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Matar E, Tinazzi M, Edwards MJ, Bhatia KP. Functional Movement Disorder as a Prodromal Symptom of Parkinson's Disease-Clinical and Pathophysiological Insights. Mov Disord 2024. [PMID: 39119738 DOI: 10.1002/mds.29958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
Functional movement disorder (FMD) is a common manifestation of functional neurological disorder. FMD can occur alongside other neurological conditions, but especially in patients with established Parkinson's disease (PD). An interesting observation emerging across cohort studies and case series is that FMD can precede the diagnosis of PD, suggesting that FMD may itself be a prodromal symptom of neurodegeneration. Such a notion would have significant clinical implications for the assessment and management of people with FMD, particularly with respect to decisions around the use of auxiliary investigations, counselling, and follow-up. In this Viewpoint we review the evidence concerning the temporal relationship between FMD and PD. We discuss the potential explanations and mechanisms for FMD as a prodromal symptom of PD, and highlight clinical considerations and important outstanding questions in the field. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elie Matar
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, London, United Kingdom
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- Department of Neuropsychiatry, Maudsley Hospital, London, United Kingdom
| | - Kailash P Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, London, United Kingdom
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Silveri MC, Lo Monaco MR, Tondinelli A, Petracca M, Zinzi P, Fragapane S, Pozzi G, Pagnini F, Bentivoglio AR, Di Tella S. Social cognition in Parkinson's disease and functional movement disorders. Neurol Sci 2024; 45:3775-3784. [PMID: 38521891 DOI: 10.1007/s10072-024-07452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Functional movement disorders (FMD) can overlap with Parkinson's disease (PD), and distinguishing between the two clinical conditions can be complex. Framing social cognition (theory of mind) (TOM) disorder, attention deficit, and psychodynamic features of FMD and PD may improve diagnosis. METHODS Subjects with FMD and PD and healthy controls (HC) were administered tasks assessing TOM abilities and attention. The psychodynamic hypothesis of conversion disorder was explored by a questionnaire assessing dissociative symptoms. A comprehensive battery of neuropsychological tasks was also administered to FMD and PD. RESULTS Although both FMD and PD scored lower than HC on all TOM tests, significant correlations between TOM and neuropsychological tasks were found only in PD but not in FMD. Only PD showed a reduction in attentional control. Dissociative symptoms occurred only in FMD. DISCUSSION Cognitive-affective disturbances are real in FMD, whereas they are largely dependent on cognitive impairment in PD. Attentional control is preserved in FMD compared to PD, consistent with the hypothesis that overload of voluntary attentional orientation may be at the basis of the onset of functional motor symptoms. On a psychodynamic level, the confirmation of dissociative symptoms in FMD supports the conversion disorder hypothesis. CONCLUSION FMD and PD can be distinguished on an affective and cognitive level. At the same time, however, the objective difficulty often encountered in distinguishing between the two pathologies draws attention to how blurred the boundary between 'organic' and 'functional' can be.
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Affiliation(s)
- Maria Caterina Silveri
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Maria Rita Lo Monaco
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Alice Tondinelli
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Martina Petracca
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Paola Zinzi
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Serena Fragapane
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Gino Pozzi
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Anna Rita Bentivoglio
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Sonia Di Tella
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
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Zeuner KE, Schwingenschuh P. [Additional functional symptoms in Parkinson's disease and tremor syndromes]. DER NERVENARZT 2024; 95:525-531. [PMID: 38180511 DOI: 10.1007/s00115-023-01594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
Patients with Parkinson's Disease or a tremor syndrome may present with additional functional movement disorders. The differential diagnosis is particularly difficult. In some cases, functional symptoms occur either before the manifestation of the organic disease or can emerge as an additional symptom after Parkinson's disease or tremor became apparent. In patients with Parkinson's disease the prevalence for additional functional symptoms is 7 %. In the case that patients with Parkinson's diseases have one side that is more severely affected, additional functional motor symptoms such as functional rest tremor also occur on that same, predominantly affected side. Functional gait disorders occur frequently. Clinically, patients appear notably slow in automatized, daily tasks. Their speech is more whispering than hypophonic, bradykinesia during finger tapping manifest without a decrement. The Dopamintransporterszintigraphy (123) I FP-CIT SPECT; DaTSCANTM) may be helpful to differentiate between functional Parkinsonism and Parkinson's disease. Functional tremor in patients with an organic tremor syndrome is diagnosed with the same distraction techniques as in solely functional tremor. This includes cognitive, motor, and suggestive distraction maneuvers. In some cases, additional neurophysiological investigations such as accelerometry are useful for the differential diagnosis. It is most important to identify patients with additional functional symptoms in non-functional movement disorders, because the therapeutic approach differs and a multi professional team is required to initiate effective treatment strategies.
