Patient-specific measurement of functional movement disorders

Functional movement disorders (FMD) are hard to diagnose and treat. The
underlying etiology of FMDs remains poorly understood with several postulated
mechanisms and an acknowledgement of the contribution of biological,
psychogenic, and cultural factors. The old term *psychogenic* movement
disorders suggests a psychological background of FMD, but case-control studies
have demonstrated only an assocation, and not causation, between psychogenic
factors and FMDs in a subset of patients. Besides, many somatic symptoms are
strongly associated with psychiatric disorders, so these psychogenic factors
are probably also relevant in neurological movement disorders disorders.
An alternative means of investigation is to study patients on an individual
basis, attempting to identify which factors contribute the most to the
patient*s symptoms. This is possible by applying a multivariate time-series
analysis. In this study, we will use a web based diary system to focus on
contributing factors that are known to modulate functional symptoms. At the
same time we will use actigraphy to objectively assess the patients symptoms.

We aim to study the contributing factors to movement disorder symptoms in
subjects with a FMD using a web based diary. At the same time, objective
symptom assessment will be performed using an actigraphy wristband.
Associations between potential contributing factors and symptom fluctuations in
FMD patients will be compared with those in a group with other neurological
movement disorders.

A replicated single-subject time-series design will be used. Patients with a
(functional or neurological) movement disorder will be monitored for 30 days,
five times a day, by using a web based diary. In addition, patients will wear
an actigraphy wristband during daytime.

There are no risks involved in participating in the study. The burden
associated with participation consists of:
(1) An inclusion interview with video measurement; a screening for depression,
anxiety, and somatisation; and completing questionnaires on self-efficacy,
quality of life, and clinical global impression (total of 45 minutes).
(2) Wearing an actigraphy wristband during daytime, and completion of an
internet based diary at fixed times (5 x 5 minutes a day) during the study
period (30 days).
(3) At the end of the study period, subjects will receive an e-mail to give
general feedback to the study and will be asked for the second time to complete
the questionnaires on self-efficacy, quality of life, and clinical global
impression (30 minutes)
(4) One month the end of 30 days measuring, subjects will receive a third time
the questionnaires on self-efficacy, quality of life, and clinical global
impression to determine whether they benefited from participating in this study
(10 minutes).