The goal of this observational study is to learn about functional neurological disorders in patients with common non-functional movement disorders ("functional overlay"). The main questions it aims to answer are: * What is the frequency of functional neurological disorders in patients with non-functional movement disorders (functional overlay)? * What are the characteristics of functional neurological disorders in patients with non-functional movement disorders? Participants will be examined clinically and electrophysiologically, the examinations consist of: * a neurological examination * neuropsychological testing * electrophysiological tremor diagnostic * questionnaires about psychological, biological and social risk factors Researchers will compare patients with functional motor disorders to patients wit non-functional movement disorders to see if they differ from each other regarding the functional symptoms.
Functional neurological disorders (FND) are common neurological disorders that are present in up to 16% of patients in neurological outpatient clinics. They are associated with a significant reduction in quality of life, can lead to permanent impairment, and have a poor prognosis, especially if the diagnosis is delayed. FND have multifactorial causes and risk factors, including psychological stressors, childhood trauma, female gender, psychiatric disorders such as depression, anxiety disorder, or post-traumatic stress disorder, and other functional disorders such as irritable bowel syndrome or chronic pain syndrome. Patients with FND often report additional cognitive complaints ("cognitive fog"). A mismatch of various regulatory mechanisms, a disruption of sensory processing and motor output is assumed to be a central part of the pathogenesis. A characteristic feature of FND is a variability of symptoms according to attention. FND can be intensified by increased attention and weakened by distraction. Positive diagnostic criteria for FND have been established recently, so that by definition FND are no longer a diagnosis of exclusion. The clinical presentations of FND are diverse and include impaired limb movement control, disturbances in vigilance that may be associated with seizures, and non-motor symptoms. FND often coincide and often coexist with pain, fatigue, sleep disorders, and cognitive disorders. Particularly non-motor functional symptoms are highly debilitating for patients. The coincidence of "organic" neurological disorders and FND in the same patients ("functional overlay") is probably not uncommon, but has been investigated primarily in patients with Parkinson's Disease and epilepsy, so far. However, it is important to recognize FND in patients with movement disorders in order to treat them adequately and to protect them from incorrect treatment (surgery, unnecessary medication, etc.). However, the basic prerequisite for this is an exploration of the frequency and characteristics of the functional symptoms in movement disorders.
Study Type
OBSERVATIONAL
Enrollment
216
A neurological examination following a protocol to detect positive signs of functional neurological disorders.
A standardized question about the patient´s history. The response time is measured. Question: "Could you tell me about the problems with the movement disorder you are experiencing?"
Neuropsychological cognitive testing including: * Montreal Cognitive Assessment (MOCA) * Rey-Osterrieth Complex Figure Test (ROCFT) * Wechsler Memory Scale IV * Comprehensive Trail Making Test (CTMT) * semantic and phonematic fluency tests
* Short Form 36 (SF 36) * Somatic Symptom Disorder - B Criteria Scale (SSD 12) * Patient Health Questionnaire 9 (PHQ 9) * Patient Health Questionnaire 15 (PHQ 15) * Generalized Anxiety Disorder 7 (GAD 7) * Fatigue Severity Scale (FSS) * Psychosomatic Competence Inventory (PSCI) * Work Ability Index (WAI) * Level of Personality Functioning Scale * Toronto Alexithymia Scale * Levels of Emotional Awareness Scale (short version) * Certainty About Mental States Questionnaire * Somatosensoric Amplification Scale * Personality Inventory for DSM-5 short version (PID5BF+M) * Childhood Trauma Questionnaire * European Quality of Life 5 Dimensions 5 Level Version (EQ5D5L)
Accelerometry following a standardized protocol, using a triaxial accelerometer transducer (Biometrics ACL300, Sensitivity 6 100 mV/G, Biometrics Ltd, UK)
Medical University of graz
Graz, Styria, Austria
RECRUITINGFunctional neurological symptoms
Diagnosed by positive signs for functional neurological symptoms, as assessed in the neurological examination
Time frame: on average 30 minutes
Duration of anamnesis
Duration in seconds of the response to the question: "Could you tell me about the problems with the movement disorder you are experiencing?"
Time frame: 1 to 3 minutes
Tremor diagnostic
Sum score of a electrophysiological test battery for psychogenic tremor, a scale from 0 to 10 with higher numbers indicating a higher probability for functional tremor
Time frame: up to 20 minutes
Subjective quality of life
European Quality of Life 5 Dimensions 5 Level Version (EQ 5D 5L), results in a 5-digit number that describes the patient's health state
Time frame: 5 minutes
Subjective health
Short Form 36 Questionnaire (SF-36), a 36 items questionnaires that results in 8 scales that describe the subjective health state of the patient, higher values indicating better health
Time frame: up to 10 minutes
Fatigue
Fatigue severity scale (FSS): 9 item questionnaire with a 7 point Likert scale, higher values indicating more fatigue
Time frame: up to 5 minutes
General anxiety
General anxiety disorder scale 7 (GAD-7): a 7 items questionnaire (0 to 21 points, higher values indicating more anxiety)
Time frame: 3 minutes
Somatic symptoms
Patient health questionnaire 15 (PHQ 15): a 15 item questionnaire (0 to 30 points, higher values indicating more somatic symptoms)
Time frame: 5 minutes
Depression
Patient health questionnaire 9 (PHQ 9): a 9 item questionnaire (0 to 27 points, higher values indicating more depressive symptoms)
Time frame: 3 minutes
Psychosomatic Competence
Psychosomatic Competence Inventory (PSCI): a 44 items questionnaire with a 6 point Likert scale, resulting in 6 subscales, higher values indicate higher psychosomatic competence
Time frame: up to 10 minutes
Work ability
Work ability index (WAI): 7 item questionnaire, 7 to 49 points, with higher values indicating better work ability
Time frame: 5 minutes
Trauma in childhood
Child Trauma Questionnaire (CTQ): 28 items questionnaire, 5 point Likert scale, resulting in 5 subscales with 5 to 25 points, with higher values indicating more trauma experience
Time frame: up to 10 minutes
Attachment styles
Experience of Close Relationships-Revised (ECR-RD 12): 12 items questionnaire with a 7 point Likert scale, resulting in 2 subscales
Time frame: 5 minutes
Alexithymia
Toronto alexithymia scale (TAS): 26 items questionnaire with a 5 point Likert scale, higher values indicating more alexithymia
Time frame: 5 minutes
Personality traits
The Personality Inventory for DSM-5 and ICD-11 Plus Modified (PID5BF + M): a 36 items questionnaire, with a 4 point Likert scale, resulting in 6 subscales
Time frame: up to 10 minutes
Personality functioning
Levels of personality functioning scale (LPFS): a 80 items questionnaire, with a 4 point Likert scale, resulting in 4 subscales
Time frame: up to 15 minutes
Executive function
Comprehensive trail making test (CTMT)
Time frame: up to 10 minutes
Memory
Wechsler Memory Scale
Time frame: up to 15 minutes
Visuospatial abilities
Rey-Osterrieth complex figure test
Time frame: up to 15 minutes
Functional cognitive symptoms
Incongruence in cognitive tests
Time frame: up to 60 minutes
Semantic word fluency
number of animals that can be listed in 2 minutes
Time frame: 2 minutes
phonematic word fluency
number of words, that start with the letter "b", that can be listed in 2 minutes
Time frame: 2 minutes
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