Abstract
Functional movement disorders (FMDs) are common in neurological practice and a source of significant distress and disability. There is consensus that successful explanation which helps the patient feel confident that the diagnosis is correct is an essential platform for further treatment. Many doctors find delivering the diagnosis difficult. In these two short films, we explore why certain ways of approaching the explanation of an FMD can cause difficulties, especially failure to give an explicit diagnostic label, and a tendency to jump to a speculative etiological discussion about possible psychological factors instead of helping the patient understand the nature and mechanism of the movement disorder itself. Demonstrating the physical signs to the patient is often of key importance in helping the patient to understand that, first, the diagnosis is made positively and not just because the tests are normal. Crucially, it also shows the potential for symptom reversibility, which can then feed in to an understanding of how physiotherapy promotes automatic movement and “retrains the brain.” Seeing the patient again is important in assessing the patient's confidence and readiness for therapy as well as calibrating your own communication skills.
Keywords: functional movement disorders, diagnosis, clinical practice, psychogenic
Author Roles
J.S. wrote the script. I.H. revised the script.
Disclosures
Ethical Compliance Statement
The authors have reviewed the “manuscript pre‐submission and ethical publication guidelines” of the journal. The authors affirm that this work is consistent with the ethical guidelines mentioned therein.
Funding sources and conflicts of interest
The authors report no sources of funding. J.S. runs a free nonprofit self‐help website, www.neurosymptoms.org, which is mentioned in the article.
Financial disclosures for previous 12 months
J.S. and I.H. are employed by NHS Lothian. J.S. carries out independent expert testimony work for personal injury and medical negligence claims and receives royalties from UpToDate for articles on functional neurological disorder. I.H. has received funding from an Association of British Neurologists/Patrick Berthoud Charitable Trust Clinical Research Training Fellowship.
Supporting information
Video S1. Video 1 looks at common pitfalls of explanation of FMD, including failure to make a positive diagnosis and jumping to conclusions about psychological factors. It then presents an alternative based on normal practice. Name the condition and explain how the physical signs, such as the tremor entrainment test, lead to the diagnosis.1 Use the signs to explain why treatment may help.
Video S2. Video 2 uses clips from patients with FMD to explore how it is possible to explain functional limb weakness and functional dystonia to a patient. We discuss the follow‐up visit, and the importance of assessing patient's confidence in the diagnosis and readiness for further treatment referral. Clips reproduced by permission of Itzit Films (https://youtu.be/w4lqr4Mo32M) and Wiley.2
References
- 1. Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol 2016;139:543–553. [DOI] [PubMed] [Google Scholar]
- 2. Stone J, Gelauff J, Carson A. A “twist in the tale”: altered perception of ankle position in psychogenic dystonia. Mov Disord 2012;27:585–586. [DOI] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Video S1. Video 1 looks at common pitfalls of explanation of FMD, including failure to make a positive diagnosis and jumping to conclusions about psychological factors. It then presents an alternative based on normal practice. Name the condition and explain how the physical signs, such as the tremor entrainment test, lead to the diagnosis.1 Use the signs to explain why treatment may help.
Video S2. Video 2 uses clips from patients with FMD to explore how it is possible to explain functional limb weakness and functional dystonia to a patient. We discuss the follow‐up visit, and the importance of assessing patient's confidence in the diagnosis and readiness for further treatment referral. Clips reproduced by permission of Itzit Films (https://youtu.be/w4lqr4Mo32M) and Wiley.2