Objective: To characterize diagnostic delay, patterns of misdiagnosis, and healthcare utilization before diagnosis of FMD in patients evaluated in a tertiary public hospital in Peru.

Background: FMD are a frequent cause of abnormal movements in neurology clinics and are commonly misdiagnosed as other neurological conditions (I). Diagnostic delay often leads to repeated emergency visits, extensive diagnostic testing, and unnecessary treatments (II). Although the healthcare burden associated with FMD has been described in high-income countries, data from low- and middle-income healthcare systems remain scarce.

Method: We retrospectively reviewed clinical records of patients evaluated in a multidisciplinary Functional Neurological Disorders program at a tertiary public hospital over 12 months. Patients with FMD (tremor, dystonia, abnormal gait, myoclonus, or functional weakness) were included, while epileptic and primarily vestibular presentations were excluded. Extracted data included prior diagnoses, investigations, treatments received, and diagnostic delay.

Results: Sixty-one patients with confirmed FMD were identified. Patients received a mean of 2.1 neurological diagnoses before the correct diagnosis, and 29% had three or more alternative diagnoses. The estimated diagnostic delay was 2.8 years (range 3 months–11 years). Before diagnosis, most patients underwent investigations, with neuroimaging performed in ~95% of cases. A history of sexual abuse or interpersonal violence was documented in 9 patients (16%), although psychosocial trauma is likely underreported in routine clinical records. Healthcare utilization was substantial: 69% had emergency visits and 60% required hospital admissions before diagnosis. Misdiagnoses included cerebrovascular events (14), dystonia (11), parkinsonian syndromes (8), myasthenia gravis (5), and inflammatory disorders such as myelitis or encephalitis (6). Treatments based on alternative diagnoses included levodopa for suspected parkinsonism (10), botulinum toxin injections (6), corticosteroids (14), and intravenous immunoglobulins (4).

Conclusion: FMD remain frequently misdiagnosed, resulting in prolonged diagnostic delays and substantial healthcare utilization. In low- and middle-income settings, earlier recognition of positive clinical signs may reduce unnecessary investigations and treatments.

table1

References: I. Delgado, C., Kurtis, M., Pareés, I., et al. (2022). Clinical and demographic characteristics of patients with functional movement disorders: A consecutive cohort study from a specialized clinic. Acta Neurologica Belgica, 122(1), 97–103. https://doi.org/10.1007/s13760-021-01624-0
II. Tinazzi, M., Gandolfi, M., Tamburin, S., et al. (2021). Economic costs of delayed diagnosis of functional motor disorders: Preliminary results from a cohort of patients of a specialized clinic. Frontiers in Neurology, 12, 786126. https://doi.org/10.3389/fneur.2021.786126

« Back to 2026 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/functional-movement-disorders-in-a-public-health-system-misdiagnosis-diagnostic-delay-and-healthcare-utilization-in-61-patients/