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Affiliation(s)
- Kirsten E Zeuner
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3 Haus 41, 24105, Kiel, Deutschland.
| | - Petra Schwingenschuh
- Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz, Österreich
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Cabreira V, Alty J, Antic S, Araújo R, Aybek S, Ball HA, Baslet G, Bhome R, Coebergh J, Dubois B, Edwards M, Filipović SR, Frederiksen KS, Harbo T, Hayhow B, Howard R, Huntley J, Isaacs J, LaFrance WC, Larner AJ, Di Lorenzo F, Main J, Mallam E, Marra C, Massano J, McGrath ER, McWhirter L, Moreira IP, Nobili F, Pennington C, Tábuas-Pereira M, Perez DL, Popkirov S, Rayment D, Rossor M, Russo M, Santana I, Schott J, Scott EP, Taipa R, Tinazzi M, Tomic S, Toniolo S, Tørring CW, Wilkinson T, Frostholm L, Stone J, Carson A. Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study. Eur J Neurol 2024:e16318. [PMID: 38700361 DOI: 10.1111/ene.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/18/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. METHODS International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken. RESULTS Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD. CONCLUSIONS Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Sonja Antic
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Selma Aybek
- Neurology, Faculty of Sciences and Medicine, Fribourg University, Fribourg, Switzerland
| | - Harriet A Ball
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rohan Bhome
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Jan Coebergh
- Department of Neurology, St George's University of London, London, UK
| | - Bruno Dubois
- Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer (IM2A), AP-HP, Brain Institute, Sorbonne University, Paris, France
| | - Mark Edwards
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry Psychology and Neurosciences, Kings College London, London, UK
| | - Saša R Filipović
- University of Belgrade Institute for Medical Research, Belgrade, Serbia
| | - Kristian Steen Frederiksen
- Clinical Trial Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bradleigh Hayhow
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Jeremy Isaacs
- Department of Neurology, St George's University of London, London, UK
| | - William Curt LaFrance
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Francesco Di Lorenzo
- Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - James Main
- Bristol Dementia Wellbeing Service, Devon Partnership NHS Trust, Bristol, UK
| | | | - Camillo Marra
- Department of Neuroscience, Catholic University of the Sacred Heart, Memory Clinic - Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - João Massano
- Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
| | - Emer R McGrath
- School of Medicine, University of Galway, Galway, Ireland
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Isabel Portela Moreira
- Neurology Department, Private Hospital of Gaia of the Trofa Saúde Group, Vila Nova de Gaia, Portugal
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Catherine Pennington
- Clinical Lecturer, University of Edinburgh, Edinburgh, UK
- Neurology Department, NHS Forth Valley, Larbert, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Miguel Tábuas-Pereira
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - David L Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Dane Rayment
- Rosa Burden Centre for Neuropsychiatry, Southmead Hospital, Bristol, UK
| | - Martin Rossor
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Emmi P Scott
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ricardo Taipa
- Neuropathology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Svetlana Tomic
- Department of Neurology, University Hospital Center Osijek, Medical School on University of Osijek, Osijek, Croatia
| | - Sofia Toniolo
- Cognitive Disorder Clinic, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Mavroudis I, Kazis D, Kamal FZ, Gurzu IL, Ciobica A, Pădurariu M, Novac B, Iordache A. Understanding Functional Neurological Disorder: Recent Insights and Diagnostic Challenges. Int J Mol Sci 2024; 25:4470. [PMID: 38674056 PMCID: PMC11050230 DOI: 10.3390/ijms25084470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder's multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK;
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Technical (ISPITS), Marrakech 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, Settat 26000, Morocco
| | - Irina-Luciana Gurzu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (A.I.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Carol I Avenue 20th A, 700505 Iasi, Romania
- Center of Biomedical Research, Romanian Academy, Iasi Branch, Teodor Codrescu 2, 700481 Iasi, Romania
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
- Preclinical Department, Apollonia University, Păcurari Street 11, 700511 Iasi, Romania
| | - Manuela Pădurariu
- “Socola” Institute of Psychiatry, Șoseaua Bucium 36, 700282 Iasi, Romania;
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (A.I.)
| | - Alin Iordache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (A.I.)
