Chinese expert consensus on the diagnosis and treatment of functional movement disorder (second edition)

doi:10.3969/j.issn.1672-6731.2023.12.002

Abstract

Abstract:

Functional movement disorder (FMD) is a common category of dissociative/conversion disorder and has become representative disease spectrum of functional neurological disorder (FND) and an important branch of movement disorder diseases. In 2021, we introduced the Chinese expert consensus on the diagnosis and treatment of FMD domestically for the first time. With the progressively understanding of FMD and clinical experiences from FND-multi-disciplinary team (MDT), this article summarizes the research progress in FMD diagnosis and treatment over the past two years. Building upon the initial version, it provides a more detailed overview of FMD's epidemiology, pathophysiology, clinical manifestations, auxiliary examinations, diagnosis and differential diagnosis, treatment and prognosis, along with relevant recommended insights. The aim is to offer more specific diagnostic and therapeutic foundations for clinicians.

Key words: Conversion disorder, Motor disorders, Diagnostic and treatment guideline

摘要：

功能性运动障碍是一类常见的分离性/转换性障碍，已成为功能性神经系统疾病（以下简称功能性神经疾病）的代表性疾病谱系以及运动障碍疾病的最重要分支之一。2021年功能性运动障碍的诊断与治疗中国专家共识编写组发布首版《功能性运动障碍的诊断与治疗中国专家共识》。随着对功能性运动障碍认识的深入，共识编写组结合国内功能性神经疾病多学科诊疗模式门诊的设置及相关临床实践，纳入近2年最新临床研究进展，在首版基础上进一步详细阐明功能性运动障碍的流行病学、病因及病理生理学机制、临床表现、辅助检查、诊断与鉴别诊断、治疗及预后及其相关推荐意见，以期为疾病提供更具体的诊断与治疗依据，推动我国功能性运动障碍诊断与治疗水平的发展。

关键词: 转换障碍, 运动障碍, 诊疗指南

Chinese Expert Group on the Diagnosis and Treatment of Functional Movement. Chinese expert consensus on the diagnosis and treatment of functional movement disorder (second edition)[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(12): 1061-1071.

功能性运动障碍的诊断与治疗中国专家共识编写组. 功能性运动障碍的诊断与治疗中国专家共识(第二版)[J]. 中国现代神经疾病杂志, 2023, 23(12): 1061-1071.

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URL: http://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2023.12.002

http://journal11.magtechjournal.com/cjcnn/EN/Y2023/V23/I12/1061

Figures/Tables 2

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推荐强度	标准	证据等级	标准
Ⅰ级	证据或高度一致的专家共识认为治疗有效/获益	A级	证据来源于多个随机临床试验或高质量Meta分析
Ⅱ级	对治疗有效/获益的证据不一致	B级	证据来源于单个随机临床试验或未随机分组的大样本临床试验
Ⅱa级	倾向于认为治疗有效/获益	C级	证据来源于未经严格论证的专家意见、小样本临床研究或回顾性研究
Ⅱb级	治疗有效/获益待考证
Ⅲ级	证据或高度一致的专家共识认为治疗无效，甚至有害

推荐强度	标准	证据等级	标准
Ⅰ级	证据或高度一致的专家共识认为治疗有效/获益	A级	证据来源于多个随机临床试验或高质量Meta分析
Ⅱ级	对治疗有效/获益的证据不一致	B级	证据来源于单个随机临床试验或未随机分组的大样本临床试验
Ⅱa级	倾向于认为治疗有效/获益	C级	证据来源于未经严格论证的专家意见、小样本临床研究或回顾性研究
Ⅱb级	治疗有效/获益待考证
Ⅲ级	证据或高度一致的专家共识认为治疗无效，甚至有害

诊断	临床特点
可直接确诊(documented)	心理治疗(暗示或安慰剂治疗)后症状可持续缓解
可临床确诊(clinical established)	发作症状与已知的运动障碍典型症状不一致，每次发作症状不一致，以及出现下列情况之一：其他假性体征(如震颤、肌张力障碍、肌阵挛等)、多种躯体化症状、明显精神异常
实验室检查结果支持的确诊(laboratory-supported)^[58]	经电生理检测证实的功能性运动障碍(主要是功能性震颤、功能性肌阵挛、功能性抽动)
很可能诊断(probable)	发作症状与已知的运动障碍典型症状不一致，但无上述其他特征
有可能诊断(possible)	已存在心理障碍且症状可能是功能性的

诊断	临床特点
可直接确诊(documented)	心理治疗(暗示或安慰剂治疗)后症状可持续缓解
可临床确诊(clinical established)	发作症状与已知的运动障碍典型症状不一致，每次发作症状不一致，以及出现下列情况之一：其他假性体征(如震颤、肌张力障碍、肌阵挛等)、多种躯体化症状、明显精神异常
实验室检查结果支持的确诊(laboratory-supported)^[58]	经电生理检测证实的功能性运动障碍(主要是功能性震颤、功能性肌阵挛、功能性抽动)
很可能诊断(probable)	发作症状与已知的运动障碍典型症状不一致，但无上述其他特征
有可能诊断(possible)	已存在心理障碍且症状可能是功能性的

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[2]	Jin-tao WANG, Gang WANG. Functional dystonia: one case report [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(9): 850-852.
[3]	Pei HUANG, Gang WANG. Progress on diagnosis and treatment of functional parkinsonism [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(8): 738-741.
[4]	Ling YUE, Yu XU, Gang WANG. Functional parkinsonism: one case report [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(8): 742-744.
[5]	Qing-shuo ZHANG, Dan-dan SONG, Shi-yue ZHOU, Jin-lu ZHANG, Xiao-xu HAN, Shun-liang XU. Diagnosis and treatment of functional gait disorder [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 604-609.
[6]	Jing PAN, Gang WANG. Functional gait disorder: one case report [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 610-612.
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[11]	LI Juan, LI Yue-wen, CHEN Xian-wen. Adult-onset functional tremor: one case report [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(4): 356-358.
[12]	LI Wan-lin, GAO Yuan, MA Qin-ying, DING Yan, TIAN Shu-juan, WANG Hua-long. Progress in diagnosis and treatment of functional tremor [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(4): 351-355.
[13]	PAN Xiao-ling, WANG Gang. Diagnosis and treatment of functional facial disorders [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(3): 238-242.
[14]	WANG Jin-tao, WANG Gang. Classification and diagnostic criteria of functional neurological disorder [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(2): 138-142.
[15]	LI Zi-yi, FANG Kan, HUANG Xiao-jun, CAO Li. Advances on neural circuits of paroxysmal kinesigenic dyskinesia [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(2): 124-130.

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