3,065
Views
1
CrossRef citations to date
0
Altmetric
Review

Functional Gait Disorders: Clinical presentations, Phenotypes and Implications for treatment

ORCID Icon, , , & ORCID Icon
Pages 437-445 | Received 11 Jul 2022, Accepted 02 Jan 2023, Published online: 08 Jan 2023

References

  • Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022 Jun 1;21(6):537–50. 10.1016/S1474-4422(21)00422-1.
  • Edwards MJ, Bhatia KP, Edwards MJBK. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol. 2012 Mar 1;11(3):250–60. 10.1016/S1474-4422(11)70310-6.
  • Baik JS, Lang AE, Baik JSLA. Gait abnormalities in psychogenic movement disorders. Mov Disord Clin Pract [Internet]. 2007 Feb 15 [cited 2020 Dec 20];22(3):395–99. Available from http://wiley.com/10.1002/mds.21283
  • Stone J, Carson A, Duncan R, Roberts R, Warlow C, Hibberd C, Coleman R, Cull R, Murray G, Pelosi A, et al. Who is referred to neurology clinics? - The diagnoses made in 3781 new patients. Clin Neurol Neurosurg [Internet]. 2010 Nov [cited 2020 Nov 12];112(9):747–51. Available from https://pubmed.ncbi.nlm.nih.gov/20646830/10.1016/j.clineuro.2010.05.011
  • Clinical lectures on the diseases of the nervous system : delivered at the infirmary of La Saltptrire/by J.M. Charcot translated by Thomas Savill : Charcot, J. M. (Jean Martin), 1825-1893 . Free download, borrow, and streaming : Internet archive [Internet]. [cited 2022 May 24]. Available from. https://archive.org/details/b21270211_001
  • Stone J, Hewett R, Carson A, Warlow C, Sharpe M. The ‘disappearance’ of hysteria: historical mystery or illusion? J R Soc Med [Internet]. 2008 Jan [cited 2021 Dec 8];101(1):12. Available from /pmc/articles/PMC2235919/
  • Perez DL, Edwards MJ, Nielsen G, Kozlowska K, Hallett M, Curt Lafrance W. Decade of progress in motor functional neurological disorder: continuing the momentum. J Neurol Neurosurg Psychiatry [Internet]. 2021 Jun 1 [cited 2022 Nov 21];92(6):668–77. doi:10.1136/jnnp-2020-323953.
  • LaFaver K, Maurer CW, Nicholson TR, Perez DL, editors. Functional movement disorder. 2022 [cited 2022 Nov 21]; Available from https://link.springer.com/10.1007/978-3-030-86495-8
  • Demartini B. Functional gait disorder. Curr Clin Neurol [Internet]. 2022 [cited 2022 Nov 7];135–45. Available from https://link.springer.com/chapter/10.1007/978-3-030-86495-8_11.
  • Stone J, Carson A, Duncan R, Roberts R, Coleman R, Warlow C, Murray G, Pelosi A, Cavanagh J, Matthews K, et al. Which neurological diseases are most likely to be associated with “symptoms unexplained by organic disease. J Neurol [Internet]. 2012 Jan 16 [cited 2020 Dec 3];259(1):33–38. http://www.statsdirect.com.
  • Eames P. Hysteria following brain injury. J Neurol Neurosurg Psychiatry [Internet]. 1992 [[cited 2022 Nov 7]];55:1046–53. http://jnnp.bmj.com/
  • Carson AJ, Stone J. Functional and dissociative (psychogenic) neurological symptoms. In: Daroff R, Fenichel G, Jankovic J, Mazziotta J, editors. Bradley’s neurology in clinical practice. Philadelphia: Elsevier; 2012. p. 2147–62.
  • Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry [Internet]. 2012 Jan 1 [cited 2021 Feb 16];83(1):67–69. doi:10.1136/jnnp-2011-300125.
  • Pareés I, Brown H, Nuruki A, Adams RA, Davare M, Bhatia KP, Friston K, Edwards MJ. Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain [Internet]. 2014 Nov [cited 2020 Dec 3];137(11):2916–21. Available from https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awu237
  • Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ.A Bayesian account of “hysteria. Brain. 2012;135(11):3495–512.doi:10.1093/brain/aws129.