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Müller‐Vahl KR, Pisarenko A, Fremer C, Haas M, Jakubovski E, Szejko N. Functional Tic-Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome. Mov Disord Clin Pract 2024; 11:227-237. [PMID: 38468554 PMCID: PMC10928340 DOI: 10.1002/mdc3.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Comorbid functional tic-like behaviors (FTB) have been described only rarely in patients with Tourette syndrome (TS). OBJECTIVES We present the first large sample of patients suffering from TS and FTB to raise awareness of this clinical presentation and to guide how to differentiate one from the other. METHODS We analyzed clinical data of 71 patients (n = 27 [38.0%] female, mean age: 21.5, range: 11-55) with TS + FTB. RESULTS In the majority of patients, FTB started abruptly on average 15 years after tic onset with "treatment-resistant" complex movements and ("coprophenomena-like") vocalizations preceded by timely related psychological stressors. Psychological evaluation revealed evidence for internal conflicts (79%), emotional dysregulation (56%), and maintaining factors (70%). About one third of patients had a positive history for further medically unexplained symptoms. Compared to a large TS sample (n = 1032), patients with TS + FTB were more likely to be female, and presented significantly more common with "coprophenomena-like" symptoms, atypical influential factors, atypical descriptions of premonitory sensations, and higher rates of comorbid obsessive-compulsive disorder and "self-injurious" behavior. CONCLUSIONS Based on our data it can be assumed that FTB is a common comorbidity in TS, similar to functional overlay in other movement disorders and epilepsy. Before classifying a patient as suffering from treatment-resistant TS, FTB should be ruled out.
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Affiliation(s)
- Kirsten R. Müller‐Vahl
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Anna Pisarenko
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Carolin Fremer
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Martina Haas
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
| | - Natalia Szejko
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHannoverGermany
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Department of BioethicsMedical University of WarsawWarsawPoland
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Delgado C, Lopez-Jimenez A, Lopez-Valdes E, Gomez-Mayordomo V, Baltasar-Corral A, Martínez-Castrillo JC, Alonso-Canovas A, Tabar G, García-Ruiz PJ, de la Fuente S, Vela-Desojo L, Pareés I, Kurtis MM. Functional movement disorder comorbidity in Parkinson's disease: A multicenter descriptive study. Parkinsonism Relat Disord 2023; 114:105776. [PMID: 37544162 DOI: 10.1016/j.parkreldis.2023.105776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/16/2023] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Isabel Pareés
- Hospital Ruber Internacional, Madrid, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
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Glovinsky D, Gruber-Baldini AL, Himelhoch S, Anderson KE, Shulman LM. Somatoform Symptoms in Parkinson Disease. Cogn Behav Neurol 2022; 35:255-262. [PMID: 36201624 DOI: 10.1097/wnn.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/10/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Co-occurring somatoform symptoms complicate the diagnosis and treatment of Parkinson disease (PD). OBJECTIVE To learn more about the relationship between somatoform symptoms and PD by comparing demographic and clinical features across PD groups differing in somatoform symptom severity. METHOD Using standardized Brief Symptom Inventory-18 (BSI-18) scores to measure somatoform symptom severity, we assigned 1093 individuals with PD to one of four subgroups using comparisons to normative means: low (M < -½ SD), average (M ± ½ SD), high (M +½ SD to +1 SD), very high (M > +1 SD). We used demographics and disease severity measures to assess each subgroup. RESULTS Most of the individuals with PD (56%) had high or very high somatoform symptom levels. Increased somatoform symptom levels were associated with female gender, lower socioeconomic status, greater disease duration, increased PD severity (Total Unified Parkinson's Disease Rating Scale), greater disability (Older Americans Resource and Services Disability subscale), increased BSI-18 Depression and Anxiety subscale scores, lower cognitive function (Mini-Mental State Examination), lower self-efficacy scores (Self-Efficacy to Manage Chronic Disease Scale), lower quality of life scores (SF-12 Health Status Survey), and greater medical comorbidity (Cumulative Illness Rating Scale-Geriatrics) (all comparisons: P < 0.001). We found no significant between-group differences for age, race, or marital status. CONCLUSION Somatoform symptom severity in individuals with PD is associated with greater PD severity and disability and is more common in females and in individuals with low socioeconomic status. Greater awareness of somatoform symptoms should help improve PD treatment.
