Positive signs from the history as an aid for early diagnosis in functional movement disorders: The prospective TASMAN study.

Autor: Lagrand TJ; Department of Neurology, University Medical Center Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands.; UMCG Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.; Department of Neurology, Alrijne Ziekenhuis, Leiderdorp, The Netherlands., Gelauff JM; Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands., Brusse-Keizer M; Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.; Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands., Lehn AC; Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.; Queensland University of Technology, Brisbane, Queensland, Australia., Tijssen MAJ; Department of Neurology, University Medical Center Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands.; UMCG Expertise Centre Movement Disorders Groningen, Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2025 Jan; Vol. 32 (1), pp. e16525. Date of Electronic Publication: 2024 Nov 21.
DOI: 10.1111/ene.16525
Abstrakt: Background and Purpose: There has been a concerted move in recent times to shift from an exclusionary to a positive diagnosis of functional movement disorders (FMDs). To date, most of the focus has been on defining positive physical signs. Here the focus was on the diagnostic specificity of specific symptoms and patient characteristics.
Methods: For this prospective cohort study, newly referred patients in the Netherlands and Australia were recruited before their first neurology appointment. Participants completed questionnaires within 2 months prior to their visit at one of the six different clinics. Directly following the first consultation, physicians received a questionnaire about their diagnostic process. Patients were excluded if the diagnosis was not a movement disorder. Univariate and multivariate regression analyses were conducted to identify predictors of FMDs. Subsequently, a predictive model was constructed and assessed using the area under the receiver operating curve.
Results: Between 1 March 2021 and 1 March 2023, 465 patients were eligible for inclusion, of whom 171 (37%) had an FMD and 294 (63%) a non-FMD. Distinguishing factors amongst these groups included age at onset, gender, history or family history of a functional and psychiatric disorder, sudden onset, specific triggers, fluctuation patterns throughout the day and over an extended period, pain, fatigue, depression, anxiety and dissociation. Using these, a predictive model was developed, yielding a discriminative accuracy of 88%.
Conclusion: Specific symptoms and patient characteristics have high diagnostic discriminative value between FMDs and non-FMDs, providing an additional tool in positive diagnosis.
(© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
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