Functional Motor Symptoms in Parkinson’s Disease and Functional Parkinsonism: A Systematic Review
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Eligibility Criteria
Search Strategy
Study Selection
Results
Functional Neurological Symptoms in PD (PD-FND)
Study | N | Age at evaluation (years) | Women | Duration of symptoms (years) | FND onset compared with PD diagnosis | Psychiatric history | Stress factor identified | Nuclear imaging | L-dopa equivalence | FND phenotype | Side of FND compared with side most affected by PD | Comments | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | ||||||||||||
Lang et al. (5) | 1 | 38 | 0 | — | 6 | Before | Depression | Job-related conflict | F-DOPA PET scan abnormal L>R | NA | Hypoesthesia, give-way weakness, gait (dragging leg), tremor | Ipsilateral | Improved with haloperidol 1 mg/day |
Gaig et al. (13) | 1 | 50 | 0 | — | 6 | NA | Anxiety, depression, and suicide attempt | Marital discord and work incapacity | DaT-SCAN (123I) abnormal | 325 mg/d | Functional parkinsonism | NA | Parkin gene mutation |
Benaderette et al. (3) | 5 | 46.2 | 2 | 40 | 8 | NA | Depression, 20%; anxiety, 20%; personality disorder | 60% total (fall at work and litigation, 40%; disability pension, 20%) | DaT-SCAN (123I) abnormal, 100% | L-dopa for 2 of 5 at 600 mg/d | Functional parkinsonism, 100%; atypical tremor, 100% | NA | Beneficial effect of L-dopa treatment in 1 of 2; use of EMG-accelerometry to document FND diagnosis |
Felicio et al. (6) | 2 | 38.5 | 1 | 50 | 6 | NA | NA | NA | DaT-SCAN (99mTC) abnormal, 100% | 1,000 mg/d | Functional parkinsonism, 100% | NA | No response to L-dopa treatment in 2 of 2 |
Onofrj et al. (1) | 37 | 71.2 | 18 | 49 | NA | Before or at the time of PD in 33 (89.2%) | NA | NA | DaT-SCAN abnormal, 100% | 424 mg/d | Paresis, 62%; abnormal posture, 32%; functional parkinsonism, 5%; catatonia, 24% | NA | |
Baik (34) | 1 | 65 | 1 | 100 | 1 | NA | Depression | 100% (son in vegetative state) | [18F]-FP-CICT PET abnormal | NA | Gait disturbance | NA | |
Pareés et al. (8) | 11 | 55.4 | 7 | 63.7 | 5.27 | Before in five (45.5%); after in four (36.4%); unknown in 2 (18.1) | Depression, 27.2%; anxiety, 18.1% | NA | DaT-SCAN (123I) abnormal, 100% | NA | Tremor, 63.6%; dystonia, 9%; gait disorder, 27.7% | Ipsilateral, 72.7%; contralateral, 9%; symmetrical, 18% | Authors proposed that common mechanisms are involved in PD and FND |
Umeh et al. (18) | 2 | 37.5 | 1 | 50 | 3.0 | NA | NA | NA | DaT-SCAN (123I) abnormal, 100% | L-dopa for 1 of 2 at 350 mg/d | Tremor, 100% | Ipsilateral, 100% | |
Colosimo (33) | 1 | 62 | 0 | — | 2.0 | After | None | 100% (stress at work) | DaT-SCAN abnormal L>R | 300 mg/d | Tremor | Ipsilateral | PD diagnosed 2 years before FND onset |
Erro et al. (11) | 1 | 60 | 0 | — | 7.0 | After | None | None | DaT-SCAN abnormal | 150 mg/d | Tremor, hypokinesia, gait disturbance | Bilateral worsening | L-dopa induced OFF; PD was diagnosed 4 years before FMD onset |
Wissel et al. (2) | 53 | 61.9 | 36 | 68 | 9.4 | Before in 14 (26%); at the time of PD in four (8%); after in 30 (57%); unknown in five (9%) | Psychiatric history in 67.3% (disorders not specified) | Current psychiatric disease (not defined), 84.9% | DaT-SCAN (123I) for 31 (58.5%), all abnormal | 971.9 mg/d | Association, 60%; gait disorder, 40%; tremor, 40%; dyskinesia, 25%; nonmotor symptoms, 25%; functional parkinsonism, 21%; dystonia, 15%; speech impairment, 11%; myoclonus, 6% | Ipsilateral, 40%; contralateral, <5%; symmetrical, 40%; NA, 20% | Study compared PD-FND patients to sex-, gender-, and age-matched PD patients |
