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Inpatient Physiotherapy for Functional (Psychogenic) Gait Disorder: A Case Series of 35 Patients.

ABSTRACT: Patients with functional gait disorder (FGD) are often referred for physiotherapy, but data on their outcome is limited. The authors present a case series of 35 patients who received targeted physiotherapy for FGD at a regional neuroscience center (mean number of sessions, 11). Significant improvements in the Modified Rivermead Mobility Index (score range, 0-40) were recorded between pretreatment and posttreatment (mean pretreatment vs. posttreatment score, 20 vs. 37, respectively). Improvements also were seen in patients who had chronic symptoms, including those with symptom duration over 6 months (mean pretreatment vs. posttreatment score, 21 vs. 33, respectively) and in patients who had no psychological intervention. These data support the hypothesis that specific physiotherapy for FGD can be surprisingly effective and further encourage the development of larger randomized trials to test efficacy.

SUBMITTER: Matthews A

PROVIDER: S-EPMC6353326 | biostudies-literature | 2016 Nov-Dec

REPOSITORIES: biostudies-literature

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Inpatient Physiotherapy for Functional (Psychogenic) Gait Disorder: A Case Series of 35 Patients.

Matthews Audrey A Brown Melanie M Stone Jon J

Movement disorders clinical practice 20160129 6

Patients with functional gait disorder (FGD) are often referred for physiotherapy, but data on their outcome is limited. The authors present a case series of 35 patients who received targeted physiotherapy for FGD at a regional neuroscience center (mean number of sessions, 11). Significant improvements in the Modified Rivermead Mobility Index (score range, 0-40) were recorded between pretreatment and posttreatment (mean pretreatment vs. posttreatment score, 20 vs. 37, respectively). Improvements ...[more]

PMID: 30838253

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Project description:Synaptotagmin 1 (SYT1) is a critical mediator of fast, synchronous, calcium-dependent neurotransmitter release and also modulates synaptic vesicle endocytosis. This paper describes 11 patients with de novo heterozygous missense mutations in SYT1. All mutations alter highly conserved residues, and cluster in two regions of the SYT1 C2B domain at positions Met303 (M303K), Asp304 (D304G), Asp366 (D366E), Ile368 (I368T) and Asn371 (N371K). Phenotypic features include infantile hypotonia, congenital ophthalmic abnormalities, childhood-onset hyperkinetic movement disorders, motor stereotypies, and developmental delay varying in severity from moderate to profound. Behavioural characteristics include sleep disturbance and episodic agitation. Absence of epileptic seizures and normal orbitofrontal head circumference are important negative features. Structural MRI is unremarkable but EEG disturbance is universal, characterized by intermittent low frequency high amplitude oscillations. The functional impact of these five de novo SYT1 mutations has been assessed by expressing rat SYT1 protein containing the equivalent human variants in wild-type mouse primary hippocampal cultures. All mutant forms of SYT1 were expressed at levels approximately equal to endogenous wild-type protein, and correctly localized to nerve terminals at rest, except for SYT1M303K, which was expressed at a lower level and failed to localize at nerve terminals. Following stimulation, SYT1I368T and SYT1N371K relocalized to nerve terminals at least as efficiently as wild-type SYT1. However, SYT1D304G and SYT1D366E failed to relocalize to nerve terminals following stimulation, indicative of impairments in endocytic retrieval and trafficking of SYT1. In addition, the presence of SYT1 variants at nerve terminals induced a slowing of exocytic rate following sustained action potential stimulation. The extent of disturbance to synaptic vesicle kinetics is mirrored by the severity of the affected individuals' phenotypes, suggesting that the efficiency of SYT1-mediated neurotransmitter release is critical to cognitive development. In summary, de novo dominant SYT1 missense mutations are associated with a recognizable neurodevelopmental syndrome, and further cases can now be diagnosed based on clinical features, electrophysiological signature and mutation characteristics. Variation in phenotype severity may reflect mutation-specific impact on the diverse physiological functions of SYT1.

Project description:BackgroundDespite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients.MethodsPatients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse.Results49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self.ConclusionsThe present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.

Dataset Information

Inpatient Physiotherapy for Functional (Psychogenic) Gait Disorder: A Case Series of 35 Patients.

Publications

Inpatient Physiotherapy for Functional (Psychogenic) Gait Disorder: A Case Series of 35 Patients.

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