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Affiliation(s)
| | | | - Seth Himelhoch
- Department of Psychiatry, University of Kentucky College of Medicine, Louisville, Kentucky
| | - Karen E Anderson
- Departments of Psychiatry
- Neurology, MedStar Georgetown University Hospital, Washington, DC
| | - Lisa M Shulman
- Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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Mostile G, Geroin C, Erro R, Luca A, Marcuzzo E, Barone P, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Dallocchio C, Arbasino C, Bono F, Bruno PA, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Albanese A, Ferrazzano G, De Micco R, Zibetti M, Calandra-Buonaura G, Petracca M, Morgante F, Esposito M, Pisani A, Manganotti P, Stocchi F, Coletti Moja M, Di Vico IA, Tesolin L, De Bertoldi F, Ercoli T, Defazio G, Zappia M, Nicoletti A, Tinazzi M. Data-driven clustering of combined Functional Motor Disorders based on the Italian registry. Front Neurol 2022; 13:987593. [PMID: 36518193 PMCID: PMC9742245 DOI: 10.3389/fneur.2022.987593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Giovanni Mostile
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
- Oasi Research Institute—IRCCS, Troina, Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Christian Geroin
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry—Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Antonina Luca
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry—Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- FERB Onlus, Ospedale S. Isidoro, Bergamo, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carlo Dallocchio
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | | | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d'Annunzio, Chieti, Italy
- Department of Medicine and Aging Sciences, University G. d'Annunzio, Pescara, Italy
| | | | - Gina Ferrazzano
- Department of Human Neurosciences, Università La Sapienza, Rome, Italy
| | - Rosa De Micco
- Department of Advanced Medical and Surgery Sciences, University of Campania—Luigi Vanvitelli, Naples, Italy
| | - Maurizio Zibetti
- Department of Neuroscience—Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Marcello Esposito
- Clinical Neurophysiology Unit, Cardarelli Hospital, Naples, Italy
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples—Federico II, Naples, Italy
| | - Antonio Pisani
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele, Rome, Italy
| | | | - Ilaria Antonella Di Vico
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Zappia
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- *Correspondence: Michele Tinazzi
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10
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Delli Pizzi S, Franciotti R, Chiacchiaretta P, Ferretti A, Edden RA, Sestieri C, Russo M, Sensi SL, Onofrj M. Altered Medial Prefrontal Connectivity in Parkinson's Disease Patients with Somatic Symptoms. Mov Disord 2022; 37:2226-2235. [PMID: 36054283 DOI: 10.1002/mds.29187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The high co-occurrence of somatic symptom disorder (SSD) in Parkinson's disease (PD) patients suggests overlapping pathophysiology. However, little is known about the neural correlates of SSD and their possible interactions with PD. Existing studies have shown that SSD is associated with reduced task-evoked activity in the medial prefrontal cortex (mPFC), a central node of the default-mode network (DMN). SSD is also associated with abnormal γ-aminobutyric acid (GABA) content, a marker of local inhibitory tone and regional hypoactivity, in the same area when SSD co-occurs with PD. OBJECTIVES To disentangle the individual and shared effects of SSD and PD on mPFC neurotransmission and connectivity patterns and help disclose the neural mechanisms of comorbidity in the PD population. METHODS The study cohort included 18 PD patients with SSD (PD + SSD), 18 PD patients, 13 SSD patients who did not exhibit neurologic disorders, and 17 healthy subjects (HC). Proton magnetic resonance (MR) spectroscopy evaluated GABA levels within a volume of interest centered on the mPFC. Resting-state functional MR imaging investigated the region's functional connectivity patterns. RESULTS Compared to HC or PD groups, the mPFC of SSD subjects exhibited higher GABA levels and connectivity. Higher mPFC connectivity involved DMN regions in SSD patients without PD and regions of the executive and attentional networks (EAN) in patients with PD comorbidity. CONCLUSIONS Aberrant reconfigurations of connectivity patterns between the mPFC and the EAN are distinct features of the PD + SSD comorbidity. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Stefano Delli Pizzi
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy.,Service of Molecular Neurology, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy
| | - Piero Chiacchiaretta
- Advanced Computing Core, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti - Pescara, Chieti, Italy.,Department of Advanced Technologies in Medicine & Dentistry, University G. d'Annunzio of Chieti - Pescara, Chieti, 66100, Italy
| | - Antonio Ferretti
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy
| | - Richard A Edden
- Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Center for Functional MRI, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Carlo Sestieri
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy.,Service of Molecular Neurology, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti- Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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11
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Mark VW. Functional neurological disorder: Extending the diagnosis to other disorders, and proposing an alternate disease term—Attentionally-modifiable disorder. NeuroRehabilitation 2022; 50:179-207. [DOI: 10.3233/nre-228003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed.
