Brain, Humans, Movement Disorders
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