RT Journal Article
SR Electronic
T1 Clinical decision-making in functional and hyperkinetic movement disorders
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 118
OP 123
DO 10.1212/WNL.0000000000003479
VO 88
IS 2
A1 van der Salm, Sandra M.A.
A1 van Rootselaar, Anne-Fleur
A1 Cath, Daniëlle C.
A1 de Haan, Rob J.
A1 Koelman, Johannes H.T.M.
A1 Tijssen, Marina A.J.
YR 2017
UL http://n.neurology.org/content/88/2/118.abstract
AB Objective: Functional or psychogenic movement disorders (FMD) present a diagnostic challenge. To diagnose FMD, clinicians must have experience with signs typical of FMD and distinguishing features from other hyperkinetic disorders. The aim of this study was to clarify the decision-making process of expert clinicians while diagnosing FMD, myoclonus, and tics.Methods: Thirty-nine movement disorders experts rated 60 patients using a standardized web-based survey resembling clinical practice. It provided 5 steps of incremental information: (1) visual first impression of the patient, (2) medical history, (3) neurologic examination on video, (4) the Bereitschaftspotential (BP), and (5) psychiatric evaluation. After full evaluation of each case, experts were asked which diagnostic step was decisive. In addition, interim switches in diagnosis after each informational step were calculated.Results: After full evaluation, the experts annotated the first impression of the patients as decisive in 18.5% of cases. Medical history was considered decisive in 33.3% of cases. Neurologic examination was considered decisive in 39.7%, the BP in 8%, and the psychiatric interview in 0.5% of cases. Most diagnostic switches occurred after addition of the medical history (34.5%). Addition of the neurologic examination led to 13.8% of diagnostic switches. The BP results led to diagnostic switches in 7.2% of cases. Psychiatric evaluation resulted in the lowest number of diagnostic switches (2.7% of cases).Conclusions: Experts predominantly rely on clinical assessment to diagnose FMD. Importantly, ancillary tests do not determine the final diagnosis of this expert panel. In general, the experts infrequently changed their differential diagnosis.BP=Bereitschaftspotential; DSM-5=Diagnostic and Statistical Manual of Mental Disorders, 5th edition; FMD=functional movement disorders; MINI-Plus=Mini-International Neuropsychiatric Interview–Plus