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儿童和青少年期的功能性运动障碍
Functional movement disorders in children and adolescents
功能性运动障碍（FMDs）也称心因性运动障碍（PMDs），与其他功能性神经疾病类似，FMDs应被视为一种生物-心理-社会性疾病，而并非仅仅是心理或精神疾病。FMDs病因包括神经生物学变化，如大脑激活模式异常以及边缘系统和运动网络之间的连接异常。遗传和表观遗传学机制，如DNA甲基化、灰质和白质形态发育的改变可能影响FMDs的发生。FMDs在儿科门诊并不少见，其临床表现形式复杂多样，是最具挑战性的运动障碍之一。由于临床认识不足，目前缺乏统一的诊断标准，使儿科医生诊断FMDs存在困难，容易与其他疾病混淆。儿科医生应该更多关注FMDs患儿，并与精神科医生、发育行为学专家和物理治疗师组成多学科团队，使FMDs患儿得到更积极地管理和治疗。
Functional movement disorders (FMDs), also known as psychogenic movement disorders (PMDs), should be considered a biological-psychological-social disease like other functional neurological diseases. It is not merely a psychological or mental disease. The etiology of FMDs includes neurobiological changes, such as abnormal patterns of cerebral activation and abnormal connectivity between the limbic system and the motor networks. Inheritance and epigenetic machinery, such as DNA methylation and changes in grey and white matter morphology, may influence the development of FMDs. FMDs are not rare in the outpatient service of pediatrics and are one of the most challenging movement disorders due to complex and diversified clinical manifestations. Due to a lack of clinical knowledge and unified diagnostic criteria, it is difficult for pediatricians to make a correct diagnosis of FMDs, which may be easily confused with other diseases. Pediatricians should pay more attention to children with FMDs and establish a multidisciplinary team with psychiatrists, specialists in developmental behavior, and physiotherapists, so as to provide active management and treatment for such children.
Functional movement disorders / Psychogenic movement disorders / Child / Adolescent
[1] Thenganatt MA, Jankovic J. Psychogenic movement disorders[J]. Neurol Clin, 2015, 33(1):205-224.
[2] Hallett M. Functional (psychogenic) movement disorders-clinical presentations[J]. Parkinsonism Relat Disord, 2016, 22(Suppl 1):S149-S152.
[3] Ertan S, Uluduz D, Ozekmekçi S, et al. Clinical characteristics of 49 patients with psychogenic movement disorders in a tertiary clinic in Turkey[J]. Mov Disord, 2009, 24(5):759-762.
[4] Dale RC, Singh H, Troedson C, et al. A prospective study of acute movement disorders in children[J]. Dev Med Child Neurol, 2010, 52(8):739-748.
[5] Kamble N, Prashantha DK, Jha M, et al. Gender and age determinants of psychogenic movement disorders:a clinical profile of 73 patients[J]. Can J Neurol Sci, 2016, 43(2):268-277.
[6] Goraya JS. Acute movement disorders in children:experience from a developing country[J]. J Child Neurol, 2015, 30(4):406-411.
[7] Gendre T, Carle G, Mesrati F, et al. Quality of life in functional movement disorders is as altered as in organic movement disorders[J]. J Psychosom Res, 2019, 116:10-16.
[8] Harris SR. Psychogenic movement disorders in children and adolescents:an update[J]. Eur J Pediatr, 2019, 178(4):581-585.
[9] Epstein SA, Maurer CW, LaFaver K, et al. Insights into chronic functional movement disorders:the value of qualitative psychiatric interviews[J]. Psychosomatics, 2016, 57(6):566-575.
[10] Ferrara J, Jankovic J. Psychogenic movement disorders in children[J]. Mov Disord, 2008, 23(13):1875-1881.
[11] Espay AJ, Maloney T, Vannest J, et al. Dysfunction in emotion processing underlies functional (psychogenic) dystonia[J]. Mov Disord, 2018, 33(1):136-145.
[12] Espay AJ, Maloney T, Vannest J, et al. Impaired emotion processing in functional (psychogenic) tremor:a functional magnetic resonance imaging study[J]. Neuroimage Clin, 2017, 17:179-187.
[13] Zhang X, Ge TT, Yin G, et al. Stress-induced functional alterations in amygdala:implications for neuropsychiatric diseases[J]. Front Neurosci, 2018, 12:367.
