{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:15:26Z","timestamp":1786976126512,"version":"build-2736575974"},"reference-count":58,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["P01 NS087987"],"award-info":[{"award-number":["P01 NS087987"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Functional dystonia (FD) is a disabling and diagnostically challenging functional movement disorder (FMD). We sought to identify historical predictors of FD vs. other primary dystonias (ODs) and develop a practical prediction algorithm to guide neurologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>1475 consecutive new patient medical records were reviewed at an adult\/pediatric tertiary\u2010referral dystonia clinic from 2005 to 2017. Ninety\u2010nine met criteria for clinically established FD (85 adults and 14 pediatric), paired with 99 age\/dystonia distribution\u2010matched OD. Univariate and multivariate regression analyses were performed to identify predictors of FD and disability. We formed a prediction algorithm, assessed using the area under the receiver operating curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Multivariate logistic regression analysis investigating independent predictors of FD (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) followed by development of a prediction algorithm showed that the most robust predictors included abrupt onset, spontaneous resolution\/recurrence, pain, cognitive complaints, being on or pursuing disability, lifetime mood\/anxiety disorder, comorbid functional somatic disorders, and having\u00a0\u22653 medication allergies. The prediction algorithm had utility for both adult and pediatric FD, with excellent sensitivity\/specificity (89%\/92%) and an area under the curve (AUC) 0.95 (0.92\u20100.98). Greater disability (modified Rankin Scale) independently correlated with a number of functional examination features, unemployment\/not attending school, number of medication allergies, and younger age of presentation. FD patients were high health\u2010care utilizers and were more frequently prescribed opiates\/opioids and benzodiazepines (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>This case\u2010control study provides an algorithm to guide clinicians in gauging their index of suspicion for a FD, with diagnostic confirmation subsequently informed by neurological examination. While this algorithm requires prospective validation, health\u2010care utilization data underscore the importance and need for more research in FD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acn3.51307","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T09:11:59Z","timestamp":1615885919000},"page":"732-748","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Functional dystonia: A case\u2010control study and risk prediction algorithm"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4727-192X","authenticated-orcid":false,"given":"Christopher D.","family":"Stephen","sequence":"first","affiliation":[{"name":"Dystonia Center and Movement Disorders Unit, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"},{"name":"Functional Neurological Disorder Research Program, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2721-583X","authenticated-orcid":false,"given":"David L.","family":"Perez","sequence":"additional","affiliation":[{"name":"Functional Neurological Disorder Research Program, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"},{"name":"Cognitive Behavioral Neurology Division, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"},{"name":"Division of Neuropsychiatry, Department of Psychiatry Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6293-806X","authenticated-orcid":false,"given":"Lori B.","family":"Chibnik","sequence":"additional","affiliation":[{"name":"Biostatistics Center, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"},{"name":"Department of Epidemiology Harvard T. 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Chan School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4445-7374","authenticated-orcid":false,"given":"Nutan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Dystonia Center and Movement Disorders Unit, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"},{"name":"Functional Neurological Disorder Research Program, Department of Neurology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26805"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2015.08.036"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.24947"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25350"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awp060"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws129"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2018.1264"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-015-0556-y"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.24903"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-305321"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.12013"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000237"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/116.4.843"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awh262"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2009.02.010"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23671"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.605262"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000135"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-801772-2.00020-5"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-309040"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-801772-2.00005-9"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-801772-2.00017-5"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25475"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-322180"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNN.0000000000000106"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-307381"},{"key":"e_1_2_8_28_1","volume-title":"Healthcare Bluebook"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2011.11.006"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2013.09.012"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-018-0023-6"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-317378"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2019.02.020"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/121.4.547"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.10594"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27402"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.5334\/tohm.466"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-020-02245-4"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2016.08.014"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2012-304397"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2018.04.030"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-8840-9"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.0919"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.12.022"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.16110302"},{"key":"e_1_2_8_46_1","first-page":"431","article-title":"Psychogenic dystonia","volume":"50","author":"Fahn S","year":"1988","journal-title":"Adv Neurol"},{"key":"e_1_2_8_47_1","article-title":"Functional or not functional; 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