Objective: To assess the prevalence of paroxysmal functional movement disorders (PFMD) seen in a specialized Unit before and after the COVID-19 pandemic.

Background: COVID-19 pandemic has had an impact on the incidence of FMD in both children and adults [1], and relevant phenotypical changes during this period have been reported [2]. Paroxysmal FMD (PFMD) manifest as intermittent attacks of abnormal involuntary movements with retained consciousness. They are likely under-estimated, since they are rarely reported and sometimes misdiagnosed as functional non-epileptic attacks. Therefore, they pose additional challenges both in diagnosis and management. Over the past two years, our observation is that there has been an increase in the number of PFMD patients seen in our FMD Unit.

Method: Retrospective analysis of consecutive FMD patients seen in our FMD Unit to explore the frequency of PFMD patients during the COVID-19 pandemic (from 3/2020, date of lockdown in Spain to 3/2022) and compare it with a control group of patients with PFMD seen in the pre-pandemic era from 1/2017 to 2/2020. Clinical phenotypes and demographic features of patients seen pre-pandemic vs. the pandemic period were compared with a Chi-squared test. Statistical significance was set at p<0.05.

Results: In the pandemic group, 24 (24.7%) patients of a total of 97 FMD patients referred to our unit had a PFMD (21 females, mean age 38.54+13.9 years). In the control group, 15 (12%) patients out of 124 had a PFMD (13 females, mean age 38+14.23 years). Comparing both time periods, the mean occurrence of PFMD during the pandemic was 12 cases/year compared to the control group (pre-pandemic), with a occurrence of 5 cases/year. Considering the non-paroxysmal FMD variation between both periods, a statistically significant increment for PFMD in the pandemic period was found (p=0.01).

Conclusion: Global stressful events, like COVID-19 pandemic, can have a profound impact in the prevalence of FMD [3]. In our experience, the COVID-19 pandemic has specifically brought about an increase in the number of patients with PFMD and this should be taken into account when planning therapeutic approaches.

References: 1. Hull M, Parnes M, Jankovic J. Increased Incidence of Functional (Psychogenic) Movement Disorders in Children and Adults Amid the COVID-19 Pandemic: A Cross-sectional Study. Neurol Clin Pract. 2021 Oct;11(5):e686-e690.

2. Machado M, Tarrano C, Mesrati F, Roze E, Vidailhet M, Aubignat M. Functional Movement Disorders During the COVID-19 Pandemic: Back to Charcot’s Era at the Salpêtrière. Mov Disord. 2022 Feb;37(2):432-434.

3. Ludwig, L., Pasman, J. A., Nicholson, T., Aybek, S., David, A. S., Tuck, S., Kanaan, R. A., Roelofs, K., Carson, A., & Stone, J. (2018). Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. The lancet. Psychiatry, 5(4), 307–320

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MDS Abstracts - https://www.mdsabstracts.org/abstract/has-the-covid-19-pandemic-had-an-impact-on-functional-movement-disorders-phenotype-experience-from-a-specialized-unit-in-spain/