Von den klinischen Charakteristika zur sicheren Diagnose funktioneller neurologischer Bewegungsstörungen

ZUSAMMENFASSUNG

Funktionelle neurologische Bewegungsstörungen gehören zu den häufigsten neurologischen Erkrankungen, führen oft zu einer erheblichen Einschränkung der Lebensqualität der Betroffenen und zu einer massiven finanziellen Belastung des Gesundheitssystems. Die Diagnose wird klinisch anhand positiver Diagnosekriterien gestellt, was apparative, kostenintensive Zusatzdiagnostik meist unnötig macht. Gehäuft kommt es allerdings zu einer erheblichen Verzögerung der Diagnose und damit verbunden, der Einleitung einer krankheitsspezifischen Therapie. In unserem Artikel möchten wir die Hauptpfeiler der klinischen Diagnose – die Inkongruenz und Inkonsistenz – die allen funktionellen Bewegungsstörungen gemeinsam ist, erläutern und darauf aufbauend die unterschiedlichen Subgruppen mit ihren individuellen klinischen Charakteristika und den dazugehörigen Untersuchungstechniken praxisnah erklären. Dies soll dazu beitragen, dass die Diagnose schnell und sicher gestellt werden kann. Außerdem ergeben sich aus den aufgeführten klinischen Charakteristika für die Therapie bedeutsame Strategien, z. B. die Modulation von Aufmerksamkeit, die in der Physio- und Psychotherapie zur Anwendung gebracht, aber vor allem durch die Patienten selbst genutzt werden können.

ABSTRACT

Functional neurological movement disorders are among the most common neurological diseases, often lead to a considerable reduction in the quality of life of those affected and to a massive financial burden on the healthcare system. The diagnosis is made clinically based on positive diagnostic criteria, which usually make additional, cost-intensive diagnostics unnecessary. However, there is often a considerable delay in diagnosis and initiation of disease-specific therapy. In our article, we would, therefore, like to explain the main pillars of clinical diagnosis – incongruence and inconsistency -, which are common to all functional movement disorders. Building on this, we will explain the different subgroups with their individual clinical characteristics and the associated examination techniques in a practical manner. This should help to ensure that the diagnosis can be made quickly and confidently. In addition, the clinical characteristics have strong implications for treatment strategies e. g., modulation of attention, which can be used in physiotherapy and psychotherapy, but above all by the patients themselves.

Schlüsselwörter

Funktionelle neurologische Bewegungsstörungen - klinische Charakteristika - positive Diagnosekriterien - Inkongruenz - Inkonsistenz - Phänomenologie

Key words

Functional movement disorders - clinical characteristics - positive diagnostic criteria - incongruence - inconsistency - phenomenology

Publication History

Article published online:
02 August 2023

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