Functional Movement Disorder: An Interdisciplinary Case-Based Approach (Current Clinical Neurology)

✍ Scribed by Kathrin LaFaver (editor), Carine W. Maurer (editor), Timothy R. Nicholson (editor), David L. Perez (editor)

• Publisher: Humana
• Year: 2022
• Tongue: English
• Leaves: 455
• Edition: 1st ed. 2022
• Category: Library

✦ Synopsis

This book is a practical manual for clinical practitioners seeking to take an interdisciplinary and multidisciplinary approach to the diagnosis and management of functional movement disorder (FMD). It discusses case vignettes, reviews the diagnostic approach, provides an update on available treatments, highlights clinical pearls and details references for further reading.

Organized into three parts, the book begins with a framework for conceptualizing FMD - including its historical context, the biopsychosocial model and an integrated neurologic-psychiatric perspective towards overcoming mind-body dualism. Part II then provides a comprehensive overview of different FMD presentations including tremor, dystonia, gait disorders, and limb weakness, as well as common non-motor issues such as pain and cognitive symptoms. The book concludes with chapters on updated practices in delivering the diagnosis, working with patients and care partners to achieve shared understanding of a complex condition, as well as an overview of evidence-based and evolving treatments. 

Supplemented with high-quality patient videos, Functional Movement Disorder is written for practicing neurologists, psychiatrists, psychologists, allied mental health professionals, and rehabilitation experts with an interest in learning more about diagnosis and management of FMD.

