Functional or not functional; that's the question: Can we predict the diagnosis functional movement disorder based on associated features?

BACKGROUND AND PURPOSE: Functional movement disorders (FMDs) pose a diagnostic challenge for clinicians. Over the years several associated features have been shown to be suggestive for FMDs. Which features mentioned in the literature are discriminative between FMDs and non-FMDs were examined in a large cohort. In addition, a preliminary prediction model distinguishing these disorders was developed based on differentiating features. METHOD: Medical records of all consecutive patients who visited our hyperkinetic outpatient clinic from 2012 to 2019 were retrospectively reviewed and 12 associated features in FMDs versus non-FMDs were compared. An independent t test for age of onset and Pearson chi-squared analyses for all categorical variables were performed. Multivariate logistic regression analysis was performed to develop a preliminary predictive model for FMDs. RESULTS: A total of 874 patients were eligible for inclusion, of whom 320 had an FMD and 554 a non-FMD. Differentiating features between these groups were age of onset, sex, psychiatric history, family history, more than one motor phenotype, pain, fatigue, abrupt onset, waxing and waning over long term, and fluctuations during the day. Based on these a preliminary predictive model was computed with a discriminative value of 91%. DISCUSSION: Ten associated features are shown to be not only suggestive but also discriminative between hyperkinetic FMDs and non-FMDs. Clinicians can use these features to identify patients suspected for FMDs and can subsequently alert them to test for positive symptoms at examination. Although a first preliminary model has good predictive accuracy, further validation should be performed prospectively in a multi-center study.

The effect of the height to which the hand is lifted on horizontal curvature in horizontal point-to-point movements.

In point-to-point reaching movements, the trajectory of the fingertip along the horizontal plane is not completely straight but slightly curved sideward. The current paper examines whether this horizontal curvature is related to the height to which the finger is lifted. Previous research suggested that the height to which the hand is lifted might be a determinant of horizontal curvature. We asked participants to make point-to-point movements in three conditions: constrained movements (i.e., fingertip keeps contact with table top) over vertically curved surfaces that differed in height, constrained movements over a flat surface, and unconstrained movements (i.e., fingertip lifted from table top). In constrained movements, we found a strong relation between horizontal curvature and lifted height of the finger. Interestingly, for unconstrained movements, the relation between horizontal curvature and height to which the finger was lifted was weak. This demonstrates that the height to which the finger was lifted relates to horizontal curvature in some, but not in all conditions. This suggests that the height to which the hand is lifted should be included, in particular for constrained movements, when giving a full account of horizontal curvature in point-to-point movements.