Functional Movement Disorder: No Longer a Diagnosis of Exclusion (Podcast)

Functional movement disorder, traditionally viewed as a psychological condition, used to be a diagnosis of exclusion. Today it’s a routine diagnosis with unique clinical features, such as distractible or entrainable tremor, give-way weakness, and sensory loss that doesn’t follow an anatomical or physiological pattern. Yet functional movement disorder remains a complex condition, requiring multidisciplinary care.

The newest episode of Cleveland Clinic’s Neuro Pathways podcast reviews current understanding of the condition and how to manage affected patients. In the 17-minute episode, neurologist Xin Xin Yu, MD, and clinical health psychologist Taylor Rush, PhD, Co-Directors of the Functional Movement Disorders Clinic in Cleveland Clinic’s Center for Neurological Restoration, discuss:

• Diagnosing the disorder — and the unique challenges physicians may face
• The sensitivity needed to present the diagnosis to the patient
• The value of combining neurological care with behavioral therapy, physical therapy and other interventions
• Virtual shared medical appointments for patients with functional movement disorder

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Yu: There is a wide spectrum of phenotypes for functional neurological symptom disorder. Dr. Rush and I often see the functional movement disorder (FMD) subtype because we work in the movement disorders clinic. However, patients with FMD can present to epilepsy, multiple sclerosis or stroke services.

We have encountered patients with FMD who also have another organic neurological disorder, such as Parkinson’s disease or epilepsy. It does become a little more complicated when two different conditions coexist. We find that there often is a tendency to focus on treating the organic condition, with less emphasis on the functional component. The latter may be viewed as not real or perhaps less serious, but we often see the functional component as more debilitating than the organic counterpart. We feel strongly that both conditions must be assessed and deserve equal attention. That’s crucial for a patient’s overall prognosis.

One other common concern is how to know that patients are not malingering. Research shows that malingering is uncommon. Most patients with FMD are genuine. In our experience, they are among the most motivated patients. They often voice the desire to get better and really start living again.

Dr. Rush: It’s often the case that we are not someone’s first evaluation. They’ve been evaluated in many other contexts by many other physicians, and many patients come in feeling a bit jaded because they don’t feel like they’ve been heard. I think that when you suspect FMD, it is important to listen to what the patients are saying and validate what they’ve been through. That is what helps them trust you and gain a foothold on the right treatment. Even if you don’t treat FMD yourself, you can at least help patients get on the right track.