  • Ejareh Dar M, Kanaan RAA. Uncovering the etiology of conversion disorder: insights from functional neuroimaging [Internet]. Vol. 12, Neuropsychiatric disease and treatment. Dove Medical Press Ltd.; 2016 cited 2021 Mar 19. 143–53. Available from https://go.gale.com/ps/i.do?p=AONE&sw=w&=11766328&v=2.1&it=r&id=GALE%7CA506651200&sid=googleScholar&linkaccess=fulltext
  • Clark CN, Edwards MJ, Ong BE, Goodliffe L, Ahmad H, Dilley MD, Betteridge S, Griffin C, Jenkins PO . Reframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology Keywords: mild traumatic brain injury; persistent symptoms; interface disorder; risk factors; imaging Abbreviations: mTBI = mild traumatic brain injury; PCS = postconcussional syndrome. [cited 2022 Nov 21]; DOI:10.1093/brain/awac149
  • Stone J, LaFrance WC, Brown R, Spiegel D, Levenson JL, Sharpe M. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res [Internet]. 2011 Dec;71(6):369–76. Available from doi:10.1016/j.jpsychores.2011.07.005.
  • Friston KJ, Daunizeau J, Kilner J, Kiebel SJ. Action and behavior: a free-energy formulation. Biol Cybern [Internet]. 2010 Mar 11 [cited 2020 Oct 28];102(3):227–60. Available from https://link.springer.com/article/10.1007/s00422-010-0364-z
  • Stone J, Carson A, Aditya H, Prescott R, Zaubi M, Warlow C, Sharpe M. The role of physical injury in motor and sensory conversion symptoms: a systematic and narrative review. J Psychosom Res. 2009 May 1;66(5):383–90. doi:10.1016/j.jpsychores.2008.07.010.
  • Stewart DE. The changing faces of somatization. Psychosomatics. 1990 May 1;31(2):153–58. doi:10.1016/S0033-3182(90)72188-3.
  • Hotopf M, Mayou R, Wadsworth M.Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. Prim Care Companion J Clin Psychiatry. 2000;2(1):31.
  • Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain [Internet]. 2004 Oct 1 [cited 2021 Sep 19];127(10):2360–72. doi:10.1093/brain/awh262.
  • Gelauff JM, Kingma EM, Kalkman JS, Bezemer R, van Engelen BGM, Stone J, Tijssen MAJ, Rosmalen JGM. Fatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders. J Neurol. 2018 Aug 1;265(8):1803–09. doi:10.1007/s00415-018-8915-7.
  • Gelauff JM, Carson A, Ludwig L, Tijssen MAJ, Stone J.The prognosis of functional limb weakness: a 14-year case-control study. Brain. 2019;142(7):2137–48.doi:10.1093/brain/awz138.
  • Věchetová G, Slovák M, Kemlink D, Hanzlíková Z, Dušek P, Nikolai T, Růžička E, Edwards MJ, Serranová T. The impact of non-motor symptoms on the health-related quality of life in patients with functional movement disorders. J Psychosom Res. 2018 Dec 1;115:32–37. 10.1016/j.jpsychores.2018.10.001.
  • Tinazzi M, Morgante F, Marcuzzo E, Erro R, Barone P, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, et al. Clinical correlates of functional motor disorders: an Italian multicenter study. Mov Disord Clin Pract. 2020 Nov 1;7(8):920–29. doi:10.1002/mdc3.13077.
  • Aybek S, Lidstone SC, Nielsen G, Macgillivray L, Bassetti CL, Lang AE, Edwards MJ. What is the role of a specialist assessment clinic for FND? Lessons from three national referral centers. J Neuropsychiatry Clin Neurosci [Internet]. 2020 Jan 7 [cited 2021 Mar 16];32(1):79–84. https://psychiatryonline.org/doi/10.1176/appi.neuropsych.19040083
  • Lavedán A, Viladrosa M, Jürschik P, Botigué T, Nuín C, Masot O, Lavedán R. Fear of falling in community-dwelling older adults: a cause of falls, a consequence, or both? PLoS One. 2018 Mar 1;13(3).