✦ Table of Contents

Preface
Series Editor’s Introduction
Contents
Contributors
Part I: Framework
1: A Historical Perspective on Functional Neurological Disorder
The Way It Was
Out With the Old…
… in With the New
What Difference Does It Make?
So, Are the Problems All Over Now?
References
2: Free Will, Emotions and Agency: Pathophysiology of Functional Movement Disorder
Introduction
Normal Function
Pathophysiology of FMD
Cortical Motor Areas
Loss of Self-Agency
Loss of Willing
Emotion Processing
Attention
Interoception
Belief and Predictive Coding
Synthesis of the Pathophysiology
Implications for Treatment
References
3: The Biopsychosocial Formulation for Functional Movement Disorder
Case Vignette 1
Case Vignette 2
Introduction to the Biopsychosocial Model and Formulation
Predisposing Vulnerabilities (Risk Factors) for FMD
Biological
Psychological
Social
Acute Precipitants for FMD
Biological
Psychological
Social
Perpetuating Factors for FMD
Biological
Psychological
Social
Integration: Creating a Cohesive Biopsychosocial Formulation
Case Vignette 1: Mr. S
Case Vignette 2: Mrs. V
References
4: Integrating Neurologic and Psychiatric Perspectives in Functional Movement Disorder
The Origins of the Divide: Shifting Foundations, Dualism and Stigma
Operationalizing the Difficulties Across Neurology and Psychiatry
The Path Forward: “Back to the Future” Using an Integrated Neuropsychiatric Perspective
Conclusion
References
Part II: Presentations
5: Functional Limb Weakness and Paralysis
History
Symptom Presentation
Symptom Onset
Prevalence and Incidence
Gender and Age of Onset
Distribution and Laterality
Other Functional Disorders and Symptoms
Other Neurological Disease
Clinical Exam
Ancillary Testing
Rule-In Tests: Is There Ancillary Testing Available to Confirm the Diagnosis?
Rule-Out Tests: Which Tests Are Necessary to Exclude Other Neurological Conditions?
Pitfalls in the Diagnosis of Functional Weakness
Treatment of Functional Weakness
References
6: Functional Tremor
Introduction
Approach to Diagnosis: Clues from the History
Tremor Onset
Variability Over Time
Discrepancy Between Subjective and Objective Symptoms
Other Functional Symptoms
Approach to Diagnosis: Clinical Examination and Positive Signs
Symptom Patterns
Role of Attention
Distractability
Entrainability
Variability
Coactivation Sign
Suggestibility
“Whack-a-Mole” Sign
Excessive Exhaustion or “La belle Indifference”
Other Functional Neurological Signs
Electrophysiology: The Role for Tremor Recordings
Standard Equipment
Entrainability and Distractability
Co-contraction
Synchronicity
Test Battery
Management
Explanation/Education
Physiotherapy
Retrainment
Botulinum Toxin
Psychological Therapies
Transcranial Magnetic Stimulation
Multidisciplinary Treatment Approaches
Conclusion
References
7: Functional Dystonia
Introduction
How to Diagnose Functional Dystonia
Diagnostic Criteria
Historical Clues and Comorbidities
Basic Clinical Features
Specific Phenotypes Based on Body Localization
Management of Functional Dystonia
Conclusions
References
8: Functional Parkinsonism
Introduction
Epidemiology
Pathophysiology
Clinical Presentation and Diagnosis
Diagnosis
History
Examination Features
Tremor
Rigidity
Bradykinesia
Gait and Balance
Psychiatric Comorbidities
Functional Parkinsonism Overlapping with Parkinson’s Disease
Additional Testing
DaTscan
Electrophysiology
Role of Medication Response
Treatment
Physiotherapy and Psychotherapy
Dopaminergic Treatment
TMS
Treating Functional Parkinsonism Accompanied by Comorbid Neurodegenerative Parkinson’s Disease
References
9: Functional Jerky Movements
Functional Jerky Movements
Clinical Presentation
History
Neurological Examination
Additional Investigations
Differential Diagnosis
Tics
Myoclonus
Cortical Myoclonus
Subcortical Myoclonus
Brainstem Myoclonus and Startle Syndromes
Spinal Myoclonus
Epilepsy
Restless Legs Syndrome
Primary Paroxysmal Dyskinesias
Management
Conclusion
References
10: Functional Facial Disorders
Introduction
Epidemiology
Clinical Features
Bilateral Involvement of the Eyelids
Unilateral Involvement of the Eyelid and/or Lower Face
Bilateral Involvement of the Lower Face
Involvement of the Tongue
Involvement of the Palate
Involvement of the Eyes
Functional Convergence Spasm
Functional Convergence Paralysis
Functional Gaze Limitation
Functional Ocular Oscillations and Nystagmus
Functional Opsoclonus
Functional Oculogyric Crisis
Functional Diplopia
Associated Conditions
Diagnosis
Differential Diagnosis
Bilateral Involvement of the Eyelids
Bilateral Involvement of the Lower Face and/or Tongue
Unilateral Involvement of the Eyelid and Lower Face
Involvement of the Eyes
Management
Outcome and Prognosis
References
11: Functional Gait Disorder
Introduction
Classification
Diagnosis
Clinical Interview
Clinical Features
Differential Diagnosis
Pathophysiology
Functional Neuroimaging Studies
Connectomic Studies
Treatment Plan
Conclusions
References
12: Functional Tics
Clinical Characteristics of Functional Tics
Phenomenological Overlap Between Primary and Functional Tics
Objective Measures to Aid Diagnosis – the Role of Neurophysiology
Risk Factors
Treatment
References
13: Functional Speech and Voice Disorders
Introduction
Epidemiology of Functional Speech and Voice Disorders
Approach to Diagnosis
Approach to Diagnosis: Clues from the History
Approach to Diagnosis: Positive Signs on Physical Examination
Examination of the Jaw, Face and Tongue
