The prognosis of functional limb weakness: a 14-year case-control study
The prognosis of functional limb weakness: a 14-year case-control study
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DOI：
10.1093/brain/awz138
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发表时间：
2019-07-01
期刊：
影响因子：
14.5
通讯作者：
Stone, Jon
中科院分区：
文献类型：
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作者：
Gelauff, Eannette M.;Carson, Alan;Stone, Jon
功能性运动障碍预后的可靠数据很少，因为现有的功能性运动障碍预后研究几乎都是回顾性的、小范围的和不受控制的。在这项研究中，我们采用前瞻性招募、对照队列设计来评估与神经系统疾病和健康对照受试者相比，功能性肢体无力患者的误诊、死亡率、症状和健康结局。我们还对预测预后的基线因素进行了探索性分析。我们对先前研究的前瞻性队列中的107名功能性肢体无力患者、46名神经性患者和38名健康对照患者进行了平均14年的随访。误诊是在一个共识会议上确定的，使用的信息来自记录，病人和他们的全科医生。死亡人数和死因是通过死亡证明收集的。用自评问卷记录肢体无力、身体和精神症状、残疾/生活质量和疾病感知的结果。结果测量在组内和组间进行比较。随访对象包括76例（71%）功能性肢体无力患者、31例（67%）神经性对照和23例（61%）健康对照。功能性肢体无力组1例（1%）和神经控制组1例（2%）出现误诊。11例功能性肢体无力患者、8例神经系统对照组和1例健康对照组死亡。功能性肢体无力组中20%的患者和神经系统对照组中18%的患者的无力完全缓解（P = 0.785），更大比例的功能性肢体无力患者的无力得到改善（P = 0.011）。结果在患者组之间具有可比性，并且比健康对照组差。没有基线因素是结果的独立预测因子，尽管躯体化障碍、一般健康、疼痛和基线时的总症状与结果有不可变的相关性。本研究是对功能性肢体无力进行的规模最大、随访时间最长的研究。经长期随访，功能性肢体无力的误诊是罕见的。该疾病的死亡率高于预期，且症状持续且致残。似乎很难根据共同的基线变量来预测结果。这些数据应该有助于告知临床医生提供更现实的结果前景，并强调积极和靶向治疗的重要性。
Reliable data on the prognosis of functional motor disorder are scarce, as existing studies of the prognosis of functional motor disorder are nearly all retrospective, small and uncontrolled. In this study we used a prospectively recruited, controlled cohort design to assess misdiagnosis, mortality and symptomatic and health outcome in patients with functional limb weakness compared to neurological disease and healthy control subjects. We also carried out an exploratory analysis for baseline factors predicting outcome. One hundred and seven patients with functional limb weakness, 46 neurological and 38 healthy control subjects from our previously studied prospective cohort were traced for follow-up after an average of 14 years. Misdiagnosis was determined in a consensus meeting using information from records, patients and their GPs. Numbers and causes of death were collected via death certificates. Outcome of limb weakness, physical and psychiatric symptoms, disability/quality of life and illness perception were recorded with self-rated questionnaires. Outcome measures were compared within and between groups. Seventy-six patients (71%) with functional limb weakness, 31 (67%) neurological and 23 (61%) healthy controls were included in follow-up. Misdiagnosis was found in one patient in the functional limb weakness group (1%) and in one neurological control (2%). Eleven patients with functional limb weakness, eight neurological control subjects and one healthy control subject had died. Weakness had completely remitted in 20% of patients in the functional limb weakness group and in 18% of the neurological controls (P = 0.785) and improved in a larger proportion of functional limb weakness patients (P = 0.011). Outcomes were comparable between patient groups, and worse than the healthy control group. No baseline factors were independent predictors of outcome, although somatization disorder, general health, pain and total symptoms at baseline were univariably correlated to outcome. This study is the largest and longest follow-up study of functional limb weakness. Misdiagnosis in functional limb weakness is rare after long-term follow-up. The disorder is associated with a higher mortality rate than expected, and symptoms are persistent and disabling. It appears difficult to predict outcome based on common baseline variables. These data should help inform clinicians to provide a more realistic outlook of the outcome and emphasize the importance of active and targeted therapy.