{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:11:32Z","timestamp":1788757892571,"version":"build-2803163510"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients experiencing autonomic storms related to dysautonomia may present with abnormal movements, including convulsions, tremors, and myoclonus. Due to these nonspecific symptoms, they are often misdiagnosed with functional neurological disorders, including psychogenic non-epileptic spells (PNES), resulting in delayed or inappropriate treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cohort study included 17 adult patients who presented to St. Elizabeth\u2019s Medical Center\u2019s emergency department with abnormal seizure-like activity. Inclusion criteria required non-epileptiform movements, confirmed by negative rEEG or cEEG testing, followed by a misdiagnosis of a functional neurological disorder, and referral to Neurology. Demographic and clinical information was collected from the electronic health record to describe the clinical pattern and treatment responses in patients with AMD initially diagnosed with PNES.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 17 patients (male [\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f6], female [\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f11]), with a mean baseline age of 52 and a median age of 64, the most common movement phenotypes were tremor (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f6), and myoclonus (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f6). Other neurological manifestations were obtundation (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f10) and presyncope (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f6). All participants showed features of orthostatic hypotension, indicating possible dysautonomia. 14 of 17 patients were started on at least one medication for symptom management, including fludrocortisone, pyridostigmine, midodrine, and propranolol, with 8 of 17 on combination therapy. 10 of 17 patients who underwent pharmacological interventions reported improvement, including a decrease or resolution of abnormal movements, reduction of autonomic dysfunction symptoms, and fewer readmissions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients presenting with abnormal seizure-like movements confirmed as non-epileptic after further evaluation should be assessed for autonomic dysfunction. Treatment targeting orthostatic hypotension may help alleviate these abnormal movements.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1839185","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:23:26Z","timestamp":1788755006000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved outcomes for patients with autonomic movement disorders originally evaluated for psychogenic non-epileptiform spells"],"prefix":"10.3389","volume":"17","author":[{"given":"Alyssa","family":"Khoo","sequence":"first","affiliation":[{"name":"Boston Medical Center Brighton","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madelynn","family":"Paul","sequence":"additional","affiliation":[{"name":"Boston Medical Center Brighton","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Rady","sequence":"additional","affiliation":[{"name":"Boston Medical Center Brighton","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Sunda","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Brik","sequence":"additional","affiliation":[{"name":"Boston University","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okeanis","family":"Vaou","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Texas San Antonio","place":["San Antonio, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Hohler","sequence":"additional","affiliation":[{"name":"Boston Medical Center Brighton","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref1","volume-title":"Anatomy, Autonomic Nervous System","author":"Waxenbaum","year":"2023"},{"key":"ref2","volume-title":"Autonomic Dysfunction","author":"S\u00e1nchez-Manso","year":"2023"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"123","DOI":"10.36922\/an.7653","article-title":"Autonomic storms and autonomic movement disorder associated with postural orthostatic tachycardia syndrome misdiagnosed as functional neurological disorder","volume":"4","author":"Khoo","year":"2025","journal-title":"Adv Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/S1474-4422(21)00422-1","article-title":"Functional neurological disorder: new subtypes and shared mechanisms","volume":"21","author":"Hallett","year":"2022","journal-title":"Lancet 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meta-analysis","volume":"34","author":"Paredes-Echeverri","year":"2022","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e13636","DOI":"10.1111\/psyp.13636","article-title":"Cross-system autonomic balance and regulation: associations with depression and anxiety symptoms","volume":"57","author":"Stone","year":"2020","journal-title":"Psychophysiology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1001\/jamapsychiatry.2016.2717","article-title":"Association of resting heart rate and blood pressure in late adolescence with subsequent mental disorders: a longitudinal population study of more than 1 million men in Sweden","volume":"73","author":"Latvala","year":"2016","journal-title":"JAMA Psychiatry"}],"container-title":["Frontiers in 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