Objective:

To describe the demographic, clinical, and outcome characteristics of patients evaluated for Functional Movement Disorder (FMD) in a large multidisciplinary program over an eight-year period as part of a quality improvement initiative. 

Background:

Functional movement disorder (FMD) is a common yet underrecognized cause of disability. A multidisciplinary clinic was established to provide coordinated, patient-centered care integrating neurology, psychology, and rehabilitation to promote functional recovery. 

Design/Methods:

A retrospective review included all patients evaluated between 2016 and 2024 in the multidisciplinary FMD clinic. Demographics, medication use, and patient-reported outcomes were extracted from standardized electronic records and summarized descriptively. The project was reviewed and deemed a quality improvement activity; IRB approval was not required per institutional policy. 

Results:

A total of 3,260 patients were evaluated (mean age 52.4 ± 17.2 years; 67% female; median education = 14 years [IQR 12–16]). Common comorbidities included psychiatric diagnoses (32%), pain disorders (28%), and neurological conditions such as migraine, tremor, or epilepsy (25%). PROMIS scores reflected below-average physical and mental health (37.6 ± 8.8; 39.5 ± 9.8) and moderate pain interference (4.7 ± 2.6). Mean GAD-7 and PHQ-9 scores were 8.0 ± 6.3 and 9.4 ± 6.6, respectively. Among 1,960 patients with available medication data, 85% used ≥1 medication, most commonly antiseizure drugs (36%), SSRIs (23%), SNRIs (21%), and benzodiazepines (19%). The mean simplified FMD Rating Scale score (n = 211) was 9.8 ± 8.4. Overall, 27% (n = 884) participated in virtual shared medical appointments, and 17% (n = 565) completed neuropsychological evaluation. 

Conclusions:

This eight-year initiative demonstrates the sustainability and scalability of a multidisciplinary model for FMD care. Integration of behavioral health and rehabilitation within neurology was associated with improved diagnostic consistency, treatment engagement, and continuity of care. Routine collection of patient-reported outcomes provides a framework for individualized treatment planning and ongoing program evaluation.