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Treatment of Functional Motor Disorders

  • MOVEMENT DISORDERS (O SUCHOWERSKY, SECTION EDITOR)
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Opinion statement

For the treatment of functional motor disorder, we recommend a three-stage approach. Firstly, patients must be assessed and given an unambiguous diagnosis, with an explanation that helps them understand that they have a genuine disorder, with the potential for reversibility. A key ingredient is allowing the patients to describe all of their symptoms as well as their ideas about what may be wrong. The patient should clearly understand that the positive diagnosis is based on the presence of typical signs (e.g., Hoover's sign for paralysis, entrainment test for tremor) that, in and of themselves, indicate the potential for reversibility. We suggest an approach that avoids the assumption that psychological stressors in the patient's life are causing the symptoms. The symptoms themselves are often the main stressor. Insisting that there must be others often leads to a frustrated doctor and an angry patient. Rather, at this initial stage, we encourage exploration of mechanisms – e.g., triggering of symptoms by pain, injury, or dissociation – and a discussion of how symptoms manifest as "abnormal motor programs" in the nervous system.

Secondly, further time spent exploring the diagnosis, treating comorbidity, and, in the context of a multidisciplinary team, experimenting with altered movements and behaviors may benefit some patients, without the need for more complex intervention.

Thirdly, some patients do require more complex treatment, often with a combination of physical rehabilitation and psychological treatments. Hypnosis, sedation, and transcranial magnetic stimulation may have a role in select patients.

Finally, although they have confidence in the diagnosis, many patients do not respond to treatment. Ultimately, however, patients with functional motor disorder may have much greater potential for recovery than health professionals often consider.

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Conflict of Interest

Jeannette M. Gelauff has received grant support from a BCN Groningen Scholarship.

Yasmine E.M. Dreissen has received grant support from the Princess Beatrix Fund for a trial on botulinum toxin in functional jerky movement disorders. These funds were paid to the AMC Medical Research BV in Amsterdam (Yasmine E.M. Dreissen’s salary is paid from this money). She has also had travel expenses paid by the Princess Beatrix Fund, and Ipsen Pharmaceuticals paid for a portion of the botulinum toxin used in the trial.

Marina A.J. Tijssen has received grant support from STW Technology Society (NeuroSIPE), Netherlands Organization for Scientific Research (NWO Medium), Fonds Nuts-Ohra, the Princess Beatrix Fund, the Gossweiler Foundation, Stichting Wetenschapsfonds Dystonie Vereniging, Ipsen, Allergan, and Medtronic. The funds were paid to the university (University of Amsterdam, and from 2012 onward, Rijksuniversiteit Groningen).

Jon Stone has received grant support from the NHS Scotland National Research Strategy Career Fellowship and the NIHR (as principal investigator); is employed by NHS Lothian; has regularly provided medicolegal expert witness testimony for negligence and personal injury cases; has received lecture honoraria from St. Louis Neurology, UK Tribunals Judiciary, Iceland Neurology Department (UCB), the Portuguese Movement Disorders (Novartis), Cork Neurology (UCB), the Movement Disorders Society, and the St. Louis Neurology Department; has received royalties from UpToDate; and runs a free self-help website for patients with functional motor disorders (www.neurosymptoms.org) mentioned in this article.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands

    Jeannette M. Gelauff MD & Marina A. J. Tijssen MD, PhD

  2. Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands

    Yasmine E. M. Dreissen MD

  3. Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK

    Jon Stone MBChB, FRCP, PhD

Authors
  1. Jeannette M. Gelauff MD
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  2. Yasmine E. M. Dreissen MD
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  3. Marina A. J. Tijssen MD, PhD
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  4. Jon Stone MBChB, FRCP, PhD
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Corresponding author

Correspondence to Jon Stone MBChB, FRCP, PhD.

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This article is part of the Topical Collection on Movement Disorders

Jeannette M. Gelauff and Yasmine E.M. Dreissen contributed equally to this work

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Gelauff, J.M., Dreissen, Y.E.M., Tijssen, M.A.J. et al. Treatment of Functional Motor Disorders. Curr Treat Options Neurol 16, 286 (2014). https://doi.org/10.1007/s11940-014-0286-5

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