  • Sudarsky L Psychogenic gait disorders [Internet]. Seminars in Neurology Semin Neurol; Jul, 2006 p. 351–56. Available from: https://pubmed.ncbi.nlm.nih.gov/16791781/
  • Scheffer AC, Schuurmans MJ, Van Dijk N, VanVan der hooft T, De Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing [Internet]. 2008 Jan 1 [cited 2021 Nov 15];37(1):19–24. doi:10.1093/ageing/afm169.
  • Popkirov S, Hoeritzauer I, Colvin L, Carson AJ, Stone J. Complex regional pain syndrome and functional neurological disorders - time for reconciliation. J Neurol Neurosurg Psychiatry. 2019 May 1;90(5):608–14. 10.1136/jnnp-2018-318298.
  • Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness [Internet]. Vol. 18, Practical Neurology. BMJ Publishing Group; 2018 cited 2021 Feb 16. 5–13. Available from http://pn.bmj.com/
  • Seemungal BM, Passamonti L. Persistent postural-perceptual dizziness: a useful new syndrome. Pract Neurol [Internet]. 2018 Feb 1 [cited 2021 Mar 14];18(1):3–4. doi:10.1136/practneurol-2017-001817.
  • Okun MS, Koehler PJ Paul Blocq and (psychogenic) astasia abasia [Internet]. Vol. 22, Movement Disorders. Mov Disord; 2007 [cited 2020 Aug 16]. p. 1373–78. Available from: https://pubmed-ncbi-nlm-nih-gov.epworth.idm.oclc.org/17516452/
  • Clinical Lectures on Paralysis, Disease of the brain, and other affections … - Robert Bentley Todd - Google books [Internet]. [cited 2022 Jan 19]. Available from: https://books.google.com.au/books?hl=en&lr=&id=BjxpAAAAIAAJ&oi=fnd&pg=PR15&ots=rocBjH9Zhp&sig=A9q7eN0WUJdUT4gO-mNrmVq7HKo&redir_esc=y#v=onepage&q&f=false
  • Nouvelle Iconographie de la Salpêtrière (Clinique des Maladies du Système Nerveux). Publiée sous la direction du Prof. Charcot (de l’Institut) par Paul Richer (chef du Laboratoire) Gilles de la Tourette (chef de Clinique) Albert Londe (Directeur du Service Photographique). Tome premier. Paris: lecroisnier et Babé, Place de l’Ecole de Médicine. 1888. J Ment Sci [Internet]. 1890 Jul [cited 2021 Dec 8]; 36(154):389–93. Available from https://www.cambridge.org/core/journals/journal-of-mental-science/article/abs/nouvelle-iconographie-de-la-salpetriere-clinique-des-maladies-du-systeme-nerveux-publiee-sous-la-direction-du-prof-charcot-de-linstitut-par-paul-richer-chef-du-laboratoire-gilles-de-la-tourette-chef-de-clinique-albert-londe-directeur-du-service-photographique-tome-premier-paris-lecroisnier-et-babe-place-de-lecole-de-medicine-1888/8A1C197B778E8B0B077B734E2CC132C2
  • Tinazzi M, Pilotto A, Morgante F, Marcuzzo E, Cuoco S, Ceravolo R, Mazzucchi S, Padovani A, Romito LM, Eleopra R, Nicoletti A. Functional gait disorders: demographic and clinical correlations. Parkinsonism Relat Disord. 2021 Oct;91:32–36. doi:10.1016/j.parkreldis.2021.08.012.
  • Lempert T, Brandt T, Dieterich M, Huppert D. How to identify psychogenic disorders of stance and gait - A video study in 37 patients. J Neurol [Internet]. 1991 Jun [[cited 2020 Aug 16]];238(3):140–46. Available from: https://link.springer.com/article/10.1007/BF00319680.
  • Jordbru AA, Smedstad LM, Moen VP, Martinsen EW. Identifying patt erns of psychogenic gait by video-recording. J Rehabil Med. 2012 Jan;44(1):31–35. doi:10.2340/16501977-0888.
  • Nonnekes J, Růžička E, Serranová T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020 Jun 16;94(24):1093–99. 10.1212/WNL.0000000000009649.
