Data-driven clustering of combined Functional Motor Disorders based on the Italian registry
IntroductionFunctional 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...
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.987593/full |
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| author | Giovanni Mostile Giovanni Mostile Christian Geroin Roberto Erro Antonina Luca Enrico Marcuzzo Paolo Barone Roberto Ceravolo Sonia Mazzucchi Andrea Pilotto Andrea Pilotto Alessandro Padovani Luigi Michele Romito Roberto Eleopra Carlo Dallocchio Carla Arbasino Francesco Bono Pietro Antonio Bruno Benedetta Demartini Orsola Gambini Nicola Modugno Enrica Olivola Laura Bonanni Laura Bonanni Alberto Albanese Gina Ferrazzano Rosa De Micco Maurizio Zibetti Giovanna Calandra-Buonaura Giovanna Calandra-Buonaura Martina Petracca Francesca Morgante Francesca Morgante Marcello Esposito Marcello Esposito Antonio Pisani Antonio Pisani Paolo Manganotti Fabrizio Stocchi Mario Coletti Moja Ilaria Antonella Di Vico Lucia Tesolin Francesco De Bertoldi Tommaso Ercoli Giovanni Defazio Mario Zappia Alessandra Nicoletti Michele Tinazzi |
| author_facet | Giovanni Mostile Giovanni Mostile Christian Geroin Roberto Erro Antonina Luca Enrico Marcuzzo Paolo Barone Roberto Ceravolo Sonia Mazzucchi Andrea Pilotto Andrea Pilotto Alessandro Padovani Luigi Michele Romito Roberto Eleopra Carlo Dallocchio Carla Arbasino Francesco Bono Pietro Antonio Bruno Benedetta Demartini Orsola Gambini Nicola Modugno Enrica Olivola Laura Bonanni Laura Bonanni Alberto Albanese Gina Ferrazzano Rosa De Micco Maurizio Zibetti Giovanna Calandra-Buonaura Giovanna Calandra-Buonaura Martina Petracca Francesca Morgante Francesca Morgante Marcello Esposito Marcello Esposito Antonio Pisani Antonio Pisani Paolo Manganotti Fabrizio Stocchi Mario Coletti Moja Ilaria Antonella Di Vico Lucia Tesolin Francesco De Bertoldi Tommaso Ercoli Giovanni Defazio Mario Zappia Alessandra Nicoletti Michele Tinazzi |
| author_sort | Giovanni Mostile |
| collection | DOAJ |
| description | IntroductionFunctional 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.MethodsData 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.ResultsFrom 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.ConclusionUsing a data-driven approach of clinical data from the Italian registry, we differentiated clinical subtypes among combined FMDs to be validated by prospective studies. |
| first_indexed | 2024-04-09T20:31:48Z |
| format | Article |
| id | doaj.art-0f90aa4aff3347918f44025e44038ef5 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T20:31:48Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-0f90aa4aff3347918f44025e44038ef52023-03-30T13:31:12ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-11-011310.3389/fneur.2022.987593987593Data-driven clustering of combined Functional Motor Disorders based on the Italian registryGiovanni Mostile0Giovanni Mostile1Christian Geroin2Roberto Erro3Antonina Luca4Enrico Marcuzzo5Paolo Barone6Roberto Ceravolo7Sonia Mazzucchi8Andrea Pilotto9Andrea Pilotto10Alessandro Padovani11Luigi Michele Romito12Roberto Eleopra13Carlo Dallocchio14Carla Arbasino15Francesco Bono16Pietro Antonio Bruno17Benedetta Demartini18Orsola Gambini19Nicola Modugno20Enrica Olivola21Laura Bonanni22Laura Bonanni23Alberto Albanese24Gina Ferrazzano25Rosa De Micco26Maurizio Zibetti27Giovanna Calandra-Buonaura28Giovanna Calandra-Buonaura29Martina Petracca30Francesca Morgante31Francesca Morgante32Marcello Esposito33Marcello Esposito34Antonio Pisani35Antonio Pisani36Paolo Manganotti37Fabrizio Stocchi38Mario Coletti Moja39Ilaria Antonella Di Vico40Lucia Tesolin41Francesco De Bertoldi42Tommaso Ercoli43Giovanni Defazio44Mario Zappia45Alessandra Nicoletti46Michele Tinazzi47Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, ItalyOasi Research Institute—IRCCS, Troina, ItalyNeurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyCenter for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry—Scuola Medica Salernitana, University of Salerno, Baronissi, ItalySection of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, ItalyNeurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyCenter for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry—Scuola Medica Salernitana, University of Salerno, Baronissi, ItalyNeurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyNeurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyFERB Onlus, Ospedale S. Isidoro, Bergamo, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyParkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, ItalyParkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, ItalyDepartment