[14] Dreissen YEM, Boeree T, Koelman JHTM, et al. Startle responses in functional jerky movement disorders are increased but have a normal pattern[J]. Parkinsonism Relat Disord, 2017, 40:27-32.
[15] Maurer CW, LaFaver K, Ameli R, et al. Impaired self-agency in functional movement disorders:a resting-state fMRI study[J]. Neurology, 2016, 87(6):564-570.
[16] Harms KC, Kapitza KP, Pahl L, et al. Association of TNF-α polymorphism rs1800629 with multisomatoform disorder in a group of German patients and healthy controls:an explorative study[J]. Cytokine, 2013, 61(2):389-393.
[17] McGowan PO, Sasaki A, D'Alessio AC, et al. Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse[J]. Nat Neurosci, 2009, 12(3):342-348.
[18] Frodl T, Szyf M, Carballedo A, et al. DNA methylation of the serotonin transporter gene (SLC6A4) is associated with brain function involved in processing emotional stimuli[J]. J Psychiatry Neurosci, 2015, 40(5):296-305.
[19] Apazoglou K, Adouan W, Aubry JM, et al. Increased methylation of the oxytocin receptor gene in motor functional neurological disorder:a preliminary study[J]. J Neurol Neurosurg Psychiatry, 2018, 89(5):552-554.
[20] Thenganatt MA, Jankovic J. Psychogenic (functional) movement disorders[J]. Continuum (Minneap Minn), 2019, 25(4):1121-1140.
[21] Anderson JR, Nakhate V, Stephen CD, et al. Functional (psychogenic) neurological disorders:assessment and acute management in the emergency department[J]. Semin Neurol, 2019, 39(1):102-114.
[22] Nielsen G, Ricciardi L, Meppelink AM, et al. A simplified version of the Psychogenic Movement Disorders Rating Scale:the Simplified Functional Movement Disorders Rating Scale (S-FMDRS)[J]. Mov Disord Clin Pract, 2017, 4(5):710-716.
[23] Erro R, Bhatia KP, Edwards MJ, et al. Clinical diagnosis of propriospinal myoclonus is unreliable:an electrophysiologic study[J]. Mov Disord, 2013, 28(13):1868-1873.
[24] Leon-Sarmiento FE, Bayona-Prieto J, Leon-Ariza JS, et al. Smell status in functional movement disorders:new clues for diagnosis and underlying mechanisms[J]. Clin Neurol Neurosurg, 2019, 177:68-72.
[25] Tripathy SK, Mishra BR, Mishra S, et al. Psychogenic limp in a child:are we aware of it?[J]. J Pediatr Orthop B, 2014, 23(4):343-345.
[26] Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders:a consensus recommendation[J]. J Neurol Neurosurg Psychiatry, 2015, 86(10):1113-1119.
[27] Sauerhoefer E, Schafflhuber C, Kratz O. Severe psychogenic tremor of both wrists in a 13-year-old girl treated successfully with a customized wrist brace:a case report[J]. J Med Case Rep, 2011, 5:158.
[28] Kaas BM, Humbyrd CJ, Pantelyat A. Functional movement disorders and placebo:a brief review of the placebo effect in movement disorders and ethical considerations for placebo therapy[J]. Mov Disord Clin Pract, 2018, 5(5):471-478.
[29] Shah BB, Chen R, Zurowski M, et al. Repetitive transcranial magnetic stimulation plus standardized suggestion of benefit for functional movement disorders:an open label case series[J]. Parkinsonism Relat Disord, 2015, 21(4):407-412.
[30] Garcin B, Mesrati F, Hubsch C, et al. Impact of transcranial magnetic stimulation on functional movement disorders:cortical modulation or a behavioral effect?[J]. Front Neurol, 2017, 8:338.
[31] Demartini B, Bombieri F, Goeta D, et al. A physical therapy programme for functional motor symptoms:a telemedicine pilot study[J]. Parkinsonism Relat Disord, 2019. pii:S1353-8020(19)30225-1.
[32] Adams C, Anderson J, Madva EN, et al. You've made the diagnosis of functional neurological disorder:now what?[J]. Pract Neurol, 2018, 18(4):323-330.
