Objective: FND account for 15% of all new patients seen in general neurology referral. Despite the burden in terms of prevalence and disability, evidence regarding effective treatments are still limited.

Background: ML, man, aged 58 years, was evaluated for sudden, myoclonic movements of neck and shoulder muscles, appeared 2 month earlier. First the symptoms was episodic during the week, then it slowly spread out and became constant. They displayed when the patient is not attention-involved in any task: while relaxing on the sofa, sitting or standing and while walking; they stopped during voluntary-directed movements and it did not present during sleep. Brain MRI and EEG performed in a out clinic, resulted negative. At the neurological evaluation the myoclonus appeared not stimulus-dependent and variable in expression: when sitting, in trunk extension, when lying down, in flexion. It was on while the patient during evaluation, it stopped while signing a document. The myoclonus showed distractibility during finger tapping with one hand, and tongue movement side-to-side, not sure entrainment. Further neurography, needle myography, SSEP, myoclonus-triggered backaveraging) resulted negative. A polysomnography confirmed myoclonus was not manifesting during sleep. This diagnostic protocol allowed to exclude organic causes. Based on positive signs of variability, distractibility and emotional correlation, it was considered a functional myoclonus and treated by the dedicated physiotherapist team.

Methods: The team has multiyear experience in approach to somatoform disorders: they are used to retraining movements with diverted attention. This can be obtained with cognitive tasks such as conversation, music, mental tasks or physical exercise such as trying fast, rhythmical, unfamiliar or unpredictable movement. They combined it with a communication technique tailored to the patient: pushing him to the target (get control over the involuntary movement) and avoiding to play the symptoms down (when it’s clearly disappearing during the tasks).

Results: There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of. As UK recommendations states ,treatment should address illness beliefs and self-directed attention through a process of education and movement retraining within a positive and non-judgemental context.

Conclusions: We aim to demonstrate that even physiotherapists not specifically trained in FND, can be effective by taking inspiration from recently published recommendation.

References: Physiotherapy for functional motor disorders: a consensus recommendation; Nielsen G, et al. J Neurol Neurosurg Psychiatry 2015;86:1113–1119.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/recognise-and-treat-functional-myoclonus-case-report/