Frasca Polara et al. (4) | 6 | 39 | 3 | 50 | 2.8 | Before in four (66.7%); after in two (33.3%) | Depression, 83.3%; anxiety, 33.3%; personality disorder, 16.6%; chronic pain syndrome, 16.6% | NA | DaT-SCAN abnormal, 33.3%; [18F]-FP-CICT abnormal, 66.7% | NA | Tremor, 66.6%; hypokinesia, 33.3%; gait disturbance, 33.3%; hypertonia fluctuation, 33.3% | Ipsilateral, 83%; symmetrical, 17% | — |
Total | 121 | 61.3 | 69 | 57 | 7.8 | Before or at the time of PD in 61/99 (61.6%) | Psychiatric history for 48/80 (60%); depression in 44.4% (12/27) | Stress factor identified in 52/63 (82.5%) | Available in 99/121, all abnormal | — | — | Ipsilateral in 38/76 (50%); symmetrical in 25/76 (32.9%); contralateral in 13/76 (17.1%) | — |
FP
Study | N | Age at evaluation (years) | Women | Duration (years) | Onset (%) | Psychiatric history | Stress factor identified | FP phenotype | FP diagnosis | Positive response to L-dopa treatment | Comments | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | Progressive | abrupt | ||||||||||
Walters et al. (19) | 1 | 64 | 0 | — | 3 | 100 | 0 | NA | NA | Dragging right then left leg; rest, action, and intention tremor; atypical gait | Clinical diagnosis | L-dopa-treatment for 1/1; positive response in 0 | Spontaneous complete resolution at 1-year follow-up |
Lang et al. (5) | 13 | 48.5 | 7 | 53.8 | 5.29 | 23.1 | 61.5 | Depression, 38.5%; conversion disorder, 30.8%; other psychiatric history, 7.7%; unclear, 15.4%; no psychiatric history 15.4% | Physical injury or illness, 46.2%; work injury, 15.4%; others stress factors, 15.4%; death in family, 7.7%; NA, 15.4% | Tremor, 84.6%; rigidity, 46.2%; bradykinesia, 100%; unusual or bizarre gait, 23.1%; weakness, 69.2% | Clinical diagnosis in 6/13; F-DOPA PET scan for 7/13, all normal | L-dopa-treatment for 5/13; positive response in 3 | One additional patient had abnormal fluoro-dopa SPECT and was reclassified as PD-FND |
Factor et al. (21) | 2 | 53.5 | 1 | 50 | 6 | 100 | 0 | Posttraumatic stress disorder, 50%; past suicide attempts, 50%; alcohol abuse | 50% (after caring for chronically ill parents) | Give-way weakness in 1; distractibility in 2/2 | NA | NA | Over 842 consecutive patients with movement disorders; 28 had functional movement disorder; 2 had FP (0.2%) |
Booij et al. (42) | 4 | NA | NA | NA | NA | NA | NA | NA | NA | NA | [123I]FP-CIT SPECT, 100% normal | NA | — |
Gaig et al. (13) | 8 | 54.2 | 5 | 62.5 | 6.1 | 50 | 50 | Depression, 75%; conversion disorder, 25%; anxiety, 12.5% | Surgery, 25%; neck injury, 12.5%; total, 37.5% | Rest or kinetic or postural tremor in all; distractibility in 6/8; voluntary resistance in 3/8; slowness in all; abnormal gait in 4/8; inexpressive face in 6/8 | [123I]SPECT, 100% normal | L-dopa-treatment for 8/8; positive response in 0 | One additional patient had an abnormal 123I SPECT, leading to detection of Parkin gene mutation, and was reclassified as PD-FND |
Benaderette et al. (3) | 4 | 54.5 | 2 | 50 | 5.5 | 75 | 25 | Depression, 50%; bipolar disorder, 25%; personality disorder, 25% | Death in family, 25%; surgery, 25%; litigation, 25% | False neurological signs in all; bizarre rigidity in 3/4; atypical tremor in 2/4 | [123I]SPECT, 100% normal | L-dopa-treatment for 4/4; positive response in 1 | All had EMG and polygraphic recording |
Felicio et al. (6) | 3 | 36.6 | 1 | 33 | 3.1 | NA | 66.6 | NA | NA | Tremor distractibility in 2/3; false hemiparesis in 2/3; voluntarily induced slowness in 1/3; bizarre retropulsion without fall in 1/3 | 99mTC, 100% normal | NA | Patients were compared with PD patients and healthy controls |
