Treatment of functional motor disorders

摘要: Functional (also known as psychogenic) motor disorders are genuine weakness or movement disorders (such as tremor, gait disorder or dystonia), but do not relate to recognised neurological disease. Symptoms are involuntary and should not be confused with feigning or malingering. The diagnosis should not be one of exclusion but rather based upon positive clinical signs that primarily indicate internal inconsistency. In some cases incongruity with recognised neurological disorder is also important but this is a lesser issue (1, 2).Functional motor disorders (FMD) have a high impact, both for individual patients as the health care system as a whole: they are the second most common functional neurological disorder seen in outpatient practice (3, 4) and account for a substantial number of inpatient admission days (5). Patients with symptoms unexplained by a recognized neurological disease have similar levels of disability, and more distress than patients with symptoms explained by disease (6). Case control studies have shown levels of disability and health status comparable to Parkinson’s disease (7) and multiple sclerosis (8). The prognosis of FMD is variable but generally unfavorable (9).