Objective: To evaluate the feasibility and effectiveness of a multimodal day-clinic treatment program for patients with functional movement disorders (FMD) integrated into a neurological movement disorders day clinic.

Background: FMD account for a substantial proportion of presentations in both the emergency departments and outpatient neurology. Although the diagnosis can often be reliably established based on clinical and supportive paraclinical findings, dedicated treatment options remain limited. Patients are frequently referred to psychiatric or psychosomatic services, where neurological expertise and specialized psychotherapeutic experience in movement disorders are often limited.

Method: We conducted a retrospective study evaluating the short-term effects of a multidisciplinary rehabilitation program for FMD embedded in a specialized movement disorder day-clinic. Short-term outcome of motor and non-motor symptoms in 38 patients with FMD (mean age 47.9 ± 16.8 years) after a 3-week program comprising 9 interdisciplinary day-care treatment. Patients attended the day-clinic in small groups (1-3 FMD patients together with 7-9 patients with Parkinson´s disease, essential tremor, or dystonia). Outcomes were assessed by comparing disease-specific motor scores (MDS-PMD), self-report questionnaires (SSS8 and FMDQ), mood (BDI), and cognitive status (MMST) before and immediately after the intervention.

Results: The most common motor symptoms were tremor/myoclonus (n=12/6), gait disturbance (n=12), and dystonia (n=6). Psychiatric comorbidities included depression (n=19), anxiety/phobia (n=7), and post-traumatic stress disorder (n=4). 19 patients had concomitant neurological disorders either at symptom onset or preceding the first manifestation of functional symptoms. With only two dropouts, patients showed significant improvement in the MDS-PMD motor score (15,9±11,7 vs. 13,3±11,7 points; p=0.0002), the self-rated FMDQ score (p=0.0008), and BDI (p=0.02).

Conclusion: Integrating patients with FMD into the multiprofessional setting of a neurological day-clinic proved highly feasible and effective. Patients benefited from neurological expertise, specialized physiotherapy, a tailored psychoeducational program and showed good acceptance of the diagnosis within routine neurological care. Establishing this concept within standard neurological services enabled short pathways from diagnosis to treatment initiation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/multidisciplinary-day-clinic-treatment-for-functional-movement-disorders-embedded-in-a-movement-disorders-center/