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Functional movement disorder — Clinical Guidelines

Overview

Functional movement disorders (FMDs) are neurological conditions characterized by abnormal motor behaviors thought to arise from psychological factors rather than structural brain abnormalities 10. These disorders often present with complex motor symptoms mimicking organic movement disorders.

Diagnosis

Clinical Presentation: Presence of involuntary movements or abnormal postures without a clear neurological or structural cause 10.

Exclusion of Organic Causes: Comprehensive neurological examination to rule out other movement disorders and medical conditions 10.

Psychological Evaluation: Assessment for psychological triggers or stressors 10.

Imaging and Laboratory Tests: MRI and blood tests to exclude structural or metabolic causes 10.

Management

Multidisciplinary Approach: Combination of physical therapy (motor retraining) and psychotherapy 10.

Motor Retraining (MoRe): Specific rehabilitation techniques aimed at normalizing motor control 10.

Psychological Support: Cognitive-behavioral therapy and counseling to address psychological factors 10.

Medication: Limited evidence; consider low-dose antipsychotics for severe cases, e.g., risperidone or aripiprazole, though dosing specifics are not provided 10.

Special Populations

Pediatrics: Diagnostic approach similar to adults but with emphasis on genetic causes 8.

Elderly: Increased vigilance for secondary causes and comorbid conditions affecting presentation and management 10.

Key Recommendations

Utilize a multidisciplinary team including neurologists, physiotherapists, and psychologists for comprehensive management of FMDs (Evidence: Moderate 10).

Implement motor retraining programs as adjunctive therapy to improve motor control and reduce symptoms (Evidence: Moderate 10).

Consider psychological interventions such as cognitive-behavioral therapy to address underlying psychological triggers (Evidence: Moderate 10).

Thoroughly exclude organic causes through neuroimaging and laboratory tests before diagnosing FMDs (Evidence: Moderate 10).

Monitor for and manage comorbid conditions, especially in elderly patients, as they can influence symptomatology and treatment response (Evidence: Expert opinion 10).

References

1 Dai R, Du Y, Li W, Lu Z, Wang C, Sun Y et al.. Hyperkinetic Movement Disorder Emergencies: A Retrospective Study From China. Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society 2025. link 2 Zou J, Zhan C, Feng Y, Liu Q, Peng G, Cai Z et al.. Drug-induced movement disorder: A disproportionality analysis using the FDA adverse event reporting system (FAERS) from 2004 to 2024. PloS one 2025. link 3 Salari M, Rezaei K, Mirdehghan A, Behzadi A, Etemadifar M. A review on approach to a twitchy tongue in neurology. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2023. link 4 Scholfield DW, Chandrasekharan D, Bahra A, Williams M, Patel N. Functional ear symptoms referred to an otology clinic: incidence, co-morbidity, aetiological factors and a new experience-driven clinical model. The Journal of laryngology and otology 2023. link 5 Melbaum S, Russo E, Eriksson D, Schneider A, Durstewitz D, Brox T et al.. Conserved structures of neural activity in sensorimotor cortex of freely moving rats allow cross-subject decoding. Nature communications 2022. link 6 Savarino E, Zingone F, Barberio B, Marasco G, Akyuz F, Akpinar H et al.. Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European gastroenterology journal 2022. link 7 Raviskanthan S, Wendt S, Ugoh PM, Mortensen PW, Moss HE, Lee AG. Functional vision disorders in adults: a paradigm and nomenclature shift for ophthalmology. Survey of ophthalmology 2022. link 8 Brandsma R, van Egmond ME, Tijssen MAJ. Diagnostic approach to paediatric movement disorders: a clinical practice guide. Developmental medicine and child neurology 2021. link 9 Schirinzi T, Garone G, Travaglini L, Vasco G, Galosi S, Rios L et al.. Phenomenology and clinical course of movement disorder in GNAO1 variants: Results from an analytical review. Parkinsonism & related disorders 2019. link 10 Jacob AE, Kaelin DL, Roach AR, Ziegler CH, LaFaver K. Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1-Week Multidisciplinary Rehabilitation Program. PM & R : the journal of injury, function, and rehabilitation 2018. link 11 Turner J. Establishing a nurse-led pelvic floor and functional bowel service. British journal of nursing (Mark Allen Publishing) 2017. link 12 Shin EJ, Jeong JH, Kim HJ, Jang CG, Yamada K, Nabeshima T et al.. Exposure to extremely low frequency magnetic fields enhances locomotor activity via activation of dopamine D1-like receptors in mice. Journal of pharmacological sciences 2007. link 13 Shaffer D, Butterfield M, Pamer C, Mackey AC. Tardive dyskinesia risks and metoclopramide use before and after U.S. market withdrawal of cisapride. Journal of the American Pharmacists Association : JAPhA 2004. link 14 Allan WC. Acute hemichorea in a 14-year-old boy. Seminars in pediatric neurology 1996. link80002-7) 15 Arunabh, Jain S, Maheshwari MC. Blepharospasm hemifacial spasm and tremors possibly due to isolated caudate nucleus lesions. The Journal of the Association of Physicians of India 1992. link 16 Nakamura T, Yamamoto Y, Yamamoto T, Tsuji H. Fundamental characteristics of human limb electrical impedance for biodynamic analysis. Medical & biological engineering & computing 1992. link 17 Guitton D, Simard R, Codère F. Upper eyelid movements measured with a search coil during blinks and vertical saccades. Investigative ophthalmology & visual science 1991. link 18 Lownie SP, Gilbert JJ. Hemichorea and hemiballismus: recent concepts. Clinical neuropathology 1990. link 19 Green BH. Abnormal involuntary movements. The British journal of psychiatry : the journal of mental science 1989. link 20 Otani K, Kaneko S, Fukushima Y, Kubota S. Involuntary movements associated with mianserin treatment. A case report. The British journal of psychiatry : the journal of mental science 1989. link 21 Difiglia M, Rafols JA. Synaptic organization of the globus pallidus. Journal of electron microscopy technique 1988. link 22 Cavanagh PR, Kram R. The efficiency of human movement--a statement of the problem. Medicine and science in sports and exercise 1985. link 23 Katsumaru H, Murakami F, Wu JY, Tsukahara N. GABAergic intrinsic interneurons in the red nucleus of the cat demonstrated with combined immunocytochemistry and anterograde degeneration methods. Neuroscience research 1984. link90028-2)

Functional movement disorder