Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter

M J Edwards; L H Koens; J Liepert; J Nonnekes; P Schwingenschuh; A M M van de Stouwe; F Morgante

doi:10.1016/j.cnp.2023.12.006

Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter

Clin Neurophysiol Pract. 2024 Jan 24:9:69-77. doi: 10.1016/j.cnp.2023.12.006. eCollection 2024.

Authors

M J Edwards^{1

2}, L H Koens^{3

4

5}, J Liepert⁶, J Nonnekes^{7

8

9}, P Schwingenschuh¹⁰, A M M van de Stouwe^{3

4

11}, F Morgante¹²

Affiliations

¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
² Department of Neuropsychiatry, Maudsley Hospital, London, UK.
³ Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁵ Department of Neurology and Clinical Neurophysiology, Martini Ziekenhuis, Groningen, the Netherlands.
⁶ Kliniken Schmieder Allensbach, Allensbach, Germany.
⁷ Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
⁸ Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands.
⁹ Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, the Netherlands.
¹⁰ Department of Neurology, Medical University of Graz, Graz, Austria.
¹¹ Department of Neurology, Ommelander Ziekenhuis, Scheemda, the Netherlands.
¹² Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.

Abstract

Functional Motor Disorders are common and disabling. Clinical diagnosis has moved from one of exclusion of other causes for symptoms to one where positive clinical features on history and examination are used to make a "rule in" diagnosis wherever possible. Clinical neurophysiological assessments have developed increasing importance in assisting with this positive diagnosis, not being used simply to demonstrate normal sensory-motor pathways, but instead to demonstrate specific abnormalities that help to positively diagnose these disorders. Here we provide a practical review of these techniques, their application, interpretation and pitfalls. We also highlight particular areas where such tests are currently lacking in sensitivity and specificity, for example in people with functional dystonia and functional tic-like movements.

Keywords: Clinical neurophysiology; Electrophysiology; Functional Movement Disorders; Functional Neurological Disorder.

Publication types

Review