Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1590/0004-282X20200009
Rehabilitation for motor functional neurological disorder: a follow-up study of 185 patients
Reabilitação para transtorno neurológico funcional motor: um estudo de acompanhamento de 185 casos![](https://www.thieme-connect.de/media/10.1055-s-00054595/202006/lookinside/thumbnails/10-1590-0004-282x20200009_20200009-1.jpg)
ABSTRACT
Background: Motor functional neurological disorder (mFND) is a common and disabling condition. There are no evidence-based guidelines for treatment. Long-term outcome is often poor. This study describes the epidemiological profile, symptom pattern and outcome of patients admitted to the Belo Horizonte unit of the SARAH Network of Rehabilitation Hospitals from 1997 to 2018 with functional motor symptoms resulting from functional neurological disorder. Methods: This retrospective study reviewed data from 185 patients who met inclusion criteria for mFND. Diagnoses were made by multiple professionals in the presence of positive signs and excluding other neurological and systemic conditions. Results: 75.1% were women; 48.3% were receiving social security benefits. The youngest was 3 years old, the oldest 69. 23.8% were in wheelchairs, 77.2% had psychiatric disorders, 69.7% participated in rehabilitation programs and, among them, 70% improved. Conclusion: Participation in rehabilitation is beneficial for patients with mFND. Symptoms lasting for less than 30 days and aged less than 18 years had better outcomes (p<0.001).
RESUMO
Introdução: Alterações motoras decorrentes de Transtorno Neurológico Funcional (TNF) são comuns, incapacitantes e com prognóstico ruim. Não há protocolos de tratamento baseado em evidências. Esse estudo descreve o perfil epidemiológico, os sintomas e a evolução de pacientes com alterações motoras decorrentes de Transtorno Neurológico Funcional (TNF) admitidos na unidade de Belo Horizonte da Rede SARAH de Hospitais de Reabilitação no período de 1997 a 2018. Métodos: Este estudo retrospectivo analisou dados de 185 pacientes que atenderam aos critérios de inclusão para TNF. Os diagnósticos foram realizados por múltiplos profissionais considerando a presença de sinais positivos e a exclusão de outras condições neurológicas e sistêmicas. Resultados: 75,1% eram mulheres; 48,3% estavam recebendo benefícios previdenciários. O indivíduo mais jovem tinha 3 anos de idade, e o mais velho, 69 anos. 23,8% usavam cadeira de rodas, 77,2% apresentavam desordens psiquiátricas, 69,7% tinham participado do programa de reabilitação e, dentre esses, 70% apresentaram melhora dos sintomas. Conclusão: O processo de reabilitação é benéfico para pacientes com TNF. Pacientes menores de 18 anos de idade e com sintomas de evolução com duração inferior a 30 dias apresentaram melhores resultados no tratamento (p<0,001).
Palavras-chave:
Doenças do Sistema Nervoso - Transtorno Conversivo - Transtornos do Movimento - ReabilitaçãoPublication History
Received: 24 December 2019
Accepted: 16 January 2020
Article published online:
13 June 2023
© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Feinstein A. Conversion disorder. Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):861-72. https://doi.org/10.1212/CON.20200009202000090601
- 2 Espay AJ, Lang AE. Phenotype-specific diagnosis of functional (psychogenic) movement disorders. Curr Neurol Neurosci Rep. 2015 Jun;15(6):32. https://doi.org/10.1007/s11910-015-0556-y
- 3 Garcin B. Motor functional neurological disorders: an update. Rev Neurol (Paris). 2018 Apr;174(4):203-11. https://doi.org/10.1016/j.neurol.2017.11.003
- 4 Espay A, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, et al. Current concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2018 Sep 1;75(9):1132-41. https://doi.org/10.1001/jamaneurol.2018.1264
- 5 Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, et al. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain. 2009 Oct;132(Pt 10):2878-88. https://doi.org/10.1093/brain/awp220
- 6 Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, et al. Systematic review of the misdiagnosis of conversion symptoms and “hysteria”. BMJ. 2005 Oct;331(7523):989. https://doi.org/10.1136/bmj.38628.466898.55
- 7 Binzer M, Kullgren G. Motor conversion disorder. A prospective 2-to 5-year follow-up study. Psychosomatics. 1998 Nov-Dec;39(6):519-27. https://doi.org/10.1016/S0033-3182(98)71284-8
- 8 Crimlisk HL, Bhatia K, Cope H, David A, Marsden CD, Ron MA. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ. 1998 Feb;316(7131):582-6. https://doi.org/10.1136/bmj.316.7131.582
- 9 Anderson KE, Gruber-Baldini AL, Vaughan CG, Reich SG, Fishman OS, Weiner WJ, et al. Impact of psychogenic movement disorders versus Parkinson’s on disability, quality of life, and psychopathology. Mov Disord. 2007 Nov;22(15):2204-9. https://doi.org/10.1002/mds.21687
- 10 Heruti RJ, Levy A, Adunski A, Ohry A. Conversion motor paralysis disorder: overview and rehabilitation model. Spinal Cord. 2002 Jul;40(7):327-34. https://doi.org/10.1038/sj.sc.3101308
- 11 Hallett M, Stone J, Carson A, editors. Functional neurologic disorders. Amsterdam: Elsevier; 2016. (Handbook of Clinical Neurology; 3rd series, v. 139).
- 12 Gelauff J, Stone J. Prognosis of functional neurologic disorders. Handb Clin Neurol. 2016;139:523-41. https://doi.org/10.1016/B978-0-12-801772-2.00043-6
- 13 Nielsen G, Buszewicz M, Stevenson F, Hunter R, Holt K, Dudziec M, et al. Randomized feasibility study of physiotherapy for patients with functional motor symptoms. J Neurol Neurosurg Psychiatry. 2017 May;88:484-90. https://doi.org/10.1136/jnnp-2016-314408
- 14 Jordbru A, Smedstad LM, Klungsøyr O, Martinsen EW. Psychogenic gait disorder: A randomized controlled trial of physical rehabilitation with one-year follow-up. J Rehabil Med. 2014 Feb;46(2):181-7. https://doi.org/10.2340/16501977-1246
- 15 Batla A, Pareés I, Edwards MJ, Stamelou M, Bhatia KP, Panicker JN. Lower urinary tract dysfunction in patients with functional movement disorders. J Neurol Sci. 2016 Feb;361:192-4. https://doi.org/10.1016/j.jns.2015.12.048
- 16 Nielsen G, Stone J, Edwards MJ. Physiotherapy for functional (psychogenic) motor symptoms: a systematic review. J Psychosom Res. 2013 Aug;75(2):93-102. https://doi.org/10.1016/j.jpsychores.2013.05.006
- 17 Matthews A, Brown M, Stone J. Inpatient physiotherapy for functional (psychogenic) gait disorder: a case series of 35 patients. Mov Disord Clin Pract. 2016 Jan;3(6):603-6. https://doi.org/10.1002/mdc3.12325
- 18 Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol. 2016;139:543-553. https://doi.org/10.1016/B978-0-12-801772-2.00044-8