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Publications

Journal Article Multicenter Study Observational Study Ppublish

PubMed: 42560372 DOI: 10.1007/s00702-026-03254-5

Multimodal assessment of clinical and neural changes following multidisciplinary management in functional motor disorders.

J Neural Transm (Vienna) 133(9):2733-2743

Authors: Marialuisa Gandolfi, Angela Sandri, Elisabetta Sarasso, Andrea Gardoni, Michela Russo, Silvia Basaia, Ilaria Antonella Di Vico, Roberto Erro, Serena Camozzi, Giulia Pedrotti, Melania Fasoli, Francesca Salaorni, Christian Geroin, Giancarlo Mansueto, Francesca Benedetta Pizzini, Marco Barillari, Matteo Francesco Lauriola, Mariachiara Tozzi, Francesca Rusciano, Anna Fratucello, Sofia Cuoco, Immacolata Carotenuto, Carlo Ricciardi, Francesco Amato, Claudia Vinciguerra, Annibale Botto, Daniele Romano, Marianna Amboni, Mirta Fiorio, Angela Marotta, Giovanna Maddalena Squintani, Sara Mariotto, Stefano Tamburin, Fabio Paio, Giuseppe De Biasi, Giuseppe Piscosquito, Elisa Canu, Paolo Barone, Massimo Filippi, Michele Tinazzi, Maria Teresa Pellecchia, Federica Agosta

Affiliations

  • Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Pz.le LA Scuro, 10, 37134, Verona, Italy.
  • Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
  • Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Pz.le LA Scuro, 10, 37134, Verona, Italy.
  • Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
  • Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy.
  • Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy.
  • Department of Chemical, Material and Industrial Production Engineering, University of Naples Federico II, Naples, Italy.
  • Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" University of Salerno, Salerno, Italy.
  • IRCCS Synlab SDN, Naples, Italy.
  • Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy.
  • Department of Diagnostic and Public Health, Section of Radiology, University of Verona, Verona, Italy.
  • Department of Radiology, Ospedale G.B. Rossi AOUI Verona, Verona, Italy.
  • Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy.
  • Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
  • UOC Neuroradiologia Diagnostica ed Interventistica Azienda Ospedaliera-Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
  • Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Neurophysiology service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Vita-Salute San Raffaele University, Milan, Italy.
  • Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Pz.le LA Scuro, 10, 37134, Verona, Italy.
  • Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

Abstract

Functional motor disorders (FMD) are common and disabling conditions, but objective biomarker changes following multidisciplinary management remain limited. Our objective was to investigate changes and responsiveness of multimodal biomarkers in individuals with FMD undergoing multidisciplinary management. 34 patients with clinically definite FMD (mean age 42.76 ± 11.01 years; 85.7% female; mean disease duration 0.64 ± 1.52 years) underwent a standardized multimodal assessment at baseline and 3-month follow-up after a multidisciplinary program. The intervention included a 5-day intensive rehabilitation program (2 h/day), followed by a 12-week phase of telemedicine (one session every 2 weeks) and home-based self-management (two sessions/week). Multimodal biomarkers across motor, exteroceptive, interoceptive, and brain function domains were assessed using clinical, neurophysiological, and task-based functional MRI measures. Motor symptoms improved with concurrent gains in depressive symptoms, physical quality of life, and fatigue (all, p < 0.047). Specific improvements were observed in motor performance, including reduced stride time variability during cognitive dual-tasking (p = 0.018) and enhanced postural stability mainly in the eyes-closed condition (all, p < 0.028), while neurophysiological and nociceptive measures remained unchanged. Patients showed altered baseline brain activity compared with controls; post-intervention changes were observed in motor, cerebellar, and fronto-insular regions (p < 0.001, uncorrected), without correlations with clinical outcomes. Multidisciplinary management in FMD was associated with improved clinical outcomes and specific motor and neural changes, suggesting domain-specific responsiveness and a potential role for multimodal biomarkers, requiring confirmation in larger controlled studies. Trial Registration number NCT06328790. Registered on 26 March 2024.

MeSH

Brain, Motor Disorders, Biomarkers, Signs And Symptoms, Synaptic Transmission