  • Baizabal-Carvallo JF, Alonso-Juarez M, Jankovic J, Baizabal-Carvallo JF, Alonso-Juarez MJJ. Functional gait disorders. Clinical phenomenology, and classification. Neurol Sci [Internet]. 2019 Apr 1 [cited 2020 Oct 6];14(4):911–15. Available from https://link.springer.com/article/10.1007/s10072-019-04185-8
  • Fung VSC. Functional gait disorder. In: Handbook of clinical neurology, Elsevier B.V; 2016. 263–70.
  • Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VSC, Hallett M, Jankovic J, Jinnah HA, Klein C, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord [Internet]. 2013 Jun 15 [cited 2021 Oct 25];28(7):863–73. https://onlinelibrary.wiley.com/doi/full/10.1002/mds.25475
  • ICD-11 [Internet]. [cited 2021 Aug 2]. Available from: https://icd.who.int/en
  • Psychiatry.org - DSM-5-TR Fact Sheets [Internet]. [cited 2022 Nov 21]. Available from: https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets
  • Friedman JH, LaFrance WC. Psychogenic disorders: the need to speak plainly [Internet]. Vol. 67, Archives of neurology. American Medical Association; 2010 cited 2021 Feb 14. 753–55. Available from https://jamanetwork.com/journals/jamaneurology/fullarticle/800272
  • Espay AJ, Goldenhar LM, Voon V, Schrag A, Burton N, Lang AE. Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: an international survey of movement disorder society members. Mov Disord [Internet]. 2009 Jul 15 [cited 2021 Feb 14];24(9):1366–74. Available from http://wiley.com/10.1002/mds.22618
  • Ding JM, Kanaan RAA. Conversion disorder: a systematic review of current terminology. Gen Hosp Psychiatry. 2017 Mar 1;45;51–55. 10.1016/j.genhosppsych.2016.12.009
  • Espay AJ, Lang AE. Phenotype-specific diagnosis of functional (Psychogenic) movement disorders. Curr Neurol Neurosci Rep. 2015 Jun 1;15(6). 10.1007/s11910-015-0556-y.
  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
  • Daum C, Hubschmid M, Aybek S. The value of “positive” clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review [Internet]. Vol. 85, Journal of neurology, neurosurgery and psychiatry. BMJ Publishing Group; 2014 cited 2021 Jun 2. 180–90. Available from 10.1136/jnnp-2012-304607.
  • Araújo R, Van De Warrenburg B, Lang A, Lees A, Bloem B. The waiting room: neurological observations made outside the movement disorder specialist’s consulting office. Pract Neurol [Internet]. 2019 Aug 1 [cited 2022 Jan 26];19(4):295–301. doi:10.1136/practneurol-2018-002110.
  • Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, LaFaver K, LaFrance CW, Lang AE, Nicholson T, Nielsen G, Reuber M, Voon V, Stone J, Morgante F. Current concepts in diagnosis and treatment of functional neurological disorders [Internet]. Vol. 75, JAMA neurology. American Medical Association; 2018 cited 2021 May 29. 1132–41. Available from https://jamanetwork.com/
  • Hayes MW, Graham S, Heldorf P, De Moore G, Morris JGL. A video review of the diagnosis of psychogenic gait: appendix and commentary [Internet]. Movement Disorders. 1999;14:914–21. doi:10.1002/1531-8257(199911)14:6<914::AID-MDS1002>3.0.CO;2-B.
  • Stone J, Reuber M, Carson A. Functional symptoms in neurology: mimics and chameleons. Pract Neurol [Internet]. 2013 Apr 1 [cited 2022 Nov 21];13(2):104–13. doi:10.1136/practneurol-2012-000422.
  • Aybek S, Perez DL. State of the art reVIeW diagnosis and management of functional neurological disorder. BMJ. 2022; 376:064. doi:10.1136/bmj.o64.
  • Walzl D, Solomon AJ, Stone J. Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap [Internet]. Vol. 1, Journal of Neurology. Springer Science and Business Media Deutschland GmbH; 2021 cited 2021 Apr 8. 3. 10.1007/s00415-021-10436-6.
  • Nielsen G, Stone J, Matthews A, Brown M, Sparkes C, Farmer R, Masterton L, Duncan L, Winters A, Daniell L, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015 Oct 1;86(10):1113–19. 10.1136/jnnp-2014-309255.
