The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders

Tommaso Ercoli; Christian Geroin; Enrico Marcuzzo; Angela Sandri; Luigi Michele Romito; Roberto Eleopra; Lucia Tesolin; Francesco de Bertoldi; Alessandra Nicoletti; Giovanni Mostile; Alessandro Padovani; Andrea Pilotto; Nicola Modugno; Enrica Olivola; Benedetta Demartini; Veronica Nisticò; Roberto Erro; Sofia Cuoco; Alessandro Tessitore; Rosa De Micco; Roberto Ceravolo; Eleonora Del Prete; Carlo Dallocchio; Carla Arbasino; Francesco Bono; Cataldo Mummolo; Marcello Esposito; Assunta Trinchillo; Giovanni Fabbrini; Gina Ferrazzano; Martina Petracca; Carla Piano; Laura Bonanni; Claudia Carrarini; Alberto Albanese; Carlo Alberto Artusi; Giovanni Defazio; Paola Caruso; Giovanna Calandra-Buonaura; Francesca Morgante; Antonio Pisani; Paolo Solla; Michele Tinazzi; Italian Registry of Functional Motor Disorders (IRFMD) study group

doi:10.1002/mdc3.70340

The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders

Tommaso Ercoli
, Christian Geroin
, Enrico Marcuzzo
, Angela Sandri
, Luigi Michele Romito
, Roberto Eleopra
, Lucia Tesolin
, Francesco de Bertoldi
, Alessandra Nicoletti
, Giovanni Mostile
, Alessandro Padovani
, Andrea Pilotto
, Nicola Modugno
, Enrica Olivola
, Benedetta Demartini
, Veronica Nisticò
, Roberto Erro
, Sofia Cuoco
, Alessandro Tessitore
, Rosa De Micco

Roberto Ceravolo, Eleonora Del Prete, Carlo Dallocchio, Carla Arbasino, Francesco Bono, Cataldo Mummolo, Marcello Esposito, Assunta Trinchillo, Giovanni Fabbrini, Gina Ferrazzano, Martina Petracca, Carla Piano, Laura Bonanni, Claudia Carrarini, Alberto Albanese, Carlo Alberto Artusi, Giovanni Defazio, Paola Caruso, Giovanna Calandra-Buonaura, Francesca Morgante, Antonio Pisani, Paolo Solla, Michele Tinazzi, Italian Registry of Functional Motor Disorders (IRFMD) study group

Bolzano Hospital

University of Sassari
University of Verona and University and Hospital Trust (AOUI) of Verona
Fondazione IRCCS Istituto Neurologico Carlo Besta
General Hospital Bolzano
University of Oulu, Universita di Verona, Ospedali Riuniti Trieste, University of Catania, University of Leicester, Centre Hospitalier Universitaire de Besancon, Karolinska Institutet, etc.
University of Brescia School of Medicine
IRCCS Neuromed
University of Milan-Bicocca
University of Milano-Bicocca
University of Salerno
University of Campania "Luigi Vanvitelli"
S.C. Neurologia e Stroke Unit
Center for Botulinum Toxin Therapy
Antonio Cardarelli Hospital
S. Paolo Hospital
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
University "G. d'Annunzio" of Chieti-Pescara
University San Raffaele and IRCCS San Raffaele
IRCCS Humanitas Clinical and Research Hospital
University "Aldo Moro" of Bari
City St George's University of London
Department of Molecular Medicine University of Pavia Pavia Italy

Research output: Contribution to journal › Original Article › peer-review

Abstract

BACKGROUND: Functional motor disorder (FMD) is a diagnosis of inclusion based on the presence of positive signs on clinical examination, and only a few tests are validated as biomarkers for FMD identification.

OBJECTIVES: The aim of this study was to assess the relative frequency of different types of conventional instrumental investigations (such as magnetic resonance imaging/computed tomography [MRI/CT] scan, dopamine transporter single-photon emission computed tomography (DaT-SPECT), electroencephalography (EEG), neurophysiological tests, and other tests) in FMD patients before diagnosis and to identify the clinical and demographic features associated with their use.