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Affiliation(s)
- Victor W. Mark
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Onofrj M, Russo M, Carrarini C, Delli Pizzi S, Thomas A, Bonanni L, Espay AJ, Sensi SL. Functional neurological disorder and somatic symptom disorder in Parkinson's disease. J Neurol Sci 2021; 433:120017. [PMID: 34629180 DOI: 10.1016/j.jns.2021.120017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022]
Abstract
The occurrence of Functional Neurological Disorder (FND) and Somatic Symptom Disorder (SSD) in PD was not commonly accepted until recently, despite some evidence that emerged in the pre and early L-Dopa era. More recently, the recognition of FND and SSD were noted to be relevant for the management of PD. FND and SSD appear early in the course of PD, often preceding motor symptoms, may interfere with treatment outcomes, often acquire psychotic features during progression, and are mixed with and often concealed by the progressive cognitive decline. We review the related features from the range of the available reports and discuss theoretical models conceived to explain the potential pathophysiological background of these disorders. Finally, we suggest that FND and SSD should be included among the non-motor symptoms of PD and be considered a prodromal feature in a subset of patients. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States.
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13
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Tinazzi M, Geroin C, Erro R, Marcuzzo E, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Pascarella A, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Antelmi E, Zanolin E, Albanese A, Ferrazzano G, de Micco R, Lopiano L, Calandra-Buonaura G, Petracca M, Esposito M, Pisani A, Manganotti P, Stocchi F, Coletti Moja M, Antonini A, Ercoli T, Morgante F. Functional motor disorders associated with other neurological diseases: Beyond the boundaries of "organic" neurology. Eur J Neurol 2021; 28:1752-1758. [PMID: 33300269 DOI: 10.1111/ene.14674] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The aims of this study were to describe the clinical manifestations of functional motor disorders (FMDs) coexisting with other neurological diseases ("comorbid FMDs"), and to compare comorbid FMDs with FMDs not overlapping with other neurological diseases ("pure FMDs"). METHODS For this multicenter observational study, we enrolled outpatients with a definite FMD diagnosis attending 25 tertiary movement disorder centers in Italy. Each patient with FMDs underwent a detailed clinical assessment including screening for other associated neurological conditions. Group comparisons (comorbid FMDs vs. pure FMDs) were performed in order to compare demographic and clinical variables. Logistic regression models were created to estimate the adjusted odds ratios (95% confidence intervals) of comorbid FMDs (dependent variable) in relation to sociodemographic and clinical characteristics (independent variables). RESULTS Out of 410 FMDs, 21.7% of patients (n = 89) had comorbid FMDs. The most frequent coexisting neurological diseases were migraine, cerebrovascular disease and parkinsonism. In the majority of cases (86.5%), FMDs appeared after the diagnosis of a neurological disease. Patients with comorbid FMDs were older, and more frequently had tremor, non-neurological comorbidities, paroxysmal non-epileptic seizures, major depressive disorders, and benzodiazepine intake. Multivariate regression analysis showed that diagnosis of comorbid FMDs was more likely associated with longer time lag until the final diagnosis of FMD, presence of tremor and non-neurological comorbidities. CONCLUSIONS Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non-neurological diseases.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Baronissi, SA, Italy
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry -Scuola Medica Salernitana, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Baronissi, SA, Italy
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Zappia
- Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department G.F. Ingrassia, University of Catania, Catania, Italy
| | - Carlo Dallocchio
- Neurology Unit, Department of Medical Area, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Neurology Unit, Department of Medical Area, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Angelo Pascarella
- Botulinum Toxin Center, Neurology Unit, A.O.U. Mater Domini, Catanzaro, Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics - Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics - Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti-Pescara, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Università La Sapienza, Rome, Italy
| | - Rosa de Micco
- Department of Advanced Medical and Surgery Sciences, University of Campania - Luigi Vanvitelli, Naples, Italy
| | - Leonardo Lopiano
- Department of Neuroscience - Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences of Bologna, IRCCS, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele, Roma, Italy
| | | | - Angelo Antonini
- Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
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14
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Kurtis MM, Pareés I. Functional movement disorder comorbidity in Parkinson's disease: Unraveling the web. Parkinsonism Relat Disord 2020; 82:138-145. [PMID: 33092981 DOI: 10.1016/j.parkreldis.2020.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
Functional movement disorders are commonly seen in neurology services and may coexist with other neurological diseases. This combination is known as "functional overlay" and an increasing interest on this topic has emerged in the past decade as the field of functional neurological disorders has moved forward. Some neurological diseases may be more prone to develop "functional overlay" than others, and within the field of movement disorders, most studies have focused on patients with Parkinson's disease. This review comprehensively summarizes the current body of knowledge on this topic and provides an expert opinion to equip clinicians with a pragmatic approach to recognize functional movement disorders in patients with Parkinson's disease, to communicate the diagnosis and to become familiar with potential therapies in this complex clinical scenario. Potential underlying mechanisms and risk factors that may play a role in increasing the vulnerability of Parkinson's disease patients to develop functional movement disorder comorbidity are also discussed within the framework of modern neurobiological theories of brain functioning.
