Dataset Information

Gender Differences in Functional Movement Disorders.

ABSTRACT: Background:Functional neurological disorders are generally more common in females than males, but the reason for this gender difference is not well understood. Objectives:In this study, we aim to compare the clinical and demographic features of functional movement disorders (FMDs) between males and females. Methods:We examined clinical data and video-recordings of patients with FMDs evaluated at the Baylor College of Medicine Movement Disorders Clinic. Results:Of the 196 patients with FMDs, males represented only 30% (n = 59) of the entire cohort. Men had an older age at onset: 40.5 versus 34.1?years (P =?0.026) and an older age at evaluation: 43.8 versus 38.1?years (P =?0.041) compared to women. Functional dystonia was more frequently observed in women: 47.5 versus 20.3% (P

SUBMITTER: Baizabal-Carvallo JF

PROVIDER: S-EPMC7011817 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Gender Differences in Functional Movement Disorders.

Baizabal-Carvallo José Fidel JF Jankovic Joseph J

Movement disorders clinical practice 20191224 2

<h4>Background</h4>Functional neurological disorders are generally more common in females than males, but the reason for this gender difference is not well understood.<h4>Objectives</h4>In this study, we aim to compare the clinical and demographic features of functional movement disorders (FMDs) between males and females.<h4>Methods</h4>We examined clinical data and video-recordings of patients with FMDs evaluated at the Baylor College of Medicine Movement Disorders Clinic.<h4>Results</h4>Of the ...[more]

PMID: 32071937

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Project description:Introduction: Functional movement disorder (FMD) is a type of functional neurological disorder characterized by abnormal movements that patients do not perceive as self-generated. Prior imaging studies show a complex pattern of altered activity, linking regions of the brain involved in emotional responses, motor control, and agency. This study aimed to better characterize these relationships by building a classifier using a support vector machine to accurately distinguish between 61 FMD patients and 59 healthy controls using features derived from resting-state functional magnetic resonance imaging. Materials and Methods: First, we selected 66 seed regions based on prior related studies, then we calculated the full correlation matrix between them before performing recursive feature elimination to winnow the feature set to the most predictive features and building the classifier. Results: We identified 29 features of interest that were highly predictive of the FMD condition, classifying patients and controls with 80% accuracy. Several key features included regions in the right sensorimotor cortex, left dorsolateral prefrontal cortex, left cerebellum, and left posterior insula. Conclusions: The features selected by the model highlight the importance of the interconnected relationship between areas associated with emotion, reward, and sensorimotor integration, potentially mediating communication between regions associated with motor function, attention, and executive function. Exploratory machine learning was able to identify this distinctive abnormal pattern, suggesting that alterations in functional linkages between these regions may be a consistent feature of the condition in many FMD patients. Clinical-Trials.gov ID: NCT00500994 Impact statement Our research presents novel results that further elucidate the pathophysiology of functional movement disorder (FMD) with a machine learning model that classifies FMD and healthy controls correctly 80% of the time. Herein, we demonstrate how known differences in resting-state functional magnetic resonance imaging connectivity in FMD patients can be leveraged to better understand the complex pattern of neural changes in these patients. Knowing that there are measurable predictable differences in brain activity in patients with FMD may help both clinicians and patients conceptualize and better understand the illness at the point of diagnosis and during treatment. Our methods demonstrate how an effective combination of machine learning and qualitative approaches to analyzing functional brain connectivity can enhance our understanding of abnormal patterns of brain activity in FMD patients.

Project description:Background: Functional (psychogenic) movement disorders often have distinguishable clinical features in the orofacial region. Tonic mandibular deviation accompanying ipsilateral downward and lateral lip pulling is the most common phenotype seen in patients with facial functional movement disorders. However, functional movement disorders in the stomatognathic system are underrecognized. Objective: This study aimed to evaluate clinical characteristics and phenomenology in patients with functional movement disorders in the stomatognathic system. Methods: Ten-item inclusion criteria (point range: 0-10) for functional movement disorders in the stomatognathic system was produced, based on previously established criteria for functional movement disorders and general signs of functional facial dystonia, to determine subject inclusion. The criteria included inconsistency, incongruence, and paroxysm in symptoms; rapid onset; distractibility; suggestibility; static course; spreading to multiple sites; spontaneous remission; and lack of sensory tricks. Fifty-eight patients [42 women (72.4%), 16 men (27.6%); mean age: 46.2 years] scored over 7 points on the criteria and were included in further analyses. Characteristic features, including the pattern and site of abnormal movements, were assessed in clinical examination. Results: Frequent items in the scale were inconsistent symptoms (93.1%), incongruous symptoms (91.4%), spreading to multiple sites (89.7%), paroxysmal symptoms (86.2%), and lack of sensory tricks (81%). Sixty percent of patients exhibited a pattern resembling dystonia. Some patients had a combination of organic and functional disease. Common involuntary movements included jaw deviation (74.1%), jaw closing (50%), lip pulling (34.5%), and tongue movement (31%). A functional dystonia phenotype (unilateral lower lip pulling and jaw deviation) was observed in 26 patients (44.8%). Characteristic features of functional stomatognathic movement disorders were rapidly repeating mandibular (lateral or tapping) and tongue movements (27.6%), which fluctuated in speed and direction. Conclusion: In 58 patients with functional movement disorders in the stomatognathic system, the functional dystonia phenotype was observed in 44.8%. Furthermore, 27.6% of patients showed the most characteristic type of functional stomatognathic movement disorders: very fast repeated jaw and/or lingual movements.

Dataset Information

Gender Differences in Functional Movement Disorders.

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Gender Differences in Functional Movement Disorders.

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