Examination of Speech
Characteristics of Specific Functional Speech/Voice Disorders & Approach to Their Diagnosis
Acquired Functional Stuttering
Articulation Abnormalities
Resonance Abnormalities
Prosodic Disturbances
Functional Mutism
Functional Voice Disorders
Muscle Tension Dysphonia
Functional Aphonia and Dysphonia
References
14: Beyond Functional Movements: The Spectrum of Functional Neurological and Somatic Symptoms
Introduction
Functional Seizures
Functional Somatosensory Deficits
Functional Visual and Auditory Symptoms
Functional Cognitive Symptoms
Persistent Postural Perceptual Dizziness
Pain, Fatigue and Other Physical Symptoms
Illness Anxiety Disorder
Conclusion
References
15: Functional Movement Disorder in Children
Characteristics of Functional Movement Disorder in the Pediatric Population
Patient Demographics
Phenomenology
Comorbidities
Predisposing Factors
Prognosis
Diagnostic Assessment of Pediatric FMD
Assessment
Physical Exam
Diagnostic Testing
Neuropsychological Assessment
Treatment of FMD in Children and Adolescents
References
16: Functional Movement Disorder in Older Adults
Introduction
Prevalence of FMD in Older Adults
Risk Factors for FMD in Older Adults
Characteristics of FMD in Older Adults
Special Treatment Considerations for FMD in Older Adults
References
Part III: Management
17: “Breaking the News” of a Functional Movement Disorder
Introduction
Why Does It Matter How the Diagnosis Is Shared?
Is There Any Evidence that Sharing the Diagnosis Matters for FND?
Patients with FND Often Have Poor Experiences of Diagnostic Explanation
Health Professionals Think Diagnostic Explanation of FND Matters
Why Do Doctors Find It Hard to “Break the News” of FND?
Sharing a Diagnosis of FND – Some Solutions
What Label Should Be Used?
Breaking the News Some More – Mechanism, Aetiology and Formulation
Should I Discuss the Potential Role of Psychological Factors in the First Consultation?
Using a Follow Up Visit to Assist Triage
What Should Be Said About Prognosis?
Difficult Communication Encounters in FND
Case 1: The Patient with a Combination of Another Neurological Condition and FND
Case 2. The Patient with Fixed Ideas of Alternative Diagnosis
Case 3. The Patient in a Medicolegal Case
Case 4. The Angry Family Member/Friend
Case 5. The FND Patient with Intellectual Disability
Case 6. The Patient with FND who is Unlikely to Improve
References
18: Motivational Interviewing for Functional Movement Disorder
Introduction
Empirical Support
Applications in Functional Movement Disorder
What Is Motivational Interviewing?
Four MI Processes
Strategies
Fundamental Strategies: Open Questions, Affirmations, Reflective Summaries – OARS
Direct Methods to Evoke Change Talk
Other Useful Strategies
Handling Sustain Talk and Discord
Learning Motivational Interviewing
Conclusions
References
19: Communication Challenges in Functional Movement Disorder
Introduction
Patient Factors That Can Make the Communication Challenging
Clinician Factors That Can Make Communication Challenging
System Factors That Can Make Communication Challenging
Conclusions
References
20: Developing a Treatment Plan for Functional Movement Disorder
Introduction
Setting Up a Specialized FMD Service
Managing Patient Flow
Keeping Some Patients Outside of Highly Specialized Services
Connection with Other Services
Protecting the Service
Creating Diagnostic Understanding and Trust
Triage
Triage and Symptom Type
Triage and Other Functional Symptoms
Triage and Co-morbidity
Triage and Timing
Triage: Getting It Right First Time
Chronic Care
What Treatment Is Right for Whom? A Broad Overview
Conclusions
References
21: Psychological Treatment of Functional Movement Disorder
Introduction
What Is Psychological Treatment?
Psychotherapeutic Modalities
The State of the Evidence: Psychotherapy in FMD
Cognitive Behavioral Therapy for FMD
Psychodynamic Psychotherapy for FMD
Humanistic-Experiential, Mindfulness, and Integrative (Holistic) Approaches
Integration of Psychotherapy into Multidisciplinary FMD Treatment Models
Psychotherapy for FMD: A Practical Approach
Diagnosis as the Initial Step in Psychotherapy
Who Is the “Right” Patient for Psychotherapy?
Who Provides Psychotherapy?
Initial Assessment and Formulation
Psychoeducation and Treatment Planning
Neuro-Behavioral Therapy (CBT-informed Psychotherapy): Process and Techniques
Cognitive Techniques
Behavioral Techniques
Relationships and Communication
Wellness Planning and Termination of Treatment
References
22: Psychiatric Comorbidities and the Role of Psychiatry in Functional Movement Disorder
Introduction
Supporting Evidence for Early Psychiatric Engagement
Risk Factors
Psychiatric Comorbidities
Management of Psychiatric Comorbidities
Post-Traumatic Stress Disorder (PTSD)
Definition/Diagnosis
Treatment
Considerations with FMD
Panic Disorder
Definition/Diagnosis
Treatment
Considerations with FMD
Generalized Anxiety Disorder
Definition/Diagnosis
Treatment
Considerations with FMD
Somatic Symptom Disorder (SSD)
Definition/Diagnosis
Treatment
Considerations with FMD
Depressive Disorders
Definition/Diagnosis
Treatment
Considerations with FMD
Personality Disorders
Definition/Diagnosis
Treatment
Considerations with FMD
Psychiatrist’s Role
Models of Psychiatric Care
Indirect
Direct
Developing Relationships with FMD Aware Psychiatrists
Considerations for the Non-Psychiatrist
Conclusions and Calls to Action
References
