Functional movement disorders: a paradigm shift (literature review)

Functional neurological disorders (FND) represent a group of pathologies in which the functioning of the nervous system is impaired. Recent advancements in research have led to a better understanding of the involved pathophysiological processes and the development of new strategies for early diagnosis. In particular, functional movement disorders (FMD) have benefited from updates to diagnostic criteria and management strategies. Aim of the Study: The aim of this research was to conduct a detailed review of the literature in order to analyze the clinical and diagnostic approach to FMD. Materials and Methods: The literature synthesis, carried out in accordance with PRISMA guidelines by two authors (OG, MC), included 47 articles published between 01/2020 and 06/2024 in English in PubMed-Medline and ResearchGate, supplemented with 7 relevant articles from citations/bibliographies. Results: FMD are pathophysiologically explained through a duality: defects in neurocircuitry involving selfagency, salience, and emotion processing systems, and psychosocial influences (predisposing, precipitating, and perpetuating factors). This paradigm shift has contributed to the development of new diagnostic tactics based on “rulein” criteria, supported by pillars such as incongruence, inconsistency, variability, and distractibility. It has also improved communication strategies with patients to ensure compliance. Additionally, a holistic management approach based on physical rehabilitation, psychotherapy, and pharmacological treatment when necessary, initiated as early as possible, is key to ensuring effective treatment and quality of life. Conclusions: Functional movement disorders represent a significant challenge in neurology, but recent advances in understanding the pathophysiological mechanisms and the adoption of “rule-in” diagnostic criteria have led to more effective treatments and better clinical outcomes. It is crucial for neurologists to adopt these new approaches to improve patient care and transform medical practice.