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Affiliation(s)
- Monica M Kurtis
- Functional Movement Disorders Unit, Movement Disorders Program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.
| | - Isabel Pareés
- Functional Movement Disorders Unit, Movement Disorders Program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain; Neurology Department, Hospital Ramon y Cajal, Madrid, Spain.
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15
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Ambar Akkaoui M, Geoffroy PA, Roze E, Degos B, Garcin B. Functional Motor Symptoms in Parkinson's Disease and Functional Parkinsonism: A Systematic Review. J Neuropsychiatry Clin Neurosci 2020; 32:4-13. [PMID: 31466517 DOI: 10.1176/appi.neuropsych.19030058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Whereas functional symptoms are common in Parkinson's disease (PD), a parkinsonian syndrome may occasionally reflect a pure functional disorder (also named functional parkinsonism [FP]). This review aimed to decipher these entities to clarify the link between functional manifestations and PD. METHODS Following the PRISMA guidelines, the authors performed a systematic literature search of the PubMed and Science Direct databases for the period 1988 to December 2018 to identify studies of patients with either FP or PD associated with functional neurological symptoms. RESULTS From the 844 articles screened, 22 were retained, including 12 studies of functional neurological symptoms in PD and 16 studies of FP. The studies of functional symptoms in PD included 121 patients-57% were women, and the mean age was 61.3 years. Psychiatric history (mostly depression) and exposure to triggering stressors were frequent: 60% and 82.5%, respectively. The most common symptom was tremor (33.8%), most often located on the side most affected by PD (50%). Studies of FP included a total of 120 patients-62% were women, and the mean age was 50.7 years. The first FP symptoms appeared on average 5 years before diagnosis, with an abrupt onset in half the cases; 67.6% had a psychiatric history, and 46.8% were exposed to triggering stressors, such as physical injury, stress at work, or loss of family or friends. CONCLUSIONS Findings suggest a possible relationship between PD and FP. Clinicians should keep in mind the possibility of functional symptoms in PD patients.