of Medical Area, Neurology Unit, ASST Pavia, Pavia, ItalyDepartment of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy0Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy0Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy1Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy1Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy2IRCCS Neuromed, Pozzilli, Italy2IRCCS Neuromed, Pozzilli, Italy3Department of Medicine and Aging Sciences, University G. d'Annunzio, Chieti, Italy4Department of Medicine and Aging Sciences, University G. d'Annunzio, Pescara, Italy5IRCCS Humanitas Research Hospital, Milan, Italy6Department of Human Neurosciences, Università La Sapienza, Rome, Italy7Department of Advanced Medical and Surgery Sciences, University of Campania—Luigi Vanvitelli, Naples, Italy8Department of Neuroscience—Rita Levi Montalcini, University of Turin, Turin, Italy9Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy0IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy1Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy2Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom3Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy4Clinical Neurophysiology Unit, Cardarelli Hospital, Naples, Italy5Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples—Federico II, Naples, Italy6IRCCS Mondino Foundation, Pavia, Italy7Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy8Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy9University and Institute of Research and Medical Care San Raffaele, Rome, Italy0Ospedale degli Infermi, Biella, ItalyNeurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy1Psichiatria, Ospedale San Maurizio, Bolzano, Italy1Psichiatria, Ospedale San Maurizio, Bolzano, Italy2Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy2Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, ItalySection of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, ItalySection of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, ItalyNeurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyIntroductionFunctional 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.MethodsData 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.ResultsFrom 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.ConclusionUsing a data-driven approach of clinical data from the Italian registry, we differentiated clinical subtypes among combined FMDs to be validated by prospective studies.https://www.frontiersin.org/articles/10.3389/fneur.2022.987593/fullcluster analysisclinical phenotypesFunctional Motor Disordersdata-driven phenotypingfunctional neurological disorder |
| spellingShingle | Giovanni Mostile Giovanni Mostile Christian Geroin Roberto Erro Antonina Luca Enrico Marcuzzo Paolo Barone Roberto Ceravolo Sonia Mazzucchi Andrea Pilotto Andrea Pilotto Alessandro Padovani Luigi Michele Romito Roberto Eleopra Carlo Dallocchio Carla Arbasino Francesco Bono Pietro Antonio Bruno Benedetta Demartini Orsola Gambini Nicola Modugno Enrica Olivola Laura Bonanni Laura Bonanni Alberto Albanese Gina Ferrazzano Rosa De Micco Maurizio Zibetti Giovanna Calandra-Buonaura Giovanna Calandra-Buonaura Martina Petracca Francesca Morgante Francesca Morgante Marcello Esposito Marcello Esposito Antonio Pisani Antonio Pisani Paolo Manganotti Fabrizio Stocchi Mario Coletti Moja Ilaria Antonella Di Vico Lucia Tesolin Francesco De Bertoldi Tommaso Ercoli Giovanni Defazio Mario Zappia Alessandra Nicoletti Michele Tinazzi Data-driven clustering of combined Functional Motor Disorders based on the Italian registry Frontiers in Neurology cluster analysis clinical phenotypes Functional Motor Disorders data-driven phenotyping functional neurological disorder |
| title | Data-driven clustering of combined Functional Motor Disorders based on the Italian registry |
| title_full | Data-driven clustering of combined Functional Motor Disorders based on the Italian registry |
| title_fullStr | Data-driven clustering of combined Functional Motor Disorders based on the Italian registry |
| title_full_unstemmed | Data-driven clustering of combined Functional Motor Disorders based on the Italian registry |
| title_short | Data-driven clustering of combined Functional Motor Disorders based on the Italian registry |
| title_sort | data driven clustering of combined functional motor disorders based on the italian registry |
| topic | cluster analysis clinical phenotypes Functional Motor Disorders data-driven phenotyping functional neurological disorder |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.987593/full |
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