#Functional neurological disorder manual
8 For these reasons, the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) now uses the term Functional Neurological Symptom Disorders instead of Psychogenic Neurological Disorders. 7 Second, because acceptance of the diagnosis is essential for successful treatment, the more descriptive term functional gait disorders is preferred over psychogenic gait disorder, which has a negative connotation for many patients. Indeed, psychological stressors are now considered only as risk factors and not as essential causative triggers. First, psychological distress is not always evident, 6 and functional gait disorders are often diagnosed in the absence of obvious precipitating stressors. 5įor several reasons, the term functional gait disorder is preferred over psychogenic gait disorder. 2, 3 When present together with other functional signs, proper recognition of a functional gait pattern is often very helpful in establishing the functional nature of the overall presentation, particularly when this is less obvious from the other neurologic signs. They are often seen together with other functional movement disorders, although pure functional gait disorders occur in approximately 6%–8.5% of patients with functional neurologic disorders. 4 However, many clinicians find these functional gait disorders difficult to diagnose.
2, 3 It is important to timely recognize the features of a functional gait as approximately 12% of patients across all neurologic disease categories have a functional overlay. Depending on the clinical setting, 2%–20% of patients referred to movement disorders outpatient clinics have a functional movement disorder, 1 and 40% of these patients have gait abnormalities without a structural lesion. For each group of signs, we highlight how specific clinical tests can bring out the inconsistencies and incongruencies that further point to a functional gait disorder.įunctional gait disorders are both common and disabling. We identify 7 groups of supportive gait signs that can signal the presence of functional gait disorders. To improve the diagnostic process, we present a sign-based approach-supported by videos-that incorporates the diverse clinical spectrum of functional gait disorders. A further complicating factor is that functional and organic gait disorders may coexist within the same patient.
Similarly, patients with dystonia or chorea can present with bizarre gait patterns that may falsely be interpreted as incongruity. Yet, these features also have potential pitfalls as inconsistency can occur in patients with dystonic gait or those with freezing of gait. It is therefore necessary to also look for inconsistency (variations in clinical presentation that cannot be reconciled with an organic lesion) and incongruity (combination of symptoms and signs that is not seen with organic lesions). However, these features can resemble and overlap with organic gait disorders. Establishing a diagnosis is based not primarily on excluding organic gait disorders but instead predominantly on recognizing positive clinical features of functional gait disorders, such as an antalgic, a buckling, or a waddling gait. The diagnosis is challenging because no single walking pattern is pathognomonic for a functional gait disorder. They are also usually disabling for affected individuals. Functional gait disorders are common in clinical practice.
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