Functional Gait Disorders: Clinical presentations, Phenotypes and Implications for treatment

Abstract

Background: Functional Gait Disorders (FGD) are a common presentation of motor-Functional Neurological Disorders (motor-FND) that affect walking ability. Aim: To provide a narrative review of the current literature on FGD. Methods: A narrative overview of published literature was undertaken, based on a systematic search of relevant databases, authoritative texts and citation tracking. Results: FGD is multidimensional and disabling, with numerous phenotypes described in the literature, including ‘knee buckling,’ ‘astasia-abasia’ and ‘excessive slowness.’ Motor symptoms such as weakness or tremor, and non-motor symptoms, such as pain and fatigue may contribute to the disability and distress in FGD. Phenotypic features and clinical signs are seen in FGD that demonstrate inconsistency and incongruity with structural disease. A limited number of treatment studies have specifically focussed on FGD, however, reporting of outcomes from motor-FND cohorts has demonstrated short and long-term improvements in walking ability through multidisciplinary rehabilitation. Conclusions: The relative contribution of motor and non-motor symptoms in FGD remains unknown, but it is likely that non-motor symptoms increase the illness burden and should be considered during assessment and treatment. Recommended treatment for FGD involves multidisciplinary rehabilitation, but optimum treatment elements are yet to be determined.