Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey

Background: Functional neurological disorders (FND) are disabling medical conditions commonly seen in neurological practice. Neurologists play an essential role in managing FND, from establishing a diagnosis to coordination of multidisciplinary team-based treatment for patients. With this study, we investigated the knowledge and the clinical experience of Italian neurologists in managing patients with FND. Methods: Members of the Italian Society of Neurology were invited via e-mail to participate in this ad hoc online survey; 492 questionnaires were returned completed. Results: The term "Functional neurological disorders" in reference to FND was used more frequently than other psychological (e.g., psychogenic or conversion), or descriptive terms (e.g., non-organic or stress-related). When speaking with patients, the respondents stated that they preferred explaining symptoms based on abnormal functioning of the nervous system than discussing mental illness and that they would refer their patient to a psychologist rather than to a psychiatrist. Few considered that physiotherapy and psychiatric interventions are useful approaches to treating FND. Some believed that patients simulate their symptoms. Conclusions: Overall, the responses suggest that knowledge about scientific advances in FND is somewhat sparse. A psychiatric-centered view of FND opens the way to an approach in which neurobiological and psychological aspects constitute essential factors of the condition. In this context, professional education could improve understanding of FND and optimize patient management

Data-driven clustering of combined Functional Motor Disorders based on the Italian registry

Functional Motor Disorders (FMDs) represent nosological entities with no clear phenotypic characterization, especially in patients with multiple (combined FMDs) motor manifestations. A data-driven approach using cluster analysis of clinical data has been proposed as an analytic method to obtain non-hierarchical unbiased classifications. The study aimed to identify clinical subtypes of combined FMDs using a data-driven approach to overcome possible limits related to "a priori" classifications and clinical overlapping

<b>Orientação e sombreamento do confinamento na temperatura da superfície do pelame de bovinos</b> - DOI: 10.4025/actascianimsci.v30i2.4702 <b>Effect of feedlot orientation and shading on haircoat surface temperature of cattle</b> - DOI: 10.4025/actascianimsci.v30i2.4702

Avaliou-se o efeito do sombreamento sobre a temperatura da superfície do pelame (TSP) de bovinos de cinco grupos genéticos, 4 &frac12; Limousin + &frac12; Nelore (L), 8 &frac12; Limousin + &frac14; Nelore + &frac14; RedAngus (LR), 4 &frac12; Limousin + &frac14; Nelore + &frac14; Simental (LS), 2 &frac14; Marchigiana + &frac14; Nelore + ¼ Simental (MS) e 4 ¾ RedAngus + ¼ Nelore + ¼ Guzerá (RG), com 20 meses de idade e peso médio de 300 kg, alojados em baias individuais de 10 m², sendo metade coberta com telhas de zinco. A dieta era isoproteica e isoenergética com relação volumoso:concentrado 67:33. A TSP do Lado 1 (L1) do confinamento, durante o dia, não diferenciou (p > 0,05) entre os grupos genéticos, enquanto que para o Lado 2 (L2), a menor média (29,48^oC) (p < 0,05) foi obtida para MS. No período noturno, a TSP do L1 foi maior (p < 0,05) para o RG (30,32^oC) e não houve diferença (p > 0,05) entre os demais. No L2, a maior TSP (p < 0,05) ocorreu para RG (30,63^oC) e a menor (p < 0,05), para MS (28,07^oC). A orientação do confinamento não influenciou a TSP dos animais, sendo a mesma influenciada pelas horas do dia e da noite, reflexo direto da intensidade de radiação térmica incidente na telha de zinco e no piso de concreto.<br>The study evaluated the effect of shading on haircoat surface temperature (HST) of cattle from five genetic groups: 4 ½ Limousin + ½ Nellore (L), 8 ½ Limousin + ¼ Nellore + ¼ RedAngus (LR), 4 ½ Limousin + ¼ Nellore + ¼ Simmental (LS), 2 ½ Marchigiana + ¼ Nellore + ¼ Simmental (MS) and 4 ¾ RedAngus + ¼ Nellore + ¼ Guzerá (RG). The cattle were 20 months old and had an average weight of 300 kg. They were housed at individual 10 m2-pens, with half covered with zinc tiles. The diet was isoproteic and isoenergetic, with a 67:33 roughage concentrate ratio. There was no difference (p > 0.05) in HST among genetic groups during daytime on Side 1 (S1) of the feedlot, while on Side 2 (S2) the lowest HST (29.48oC) (p < 0.05) was observed for MS. At night, the HST for Side 1 was higher (p < 0.05) for RG (30.32oC) and did not differ (p > 0.05) among the others. On Side 2, the highest HST (p < 0.05) occurred for RG (30.63oC) and the lowest (p < 0.05) for MS (28.07oC). The building orientation showed no effect on HST of animals, which was influenced by time of day, direct reflex action of thermal radiation intensity on zinc tiles and on the concrete floor