Jankovic (7) | 32 | 48 | 17 | 53.1 | 5.2 | 18.8 | 81.2 | 56% had a history (depression most frequent) | Job-related stress, 34%; personal life stress, 13%; physical trauma, 13%; combination of multiple stress factors, 41% | NA | NA | NA | Family history of PD present in 9/32 (28%) |
Pourfar et al. (23) | 2 | 47 | 2 | 10.0 | 8.5 | NA | NA | NA | NA | Left hand rest tremor; dragging left leg | F-DOPA PET scan, 100% normal; FDG-PET scan, 100% qualitatively normal on visual inspection | L-dopa-treatment for 2/2; Motor fluctuations and dyskinesia after 5 years for 1/2 | FDG-PET scans compared for 25 PD patients, 23 multiple system atrophy patients, and 25 healthy controls. Case 1: increased regional metabolic activity in cerebellum and motor cortex, no change in basal ganglia. Case 2: increased regional metabolic activity in cerebellum with no change in motor cortex or basal ganglia |
Umeh et al. (18) | 1 | 41 | 0 | — | 1 | NA | NA | NA | NA | Foot dystonia and right arm tremor; tremor semipurposeful, variability in frequency, distractible, and decrease in amplitude when opposite side of the body was examined; oppositional rigidity in lower extremities; deliberate slowness on finger taps | [123I]FP-CIT SPECT normal | L-dopa 600m g/d+entacapone 800mg/d with no benefit | |
Sage and Mark (20) | 36 | 51.5 | 28 | 77.7 | <1 year for 14; 1–<5 years for 14; 5–10 years for 4; >10 years for 4 | 83.4 | 16.6 | Depression, 58.3%; anxiety, 38.9% | 22.2% of sample (not specified) | Rest tremor in 8/36; postural and action tremor in 8/36; postural and rest tremor in 6/36; gait disturbance in 20/36 | NA | L-dopa for 7/36; positive response information NA | At least 10 patients had family history of parkinsonism; 5 patients worked in health care |
Bonnet et al. (22) | 1 | 37 | 1 | 100 | 6 | 0 | 100 | None had a history of psychiatric disorder; mild anxiety and depression according to HADS upon evaluation | None | Rapid-onset tremor; slowness of right hemibody; dream-enacting behaviors | First DaT-SCAN considered positive, control normal | Partial response, but L-dopa agonist induced impulse control disorders | Efficacy suprathreshold repeated transcranial magnetic stimulation |
Langevin et al. (36) | 1 | 60 | 0 | — | 5 | NA | NA | NA | NA | Right upper extremity tremor | DaT-SCAN (123I) normal | L-dopa-treatment for 1/1; positive response in 0 | Underwent deep brain stimulation |
Taylor et al. (41) | 5 | 54.4 | 3 | 60 | 0.72 | NA | NA | Depression, 60% | NA | NA | [123I]FP-CIT SPECT imaging normal | NA | Comparison with PD patients and healthy controls |
Frasca Polara et al. (4) | 6 | 57.4 | 5 | 83.3 | 5.4 | NA | 16.7 | Depression, 83.3% | NA | Tremor entrainment in 1/6; distractibility in 4/6; variability in 4/6; hypokinesia without decrement in 2/6; gegenhalten in 2/6 | DaT-SCAN for 5/6, all normal; clinical diagnosis for 1/5 | L-dopa treatment for four; positive response in 3/4 | FP represented 0.24% of patients with parkinsonism |
Kumar and Kumar (35) | 1 | 76 | 0 | — | 6 | 0 | 100 | None | NA | Bilateral upper and lower limb tremor with an unsteady gait and slowness of movements; unusual blend of rest, postural, and action tremor of both upper and lower limbs; variability and distractibility of tremor | Clinical diagnosis | L-dopa-treatment for 1/1; positive response in 0 | |
Total | 120 | 50.7 | 72 | 62.1 | 5.03 | 50 | 50 | Psychiatric history, 67.6%; depression, 55.2% | 46.8% | Tremor found in 72.2% | DaT-SCAN for 38 patients, all normal; clinical diagnosis for 12 patients; NA for 70 patients | — |
Discussion
Main Results Regarding PD-FND
Main Results Regarding FP
FP and Functional Neurological Symptoms in PD
Limitations
Conclusions
Supplementary Material
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