METHODS: Data were obtained from the Italian Registry of Functional Motor Disorders, a multicenter initiative involving patients with a diagnosis of clinically definite FMD. Patients were consecutively enrolled at 25 Italian centers during 2 phases. Data collection initially took place between September 2018 and August 2019, and during phase 2, between January 2020 and December 2022.

RESULTS: Among the 853 patients included during the 2 phases of the registry, we identified 794 patients (93.1%) who underwent 1 or more categories of conventional investigations. Overall, conventional investigations were more likely to be performed in older FMD patients (Odds ratio [OR]: 1.02; P = 0.013). Interestingly, we found that more than one category of investigation was more likely to be performed in FMD patients presenting with weakness (OR: 1.85; P = 0.002) and with additional functional symptoms (OR: 1.54; P = 0.026).

CONCLUSIONS: Our findings provide novel insights into the complex diagnostic process of FMD patients. This study highlights the need to identify reliable biomarkers that may help physicians diagnose FMD earlier and carefully select the most appropriate conventional investigations.

Original language	English
Pages (from-to)	2128-2142
Number of pages	15
Journal	MOVEMENT DISORDERS CLINICAL PRACTICE
Volume	12
Issue number	12
Early online date	Sept 2025
DOIs	https://doi.org/10.1002/mdc3.70340
Publication status	Published - Dec 2025

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10.1002/mdc3.70340

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Ercoli, T., Geroin, C., Marcuzzo, E., Sandri, A., Romito, L. M., Eleopra, R., Tesolin, L., de Bertoldi, F., Nicoletti, A., Mostile, G., Padovani, A., Pilotto, A., Modugno, N., Olivola, E., Demartini, B., Nisticò, V., Erro, R., Cuoco, S., Tessitore, A., ... Italian Registry of Functional Motor Disorders (IRFMD) study group (2025). The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders. MOVEMENT DISORDERS CLINICAL PRACTICE, 12(12), 2128-2142. https://doi.org/10.1002/mdc3.70340

@article{c096ec9b01e44d3286db073f1135f0ba,

title = "The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders",

abstract = "BACKGROUND: Functional motor disorder (FMD) is a diagnosis of inclusion based on the presence of positive signs on clinical examination, and only a few tests are validated as biomarkers for FMD identification.OBJECTIVES: The aim of this study was to assess the relative frequency of different types of conventional instrumental investigations (such as magnetic resonance imaging/computed tomography [MRI/CT] scan, dopamine transporter single-photon emission computed tomography (DaT-SPECT), electroencephalography (EEG), neurophysiological tests, and other tests) in FMD patients before diagnosis and to identify the clinical and demographic features associated with their use.METHODS: Data were obtained from the Italian Registry of Functional Motor Disorders, a multicenter initiative involving patients with a diagnosis of clinically definite FMD. Patients were consecutively enrolled at 25 Italian centers during 2 phases. Data collection initially took place between September 2018 and August 2019, and during phase 2, between January 2020 and December 2022.RESULTS: Among the 853 patients included during the 2 phases of the registry, we identified 794 patients (93.1\%) who underwent 1 or more categories of conventional investigations. Overall, conventional investigations were more likely to be performed in older FMD patients (Odds ratio [OR]: 1.02; P = 0.013). Interestingly, we found that more than one category of investigation was more likely to be performed in FMD patients presenting with weakness (OR: 1.85; P = 0.002) and with additional functional symptoms (OR: 1.54; P = 0.026).CONCLUSIONS: Our findings provide novel insights into the complex diagnostic process of FMD patients. This study highlights the need to identify reliable biomarkers that may help physicians diagnose FMD earlier and carefully select the most appropriate conventional investigations.",