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Affiliation(s)
- Marine Ambar Akkaoui
- Neurology Unit, Avicenne University Hospital, Hôpitaux Universitaires de Paris-Seine Saint Denis, Bobigny, France (Ambar Akkaoui, Degos, Garcin); Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, Paris (Degos); the Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, and Paris Diderot University, Paris (Geoffroy); the Department of Neurology, Salpêtrière Hospital, AP-HP, Paris (Roze); and Brain and Spine Institute, Faculty of Medicine of Sorbonne University, Paris (Roze, Garcin)
| | - Pierre A Geoffroy
- Neurology Unit, Avicenne University Hospital, Hôpitaux Universitaires de Paris-Seine Saint Denis, Bobigny, France (Ambar Akkaoui, Degos, Garcin); Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, Paris (Degos); the Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, and Paris Diderot University, Paris (Geoffroy); the Department of Neurology, Salpêtrière Hospital, AP-HP, Paris (Roze); and Brain and Spine Institute, Faculty of Medicine of Sorbonne University, Paris (Roze, Garcin)
| | - Emmanuel Roze
- Neurology Unit, Avicenne University Hospital, Hôpitaux Universitaires de Paris-Seine Saint Denis, Bobigny, France (Ambar Akkaoui, Degos, Garcin); Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, Paris (Degos); the Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, and Paris Diderot University, Paris (Geoffroy); the Department of Neurology, Salpêtrière Hospital, AP-HP, Paris (Roze); and Brain and Spine Institute, Faculty of Medicine of Sorbonne University, Paris (Roze, Garcin)
| | - Bertrand Degos
- Neurology Unit, Avicenne University Hospital, Hôpitaux Universitaires de Paris-Seine Saint Denis, Bobigny, France (Ambar Akkaoui, Degos, Garcin); Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, Paris (Degos); the Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, and Paris Diderot University, Paris (Geoffroy); the Department of Neurology, Salpêtrière Hospital, AP-HP, Paris (Roze); and Brain and Spine Institute, Faculty of Medicine of Sorbonne University, Paris (Roze, Garcin)
| | - Béatrice Garcin
- Neurology Unit, Avicenne University Hospital, Hôpitaux Universitaires de Paris-Seine Saint Denis, Bobigny, France (Ambar Akkaoui, Degos, Garcin); Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, Collège de France, Paris (Degos); the Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, and Paris Diderot University, Paris (Geoffroy); the Department of Neurology, Salpêtrière Hospital, AP-HP, Paris (Roze); and Brain and Spine Institute, Faculty of Medicine of Sorbonne University, Paris (Roze, Garcin)
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16
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Delli Pizzi S, Franciotti R, Ferretti A, Edden RA, Zöllner HJ, Esposito R, Bubbico G, Aiello C, Calvanese F, Sensi SL, Tartaro A, Onofrj M, Bonanni L. High
γ‐Aminobutyric
Acid Content Within the Medial Prefrontal Cortex Is a Functional Signature of Somatic Symptoms Disorder in Patients With Parkinson's Disease. Mov Disord 2020; 35:2184-2192. [DOI: 10.1002/mds.28221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Antonio Ferretti
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology The Johns Hopkins University School of Medicine Baltimore Maryland USA
- F.M. Kirby Center for Functional MRI Kennedy Krieger Institute Baltimore Maryland USA
| | - Helge J. Zöllner
- Russell H. Morgan Department of Radiology The Johns Hopkins University School of Medicine Baltimore Maryland USA
- F.M. Kirby Center for Functional MRI Kennedy Krieger Institute Baltimore Maryland USA
| | | | - Giovanna Bubbico
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
| | - Claudia Aiello
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Francesco Calvanese
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Armando Tartaro
- Department of Medical Sciences, Oral and Biotechnology University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
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17
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Paio F, Antelmi E, Conti E, Di Vico I, Tinazzi M. Functional Motor Disorders Mimicking Symptoms Upon Resolution of Cerebrovascular Disease. Mov Disord Clin Pract 2020; 7:552-554. [DOI: 10.1002/mdc3.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabio Paio
- Neurology Unit, Movement Disorders Division, Department of NeurosciencesBiomedicine and Movement Sciences, University of Verona Verona Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of NeurosciencesBiomedicine and Movement Sciences, University of Verona Verona Italy
| | - Enrico Conti
- Neurology Unit, Movement Disorders Division, Department of NeurosciencesBiomedicine and Movement Sciences, University of Verona Verona Italy
| | - Ilaria Di Vico
- Neurology Unit, Movement Disorders Division, Department of NeurosciencesBiomedicine and Movement Sciences, University of Verona Verona Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of NeurosciencesBiomedicine and Movement Sciences, University of Verona Verona Italy
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18
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Nielsen G, Stone J, Buszewicz M, Carson A, Goldstein LH, Holt K, Hunter R, Marsden J, Marston L, Noble H, Reuber M, Edwards MJ. Physio4FMD: protocol for a multicentre randomised controlled trial of specialist physiotherapy for functional motor disorder. BMC Neurol 2019; 19:242. [PMID: 31638942 PMCID: PMC6802344 DOI: 10.1186/s12883-019-1461-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with functional motor disorder (FMD) experience persistent and disabling neurological symptoms such as weakness, tremor, dystonia and disordered gait. Physiotherapy is usually considered an important part of treatment; however, sufficiently-powered controlled studies are lacking. Here we present the protocol of a randomised controlled trial (RCT) that aims to evaluate the clinical and cost effectiveness of a specialist physiotherapy programme for FMD. METHODS/DESIGN The trial is a pragmatic, multicentre, single blind parallel arm randomised controlled trial (RCT). 264 Adults with a clinically definite diagnosis of FMD will be recruited from neurology clinics and randomised to receive either the trial intervention (a specialist physiotherapy protocol) or treatment as usual control (referral to a community physiotherapy service suitable for people with neurological symptoms). Participants will be followed up at 6 and 12 months. The primary outcome is the Physical Function domain of the Short Form 36 questionnaire at 12 months. Secondary domains of measurement will include participant perception of change, mobility, health-related quality of life, health service utilisation, anxiety and depression. Health economic analysis will evaluate the cost impact of trial and control interventions from a health and social care perspective as well as societal perspective. DISCUSSION This trial will be the first adequately-powered RCT of physical-based rehabilitation for FMD. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number ISRCTN56136713 . Registered 27 March 2018.
