Functional neurological disorders in Parkinson disease

Benjamin D. Wissel, Alok K. Dwivedi, Aristide Merola, Danielle Chin, Cara Jacob, Andrew P. Duker, Jennifer E. Vaughan, Lilia Lovera, Kathrin LaFaver, Ariel Levy, Anthony E. Lang, Francesca Morgante, Melissa Jill Nirenberg, Christopher Stephen, Nutan Sharma, Alberto Romagnolo, Leonardo Lopiano, Bettina Balint, Xin X. Yu, Kailash P. BhatiaAlberto J. Espay*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


Objective: To ascertain demographic and clinical features of Parkinson disease (PD) associated with functional neurological features. Methods: A standardised form was used to extract data from electronic records of 53 PD patients with associated functional neurological disorders (PD-FND) across eight movement disorders centres in the USA, Canada and Europe. These subjects were matched for age, gender and disease duration to PD patients without functional features (PD-only). Logistic regression analysis was used to compare both groups after adjusting for clustering effect. Results: Functional symptoms preceded or co-occurred with PD onset in 34% of cases, nearly always in the most affected body side. Compared with PD-only subjects, PD-FND were predominantly female (68%), had longer delay to PD diagnosis, greater prevalence of dyskinesia (42% vs 18%; P=0.023), worse depression and anxiety (P=0.033 and 0.025, respectively), higher levodopaequivalent daily dose (972±701 vs 741±559 mg; P=0.029) and lower motor severity (P=0.019). These patients also exhibited greater healthcare resource utilisation, higher use of [(123)I]FP-CIT SPECT and were more likely to have had a pre-existing psychiatric disorder (P=0.008) and family history of PD (P=0.036). Conclusions: A subtype of PD with functional neurological features is familial in one-fourth of cases and associated with more psychiatric than motor disability and greater use of diagnostic and healthcare resources than those without functional features. Functional manifestations may be prodromal to PD in one-third of patients.

Original languageEnglish (US)
Pages (from-to)566-571
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number6
StatePublished - Jun 2018

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery


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