23: Physical Therapy: Retraining Movement
Introduction
What Is the Evidence Base for Physical Therapy for FMD?
Assessment and Treatment Planning
Subjective Assessment
Physical Assessment
Treatment Planning
Psychologically Informed Physical Therapy
Treatment
Education & Understanding
Movement Retraining
Self-Management
Secondary and Coexisiting Problems
Adaptive Equipment and Adaptations
Concluding Treatment
Summary and Conclusions
References
24: Occupational Therapy: Focus on Function
Introduction
Reasons for Referral to Occupational Therapy for FMD
Occupational Therapy Theoretical Models
Occupational Therapy Initial Assessment
Graded Goal Setting
Supported Risk Taking
Symptom Management Techniques
Fatigue and Pain Management
Vocational Rehabilitation
Aids, Adaptations and Splinting
Disability Management
Care Needs
Benefits/Insurance Claims
Housing
Relapse Prevention and Management Plan
Concluding Occupational Therapy Interventions
References
25: Speech Therapy: Being Understood Clearly
Introduction
Considerations for Initiating Treatment
Timing
Frequency
Patient Readiness
Measuring Therapy Outcomes
Treatment of Functional Speech and Voice Disorders
Diagnostic Counseling and Education
Discussing Functional Speech/Voice Disorder Features
Understanding Typical and Altered Motor Speech Function
Describing Atypical Speech Features
Facilitating Change
Change Facilitation Specific to Functional Speech/Voice Disorder Subtype
Acquired Functional Stuttering
Prosodic/Articulatory Disturbance
Functional Voice Disorders
Functional Mutism
Functional Movements of the Face
Building Independence
Mutual Setting of Treatment Goals
Prognosis for Improvement of Functional Speech and Voice Disorders
Functional Cognitive Disorder Affecting Communication
Shared Goal-Setting as Treatment
Therapeutic Management of FCD
References
26: Interdisciplinary Rehabilitation Approaches in Functional Movement Disorder
Introduction
Planning Interdisciplinary Treatment for FMD
Contraindications for FMD Treatment
What Is the Evidence for Interdisciplinary FMD Treatment?
Treatment Principles
Follow Up Planning and Relapse Prevention
Treatment Modalities Under Development
Insurance Coverage of FMD Treatment
References
27: Placebo Effects and Functional Neurological Disorder: Helpful or Harmful?
Introduction
A Primer on Placebo
Historical Context for the Use of Placebo in FND
Placebo Effects in Medicine
Placebos in FND: Helpful or Harmful?
Arguments in Favor of the Therapeutic Use of Placebos in FND
A Shared Neurobiology Between Placebo Effects and FND
Anecdotes and Indirect Evidence for the Effectiveness of Placebo
Considerations Relevant to Current FND Management
Arguments Against the Use of Placebo to Treat FND
Ethical Perspectives
Unique Vulnerabilities of the FND Population Related to Placebo Use
Lack of Evidence Supporting Placebo Use in FND
Conclusion
References
28: Transcranial Magnetic Stimulation (TMS) as Treatment for Functional Movement Disorder
Introduction
Evidence for TMS as Treatment for FND
Case Reports
Functional Movement Disorder
Other FND Symptoms
Randomized Controlled Trials (RCTs)
Methodological Issues
Control Intervention
Parallel or Cross-Over Design
Outcomes Measures
Potential Mechanisms
Neuromodulation
Belief and Expectation
Perception of Action
Future Directions
Research Methodology
Other Types of Neuromodulation
Conclusions
References
29: Measuring Symptoms and Monitoring Progress in Functional Movement Disorder
Clinical Vignette
Introduction
Principles of Outcome Measurement
What to Measure?
Purpose of Measurement
Complexity of Measurement in FMD
Temporal Variability of Symptoms
Disabling Symptoms Are Experienced Across Multiple Domains of Measurement
Discrepancy Between Subjective Report and Objective Measurements of Symptoms
Objective Versus Subjective Measurements
Outcome Measures Used in FMD Clinical Research
Recommendations and Future Directions
References
30: Overcoming Treatment Obstacles in Functional Movement Disorder
Barriers to Effective FMD Treatment
Treatment Barrier 1: Challenges of the FMD Diagnosis
Treatment Barrier 2: Psychosocial and Motivational Factors
Treatment Barrier 3: Physical, Psychological, and Cognitive Issues
Treatment Barrier 4: Treatment Expectations
Treatment Barrier 5: Access to Treatment
Treatment Barrier 6: Patient Engagement and Plateaus
Case Discussion
Conclusion
References
31: Management Considerations for Pediatric Functional Movement Disorder
Part I: Presentation, Assessment, and Diagnosis
The Child’s Body Signals Stress and Distress: The Somatic Narrative
The Importance of the Psychosocial History
Stress Can Be Physical or Emotional: Physical Stress Events Often Trigger FND Symptoms
Maltreatment Occurs in a Subset of Cases Only
Illness Models in the Family
Multiple FND Symptoms, Migrating Symptoms, and Comorbidity with Complex Pain and Other Functional Somatic Symptoms Is Common
The Need to Provide a Positive Diagnosis of a Functional Disorder
Part II: Co-constructing a Formulation
Providing an Explanation and Co-constructing a Formulation
Mental Health Comorbidities
Part III: Treatment
Psychoeducation
Stabilizing the Circadian Clock
Daily Psychotherapy Sessions
Physiotherapy
Family Intervention
School Intervention
Conclusion
References
32: Choosing a Career in Functional Movement Disorder
Introduction
Kathrin LaFaver MD
Carine W. Maurer MD, PhD
Timothy R. Nicholson MD, PhD
David L. Perez MD, MMSc
References
Index