Functional Movement Disorders and Deep Brain Stimulation: A Multi‐Center Study
Luca Marsili, Elizabeth G. Keeling, Ricardo Maciel, Maria Fiorella Contarino, Rodi Zutt, Michael S. Okun, Leonardo Almeida, Wissam Deeb, Drew S. Kern, Daniel Macías‐García, Fátima Carrillo, Pablo Mir, Aristide Merola, Alberto J. Espay, Alfonso Fasano
Abstract
Background: Functional movement disorders (FMD) are a commonly under-recognized diagnosis in patients with underlying neurodegenerative diseases. FMD have been observed in patients undergoing deep brain stimulation (DBS) for Parkinson's disease (PD) and other movement disorders. The prevalence of coexisting FMD among movement disorder-related DBS patients is unknown, and it may occur more often than previously recognized. Methods: We retrospectively assessed the relative prevalence and clinical characteristics of FMD occurring post-DBS, in PD and dystonia patients (FMD+, n = 29). We compared this cohort with age at surgery-, sex-, and diagnosis-matched subjects without FMD post-DBS (FMD-, n = 29). Results: Both the FMD prevalence (0.2%-2.1%) and the number of cases/DBS procedures/year varied across centers (0.15-3.65). A total of nine of 29 FMD+ cases reported worse outcomes following DBS. Although FMD+ and FMD- manifested similar features, FMD+ showed higher psychiatric comorbidity. Conclusions: DBS may be complicated by the development of FMD in a subset of patients, particularly those with pre-morbid psychiatric conditions.