Objective: To evaluate the prevalence and clinical profile of comorbid functional neurologic disorders (FNDs) among patients with Parkinson’s disease (PD) in a rural medical teaching hospital in Western India.

Background: FNDs are not uncommon, though under-recognized, in PD. They may lead to worse quality of life, increased healthcare utilization, and polypharmacy. However, limited data exist on the clinical profile of comorbid FNDs among patients with PD in rural areas of India.

Method: Patients with PD and comorbid FNDs were ambispectively identified between Jan 2012 to Dec 2022 in Parkinson’s clinic of a rural teaching hospital. They were evaluated using structures forms.Clinical characteristics, triggering and perpetuating stressors, quality of life, healthcare utilization of comorbid FNDs were evaluated and compared with patients with PD without any comorbid FNDs.

Results: Among 288 patients with PD, 33 (11.4%) had comorbid FNDs.19 patients had functional movement disorders (tremors, myoclonus, levodopa associated offs, violent dyskinesias, dystonia or gait impairment). 14 had other FNDs (functional motor weakness, sensory loss, mutism, seizures and unresponsiveness). Higher prevalence of depression and anxiety  were seen in ones with comorbid FND than with PD only (87.9% vs. 33.7%; p<0.001). They also had a higher prevalence of triggering stressors (75.8% vs. 13.9%; p<0.001) and perpetuating stressors (78.8% vs. 41.5%; p=0.002). Patients with comorbid FNDs had worse quality of life [Parkinson’s Disease Questionnaire-8 (PDQ-8) (median 34.1 vs. 10.4; p<0.001)]. They also had higher healthcare utilization [hospital visits (median 3.4 /month vs. 0.6 /month; p<0.001);hospitalization days (median 8 vs. 2; p<0.001)]. Comorbid FND patients received higher number of medications (median 9 vs. 5; p<0.001). Three-fourths of patients with comorbid FNDs were initially treated elsewhere,,comorbid FND was missed as a pitfall leading to consultation at our hospital.

Conclusion: Our findings highlight the need for increased awareness, early recognition and appropriate management of comorbid FNDs in patients with PD in rural areas.

References: 1. Wissel B, Dwivedi A, Chin D, et al. Functional neurological disorders in Parkinson disease. J Neurol Neurosurg Psychiatry. 2018
2. Monica M. Kurtis, Isabel Pareés, Functional movement disorder comorbidity in Parkinson’s disease: Unraveling the web, Parkinsonism and Related Disorders, https://doi.org/10.1016/j.parkreldis.2020.10.022

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/comorbid-functional-neurologic-disorders-in-patients-with-parkinson-s-disease-in-a-rural-hospital-in-western-part-of-india/