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Review of Functional movement disorder: An interdisciplinary case-based approach (LaFaver, Maurer, Nicholson, & Perez, 2022)

Functional movement disorder: An interdisciplinary case-based approach

Editors: Kathrin LaFaver, Carine W. Maurer, Timothy R. Nicholson, and David L. Perez

Series Editor: Daniel Tarsy, Current Clinical Neurology

Publisher: Humana Press

ISBN 978-3-030-86494-1

ISBN 978-3-030-86495-8 (eBook)

SSN 2524–4043 (electronic)

Functional neurologic symptom disorder is a condition that those of us working in neurorehabilitation may encounter but not necessarily always recognize. There has been a significant burgeoning of knowledge in this area over the last 20 years in the context of understanding underlying mechanisms, assessment and treatment of this important class of impairments. The critical need to differentiate functional neurological disorders which are often disabling from other types of impairments given differences in underlying mechanisms, prognosis and clinical treatment cannot be overstated. Although there has been a significant increase in literature and evidence-based medicine examining functional neurological disorders, there are few published texts on any aspect of this condition, nevermind specific aspects such as in the text being reviewed here on functional movement disorders (FMDs).

The editors of this volume published through Current Clinical Neurology are all well-known contributors to the literature in the area of FNDs and have assembled a diverse list of contributors and topics addressing this fascinating area of neurology and neurorehabilitation. The first 4 chapters of the book make up part 1 which is entitled “framework” and provides important perspectives on historical aspects of the disorder nicely presented by Dr. Kanaan. The next chapter by Dr. Hallet provides a very nice review of anatomy and FND pathophysiology in the context of a number of hypotheses regarding drivers for FNDs, which makes for interesting reading and suggests the underpinnings of FMD lay in a multi-network brain disorder. The next chapter by MacGillivray and Lidstone takes an interesting look at biopsychosocial aspects of FMD, and this is followed by a chapter delving into the integration of psychiatric and neurological perspectives of the disorder (authored by Anderson, Perez and Price).

The second part of the book deals with specific functional motor presentations as well as their occurrence in children and older adults. Many of the well-known functional motor disorders are discussed including limb weakness, dystonia, gait disorders, among others, in addition to functional facial disorders as well as speech and voice disorders. These chapters are all nicely laid out with clinical vignettes, details regarding key clinical features needed for differential diagnosis and management strategies. All the chapters are complemented by some high quality demonstrative photographs as well as summary tables. Although I found all these chapters quite informative, the chapter on functional speech and voice disorders was particularly intriguing given the common occurrence of stuttering that I encounter in my clinical practice working with persons following traumatic brain injury. The chapter by Adams and Perez in section 2 covers some interesting topics, albeit not always motor disorders per se, including functional seizures, somatosensory deficits, visual and auditory symptoms as well as cognitive impairment and PPPD (persistent postural perceptual dizziness). I would strongly concur with the authors cautionary notation that failure on validity measures is not synonymous with a functional cognitive disorder given the spectrum of conditions that can cause poor performance on such measures. In this chapter, the authors also discuss pain, fatigue and other physical symptoms as well as illness anxiety disorder. It is a very nice chapter in terms of pulling together a number of topics not otherwise discussed in the book.

The third part of the book deals with management and covers a vast array of different topics from communicating the diagnosis to interviewing techniques, treatment planning, psychological and psychiatric interventions as well as more traditional rehabilitation interventions. Interdisciplinary rehabilitation approaches discussed in chapter 26 are quite interesting and include a review of multidisciplinary rehabilitation program studies. What is lacking in this chapter is a discussion of inpatient versus various outpatient treatment formats and what might be preferred/most efficacious for addressing these types of problems, particularly given the frequent challenge of funding limitations when a payor interprets the diagnosis as a mental health one and not a neurological problem (i.e., medical problem). The other chapters in this section cover a variety of topics from the role of placebos to neuromodulation, symptom monitoring, dealing with treatment obstacles and managing pediatric FMDs. The last chapter focuses on considerations in choosing a career in functional movement disorders. It is a “different chapter” in that each of the editors provides personal opinions about their history in the field and experiences and commitment to working with patients with functional movement disorders.

Overall, the text is an excellent contribution to the field of neurology and neurorehabilitation. I would recommend that in the next edition, the editors consider including chapters on neurodiagnostic findings in functional movement disorders and their role in clinical assessment and management. There is historical literature on abreaction and narcosynthesis that is not addressed in the text which would be interesting in the context of reviewing what, if any, role in modern day medicine drug assisted interviews may have in the assessment and management of this class of disorders. Lastly, as a board-certified physiatrist and subspecialist in brain injury medicine, I would suggest to seek Physiatric authorship contribution in future editions given our frequent interface with this group of patients and the fact that Physiatrists often manage these types of patients. Clearly, it is of utmost importance to educate all clinicians involved with this special group of patients.

I would highly recommend the book to all physicians and clinicians working with this patient population or having the potential to encounter them so that they are appropriately identified early on in their disease course, provided with appropriate diagnoses, and ultimately with the correct treatments.


Founder, CEO & CMO, Concussion Care Centre of Virginia, Ltd.

Medical Director, Tree of Life

Professor, affiliate, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia

Professor, Visiting, Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia

Vice-Chairperson, IBIA

Chair Emeritus, IBIA