key: cord-0840479-5eduoprz
authors: Delgado, Celia; Pareés, Isabel; Jiménez‐Huete, Adolfo; Kurtis, Mónica M.
title: Impact of the COVID‐19 pandemic on Functional Movement Disorders: lessons from a specialized clinic
date: 2020-08-24
journal: Mov Disord
DOI: 10.1002/mds.28278
sha: 9bf2f44742d92b9ffcb1f93a6e1400800e4863fe
doc_id: 840479
cord_uid: 5eduoprz

nan

The COVID-19 crisis has produced major impact on healthcare systems and movement disorders patients. 1 Functional movement disorders (FMD) may affect up to 18% of patients evaluated in Movement Disorder Units and can greatly affect quality of life. 2, 3 This study aimed to explore pandemic and lockdown consequences on FMD patients.

An anonymous survey was designed (Typeform-platform) with 30 multiple-choice questions covering demographic (age, gender), social (employment, household characteristics, etc.) and clinical variables. Changes in exercise, therapies, sleep, mood, anxiety and FMD were evaluated through 3-point Likert scales (more/better, unchanged, less/worse) and General Health Condition (GHC) was assessed by a shortened Clinical Global Impression-Improvement Scale (CGI-I scale, items 1-5). 4 Patients from our FMD clinic were informed about the study (phone/email) and given the survey link. All provided written informed consent and the local ethics committee approved the study.

Bivariable analysis and multivariable logistic regression analysis were performed to investigate associations between changes in FMD and GHC and other variables using R software (3.6.2 version). Significance was set at p < 0.05.

Forty-one patients (53% of those contacted) participated: mean age 39.98±10.77 years, 53.7% women, disease duration range (0->10 years). Most patients had a functional gait disturbance (n=18, 44%) followed by dystonia (n=10, 24%) and tremor (n=9, 22%).

Other demographic characteristics are reported in Table 1 .

Most patients reported no change in their FMD (n=22, 54%). Only 5 (12 %) improved and 14 (34%) worsened during lockdown. However, about half of the patients reported being worse or much worse on GHC as per the GCI-I scale (n=20), 15 (37%) remained stable and 6 (15%) improved. Four patients had medical emergencies during lockdown but avoided seeking care due to fear of infection. Four patients reported symptoms

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suggestive of COVID-19. One was tested (SARS-CoV2 positive), required hospitalization and reported FMD worsening. Twenty-two (54%) continued exercising.

Of the 25 (61%) participants who followed speech/occupational or physical therapies, twelve (48%) were able to maintain them totally or partially telematically. About 50% referred increased anxiety, insomnia and lower mood. The variables studied and their association with changes in FMD and GHC are reported in Table 1 . None affected FMD symptoms. In contrast, GHC was significantly associated with changes in FMD, insomnia, anxiety, mood and physical exercise.

Spain was under severe lockdown for eight weeks during the infection peak. However, most patients in our cohort reported FMD stability. Although many suffered increased anxiety, insomnia and lower mood that possibly affected their GHC negatively, these non-motor symptoms did not lead to aggravation of their FMD. Functional neuroimaging suggests that excessive self-monitoring and self-awareness may play a role in the generation and perpetuation of FMDs. 5 Furthermore, therapeutic strategies are based on diverting attention from symptoms. 6 One could argue that this particular physiopathology could explain our results, as self-monitoring may decrease in the context of a worldwide crisis. Our study is limited by small sample size, self-selection bias and self-reported outcome measures. Further studies are needed to better understand the impact of the COVID-19 pandemic on FMD. 

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Internacional's Ethics Committee. All the data obtained was anonymous. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. 

This article is protected by copyright. All rights reserved. Accepted Article

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