Do demographic and clinical features and comorbidities affect the risk of spread to an additional body site in functional motor disorders?

The aim of this study is to assess changes in the body distribution and the semeiology of functional motor disorder (FMD) in patients who reported only one or more than one body site affected at FMD onset. Data were obtained from the Italian Registry of Functional Motor Disorders, which included patients with a diagnosis of clinically definite FMDs. The relationship between FMD features and spread to other body sites was estimated by multivariate Cox regression analysis. We identified 201 (49%) patients who reported only one body site affected at FMD onset and 209 (51%) who reported multiple body sites affected at onset. FMD spread from the initial site to another site in 43/201 (21.4%) patients over 5.7 +/- 7.1 years in those with only one site affected at FMD onset; FMD spread to an another body site in 29/209 (13.8%) over 5.5 +/- 6.5 years. The spread of FMD was associated with non-motor functional symptoms and psychiatric comorbidities only in the patients with one body site affected at FMD onset. Our findings provide novel insight into the natural history of FMD. The number of body sites affected at onset does not seem to have a consistent influence on the risk of spread. Furthermore, our findings suggest that psychiatric comorbidities and non-motor functional symptoms may predict the spread of FMD symptoms, at least in patients with one body site affected at onset

Data-driven clustering of combined Functional Motor Disorders based on the Italian registry

Introduction: Functional Motor Disorders (FMDs) represent nosological entities with no clear phenotypic characterization, especially in patients with multiple (combined FMDs) motor manifestations. A data-driven approach using cluster analysis of clinical data has been proposed as an analytic method to obtain non-hierarchical unbiased classifications. The study aimed to identify clinical subtypes of combined FMDs using a data-driven approach to overcome possible limits related to "a priori" classifications and clinical overlapping. Methods: Data were obtained by the Italian Registry of Functional Motor Disorders. Patients identified with multiple or "combined" FMDs by standardized clinical assessments were selected to be analyzed. Non-hierarchical cluster analysis was performed based on FMDs phenomenology. Multivariate analysis was then performed after adjustment for principal confounding variables. Results: From a study population of n = 410 subjects with FMDs, we selected n = 188 subjects [women: 133 (70.7%); age: 47.9 ± 14.4 years; disease duration: 6.4 ± 7.7 years] presenting combined FMDs to be analyzed. Based on motor phenotype, two independent clusters were identified: Cluster C1 (n = 82; 43.6%) and Cluster C2 (n = 106; 56.4%). Cluster C1 was characterized by functional tremor plus parkinsonism as the main clinical phenotype. Cluster C2 mainly included subjects with functional weakness. Cluster C1 included older subjects suffering from anxiety who were more treated with botulinum toxin and antiepileptics. Cluster C2 included younger subjects referring to different associated symptoms, such as pain, headache, and visual disturbances, who were more treated with antidepressants. Conclusion: Using a data-driven approach of clinical data from the Italian registry, we differentiated clinical subtypes among combined FMDs to be validated by prospective studies