author = "Tommaso Ercoli and Christian Geroin and Enrico Marcuzzo and Angela Sandri and Romito, \{Luigi Michele\} and Roberto Eleopra and Lucia Tesolin and \{de Bertoldi\}, Francesco and Alessandra Nicoletti and Giovanni Mostile and Alessandro Padovani and Andrea Pilotto and Nicola Modugno and Enrica Olivola and Benedetta Demartini and Veronica Nistic{\`o} and Roberto Erro and Sofia Cuoco and Alessandro Tessitore and \{De Micco\}, Rosa and Roberto Ceravolo and \{Del Prete\}, Eleonora and Carlo Dallocchio and Carla Arbasino and Francesco Bono and Cataldo Mummolo and Marcello Esposito and Assunta Trinchillo and Giovanni Fabbrini and Gina Ferrazzano and Martina Petracca and Carla Piano and Laura Bonanni and Claudia Carrarini and Alberto Albanese and Artusi, \{Carlo Alberto\} and Giovanni Defazio and Paola Caruso and Giovanna Calandra-Buonaura and Francesca Morgante and Antonio Pisani and Paolo Solla and Michele Tinazzi and \{Italian Registry of Functional Motor Disorders (IRFMD) study group\}",

note = "Lehr-KH General Hospital of Bolzano, Bolzano, Italy",

year = "2025",

month = dec,

doi = "10.1002/mdc3.70340",

language = "English",

volume = "12",

pages = "2128--2142",

journal = "MOVEMENT DISORDERS CLINICAL PRACTICE",

issn = "2330-1619",

publisher = "Wiley Verlag ",

number = "12",

}

Ercoli, T, Geroin, C, Marcuzzo, E, Sandri, A, Romito, LM, Eleopra, R, Tesolin, L, de Bertoldi, F, Nicoletti, A, Mostile, G, Padovani, A, Pilotto, A, Modugno, N, Olivola, E, Demartini, B, Nisticò, V, Erro, R, Cuoco, S, Tessitore, A, De Micco, R, Ceravolo, R, Del Prete, E, Dallocchio, C, Arbasino, C, Bono, F, Mummolo, C, Esposito, M, Trinchillo, A, Fabbrini, G, Ferrazzano, G, Petracca, M, Piano, C, Bonanni, L, Carrarini, C, Albanese, A, Artusi, CA, Defazio, G, Caruso, P, Calandra-Buonaura, G, Morgante, F, Pisani, A, Solla, P, Tinazzi, M & Italian Registry of Functional Motor Disorders (IRFMD) study group 2025, 'The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders', MOVEMENT DISORDERS CLINICAL PRACTICE, vol. 12, no. 12, pp. 2128-2142. https://doi.org/10.1002/mdc3.70340

