Lower urinary tract dysfunction in patients with functional movement disorders.

Introduction: Functional movement disorders (FMD) are not associated with the kind of structural or biochemical alterations seen in other movement disorders and therefore would be unlikely to be associated with lower urinary tract (LUT) dysfunction. However, LUT symptoms have been observed in patients with FMD.

Objective: To evaluate the frequency and pattern of LUT symptoms, their possible nature and the impact they have on the quality of life of patients with FMD.

Methods: The clinical records of patients with FMD were reviewed retrospectively and patients reporting LUT symptoms were invited to complete standardised validated questionnaires-Urinary Symptom Profile (USP) and Short Form-Qualiveen (SFQ). Management of LUT dysfunction was also reviewed.

Results: Out of the 150 patients with clinically established (n=97) or probable (n=53) FMDs, thirty (20%) self-reported LUT symptoms. Twenty two of these completed the USP and SFQ questionnaires. Overactive bladder symptoms were most commonly reported (n=14; 63.6%). Patients with fixed dystonia reported more severe LUT symptoms and had higher SFQ scores as compared to patients with other FMDs (p=0.01). Five patients with significant LUT symptoms had been referred to uroneurology. Of them, three had urinary retention managed with sacral neuromodulation, two had overactive bladder and were managed conservatively.

Conclusion: LUT dysfunction can be seen in 20% patients with FMD. Patients with fixed dystonia are more likely to report LUT dysfunction which can be severe. It may be advisable to ask for LUT symptoms in all patients with FMD and be more proactive in referring them for specialist investigation and treatment.