  • Stone J. Functional neurological disorders: the neurological assessment as treatment. In: Vol. 16, Practical neurology, BMJ Publishing Group; 2016. 7–17.
  • Gilmour GS, Nielsen G, Teodoro T, Yogarajah M, Coebergh JA, Dilley MD, Martino D, Edwards MJ. Management of functional neurological disorder. J Neurol [Internet]. 2020 Jul 1;267(7):2164–72. Available from 10.1007/s00415-020-09772-w.
  • Greiner C, Schnider A, Leemann B. Functional neurological disorders: a treatment-focused review [Internet]. Vol. 167, Swiss archives of neurology, psychiatry and psychotherapy. EMH Media; 2016 cited 2020 Dec 3. 234–40. Available from https://sanp.ch/article/doi/sanp.2016.00441
  • Jordbru AA, Smedstad LM, Klungsøyr O, Martinsen EW.Psychogen ic gait diso rde r: a random ized cont rolled trial of physical rehabilitation with one -year fo llow -up. J Rehabil Med. 2014;46(2):181–87.doi:10.2340/16501977-1246.
  • Petrochilos P, Elmalem MS, Patel D, Louissaint H, Hayward K, Ranu J, Selai C. Outcomes of a 5-week individualised MDT outpatient (day-patient) treatment programme for functional neurological symptom disorder (FNSD). J Neurol [Internet]. 2020;267:2655–66. Available from doi:10.1007/s00415-020-09874-5.
  • Demartini B, Batla A, Petrochilos P, Fisher L, Edwards MJ, Joyce E. Multidisciplinary treatment for functional neurological symptoms: a prospective study. J Neurol. 2014 Nov 25;261(12):2370–77. 10.1007/s00415-014-7495-4.
  • Mccormack R, Moriarty J, Mellers JD, Shotbolt P, Pastena R, Landes N, Goldstein L, Fleminger S, David AS. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. [cited 2020 Dec 3]; Available from: http://jnnp.bmj.com/
  • Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR, Ahlskog JE. Functional movement disorders: successful treatment with a physical therapy rehabilitation protocol. Park Relat Disord [Internet]. 2012 Mar;18(3):247–51. Available from doi:10.1016/j.parkreldis.2011.10.011.
  • Nielsen G, Buszewicz M, Stevenson F, Hunter R, Holt K, Dudziec M, Ricciardi L, Marsden J, Joyce E, Edwards MJ, et al. Randomised feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry. 2017 Jun 1;88(6):484–90. 10.1136/jnnp-2016-314408.
  • Nielsen G, Stone J, Buszewicz M, Carson A, Goldstein LH, Holt K, Hunter R, Marsden J, Marston L, Noble H, et al. Physio4FMD: protocol for a multicentre randomised controlled trial of specialist physiotherapy for functional motor disorder. BMC Neurol. 2019 Oct 21;19(1). 10.1186/s12883-019-1461-9.
  • Nicholson C, Edwards MJ, Carson AJ, Gardiner P, Golder D, Hayward K, Humblestone S, Jinadu H, Lumsden C, MacLean J, et al. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry [Internet]. 2020 Oct 1 [cited 2022 Jan 19];91(10):1037–45. https://pubmed.ncbi.nlm.nih.gov/32732388/
  • Gardiner P, Macgregor L, Carson A, Stone J. Occupational therapy for functional neurological disorders: a scoping review and agenda for research. CNS Spectr [Internet]. 2018 Jun 1 [cited 2021 Nov 19];23(3):205–12. doi:10.1017/S1092852917000797.
  • Carson A, Stone J, Hibberd C, Murray G, Duncan R, Coleman R, Warlow C, Roberts R, Pelosi A, Cavanagh J, et al. Disability, distress and unemployment in neurology outpatients with symptoms “unexplained by organic disease.” [cited 2021 Jun 23]; Available from: http://jnnp.bmj.com/
  • Gutkin M, McLean L, Brown R, Kanaan RA. Systematic review of psychotherapy for adults with functional neurological disorder. J Neurol Neurosurg Psychiatry [Internet]. 2021 Jan 1 [cited 2021 Nov 19];92(1):36–44. doi:10.1136/jnnp-2019-321926.