TY - JOUR

T1 - The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders

AU - Ercoli, Tommaso

AU - Geroin, Christian

AU - Marcuzzo, Enrico

AU - Sandri, Angela

AU - Romito, Luigi Michele

AU - Eleopra, Roberto

AU - Tesolin, Lucia

AU - de Bertoldi, Francesco

AU - Nicoletti, Alessandra

AU - Mostile, Giovanni

AU - Padovani, Alessandro

AU - Pilotto, Andrea

AU - Modugno, Nicola

AU - Olivola, Enrica

AU - Demartini, Benedetta

AU - Nisticò, Veronica

AU - Erro, Roberto

AU - Cuoco, Sofia

AU - Tessitore, Alessandro

AU - De Micco, Rosa

AU - Ceravolo, Roberto

AU - Del Prete, Eleonora

AU - Dallocchio, Carlo

AU - Arbasino, Carla

AU - Bono, Francesco

AU - Mummolo, Cataldo

AU - Esposito, Marcello

AU - Trinchillo, Assunta

AU - Fabbrini, Giovanni

AU - Ferrazzano, Gina

AU - Petracca, Martina

AU - Piano, Carla

AU - Bonanni, Laura

AU - Carrarini, Claudia

AU - Albanese, Alberto

AU - Artusi, Carlo Alberto

AU - Defazio, Giovanni

AU - Caruso, Paola

AU - Calandra-Buonaura, Giovanna

AU - Morgante, Francesca

AU - Pisani, Antonio

AU - Solla, Paolo

AU - Tinazzi, Michele

AU - Italian Registry of Functional Motor Disorders (IRFMD) study group

N1 - Lehr-KH General Hospital of Bolzano, Bolzano, Italy

PY - 2025/12

Y1 - 2025/12

N2 - BACKGROUND: Functional motor disorder (FMD) is a diagnosis of inclusion based on the presence of positive signs on clinical examination, and only a few tests are validated as biomarkers for FMD identification.OBJECTIVES: The aim of this study was to assess the relative frequency of different types of conventional instrumental investigations (such as magnetic resonance imaging/computed tomography [MRI/CT] scan, dopamine transporter single-photon emission computed tomography (DaT-SPECT), electroencephalography (EEG), neurophysiological tests, and other tests) in FMD patients before diagnosis and to identify the clinical and demographic features associated with their use.METHODS: Data were obtained from the Italian Registry of Functional Motor Disorders, a multicenter initiative involving patients with a diagnosis of clinically definite FMD. Patients were consecutively enrolled at 25 Italian centers during 2 phases. Data collection initially took place between September 2018 and August 2019, and during phase 2, between January 2020 and December 2022.RESULTS: Among the 853 patients included during the 2 phases of the registry, we identified 794 patients (93.1%) who underwent 1 or more categories of conventional investigations. Overall, conventional investigations were more likely to be performed in older FMD patients (Odds ratio [OR]: 1.02; P = 0.013). Interestingly, we found that more than one category of investigation was more likely to be performed in FMD patients presenting with weakness (OR: 1.85; P = 0.002) and with additional functional symptoms (OR: 1.54; P = 0.026).CONCLUSIONS: Our findings provide novel insights into the complex diagnostic process of FMD patients. This study highlights the need to identify reliable biomarkers that may help physicians diagnose FMD earlier and carefully select the most appropriate conventional investigations.

AB - BACKGROUND: Functional motor disorder (FMD) is a diagnosis of inclusion based on the presence of positive signs on clinical examination, and only a few tests are validated as biomarkers for FMD identification.OBJECTIVES: The aim of this study was to assess the relative frequency of different types of conventional instrumental investigations (such as magnetic resonance imaging/computed tomography [MRI/CT] scan, dopamine transporter single-photon emission computed tomography (DaT-SPECT), electroencephalography (EEG), neurophysiological tests, and other tests) in FMD patients before diagnosis and to identify the clinical and demographic features associated with their use.METHODS: Data were obtained from the Italian Registry of Functional Motor Disorders, a multicenter initiative involving patients with a diagnosis of clinically definite FMD. Patients were consecutively enrolled at 25 Italian centers during 2 phases. Data collection initially took place between September 2018 and August 2019, and during phase 2, between January 2020 and December 2022.RESULTS: Among the 853 patients included during the 2 phases of the registry, we identified 794 patients (93.1%) who underwent 1 or more categories of conventional investigations. Overall, conventional investigations were more likely to be performed in older FMD patients (Odds ratio [OR]: 1.02; P = 0.013). Interestingly, we found that more than one category of investigation was more likely to be performed in FMD patients presenting with weakness (OR: 1.85; P = 0.002) and with additional functional symptoms (OR: 1.54; P = 0.026).CONCLUSIONS: Our findings provide novel insights into the complex diagnostic process of FMD patients. This study highlights the need to identify reliable biomarkers that may help physicians diagnose FMD earlier and carefully select the most appropriate conventional investigations.

U2 - 10.1002/mdc3.70340

DO - 10.1002/mdc3.70340

M3 - Original Article

C2 - 40898960

SN - 2330-1619

VL - 12

SP - 2128

EP - 2142

JO - MOVEMENT DISORDERS CLINICAL PRACTICE

JF - MOVEMENT DISORDERS CLINICAL PRACTICE

IS - 12

ER -

The Complex Pathway of Conventional Investigations before the Diagnosis of Functional Motor Disorders

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