Objective: To propose a new multidisciplinary rehabilitation program based on association of sensorimotor retraining  and EMDR to treat FMD.

Background: There is an emerging new standard of care in FMD starting from patient’s acceptance of the diagnosis;  a multidisciplinary team composed by neurologists together with rehabilitation doctors, physioterapists, psychologist and occupational therapists can guide the patients towards a possible recovery. Sensori-motor retraining techniques and psychotherapy  (particularly conventional cognitive behavioural therapy) have already demonstrated their efficacy in FMD  (1).  
SPRInt, imprinted on movement rhythmic  exercises based on internal feedback learning (2) and EMDR, based on patient’s own rapid rhythmic eye movement, that works on dampening the power of emotionally charged memories of past traumatic events (3) have been proposed as a new possible synergic strategy in FMD care

Method: A 39 yo male, with migrane from young age,  after waking up from anterior neck spinal surgery (discectomy and disc prosthesis at C5-C6 level) presented blepharospasms and other facial abnormal movement. MRI of brain, spinal cord and DAT scan were uneventful.
He was treated with duloxetine and benzodiazepine with no result.
One months later he developed also an inconsistent gait disorder, very disabling,  with trunk flexion and marked instability which was diagnosed as functional.
Multidisciplinary treatment program over 10 months consisted in  50 SPRInt  45 minutes session (twice a week) and 25  EMDR 1 hour sessions (once a week).
Pshychological assessment pre/post treatment was performed with Millon Test. Anxiety and depression scale were tested abnormal

Results: The end-of-treatment tests show a significant improvement in previous abnormal social relations scores.
All emotional symptoms (anxiety and fear) fell below the threshold. No residual motor impairment was observed. He could walk and run with also for long distances. He mantained good results at 6 months follow up.

Conclusion: A long term combined multidisciplinary approach with SPRInt and EMDR demonstrates in our case a prolonged  efficacy in solving functional  gait and facial abnormal movements with significative released of psychological discomfort.

References: [1] Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015;86:1113–9. [PubMed: 25433033]
[2] Castagna A, Caronni A, Crippa A, Sciumè L,Giacobbi G, Corrini C, Montesano A, Ramella M . Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia—an observational study. Neurological Sciences https://doi.org/10.1007/s10072-019-04061-5 –
[3] Baek, Jinhee, et al. Neural circuits underlying a psychotherapeutic regimen for fear disorders. Nature 566.7744 (2019): 339-343.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sensorimotor-retraining-program-based-on-the-principles-of-s-p-r-int-sensorimotor-perceptive-integrated-in-association-with-e-m-d-r-eye-movement-desensitization-and-reprocessing-a-new-proposal-fo/