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Affiliation(s)
- Glenn Nielsen
- Motor Control and Movement Disorders Group, Institute of Molecular and Clinical Sciences, St Georges University of London, London, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, UCL, London, UK
- Priment Clinical Trials Unit, UCL, London, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Laura H. Goldstein
- King’s College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, UK
| | - Kate Holt
- Motor Control and Movement Disorders Group, Institute of Molecular and Clinical Sciences, St Georges University of London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, UCL, London, UK
- Priment Clinical Trials Unit, UCL, London, UK
| | - Jonathan Marsden
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, UCL, London, UK
- Priment Clinical Trials Unit, UCL, London, UK
| | - Hayley Noble
- Motor Control and Movement Disorders Group, Institute of Molecular and Clinical Sciences, St Georges University of London, London, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - Mark J. Edwards
- Motor Control and Movement Disorders Group, Institute of Molecular and Clinical Sciences, St Georges University of London, London, UK
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19
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Braus BR, Rummans TA, Lapid MI, Morgan RJ, Sampson SM, Handler EM, Dimsdale JE. Clinicians and Cognitive Bias: A Case of Frontotemporal Dementia Misdiagnosed as Conversion Disorder. Am J Psychiatry 2019; 176:690-693. [PMID: 31474126 DOI: 10.1176/appi.ajp.2018.18050551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin R Braus
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Teresa A Rummans
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Maria I Lapid
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Robert J Morgan
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Shirlene M Sampson
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Elliot M Handler
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Joel E Dimsdale
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
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20
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Somatic symptoms disorders in Parkinson's disease are related to default mode and salience network dysfunction. NEUROIMAGE-CLINICAL 2019; 23:101932. [PMID: 31491814 PMCID: PMC6658828 DOI: 10.1016/j.nicl.2019.101932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/11/2019] [Accepted: 07/13/2019] [Indexed: 01/27/2023]
Abstract
Background Somatic Symptoms Disorder (SSD) has been shown to have a clinically very high prevalence in Parkinson's Disease (PD) with frequencies ranging from 7.0% to 66.7%, higher than in the general population (10%- 25%). SSD has been associated with dysfunction in Default Mode and Salience network. Aim With the present study we aim to verify by means of resting state functional MRI whether possible specific abnormalities in the activation and functional connectivity of the default mode network (DMN) and salience network in cognitively intact PD patients may be more prominent in PD patients with somatic symptoms (SSD-PD) as compared with patients without SSD (PD). Methods Eighteen SSD-PD patients (61% male), 18 PD patients (83% male) and 22 healthy age-matched subjects (59% male) were enrolled in the study and underwent resting state functional MRI. Results fractional amplitude of low-frequency fluctuation (fALFF) showed reduced activity in bilateral lateral parietal cortex and in left anterior insula in both SSD-PD and PD compared to control group. Functional connectivity (FC) values in the DMN areas and between DMN and salience network areas were found to be lower in SSD-PD than in control group and PD. No significant correlation was found between fMRI results and demographic and clinical variables, excluding the effect of possible confounders on fMRI results. The present study, showing reduced activity in bilateral parietal areas and in the left anterior insula as compared to healthy controls, suggests a dysfunction of the DMN and salience network in PD, either with or without SSD. The FC reduction within DMN areas and between DMN and salience network areas in SSD-PD patients suggests a role of dysfunctional connectivity in the resting state network of patients with SSD. Reduced activity in parietal areas and in anterior insula in Parkinson's Disease. Functional connectivity is lower in Parkinson's disease with somatic symptoms. Somatic Symptoms in PD are related to default mode and salience network alterations.
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21
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Onofrj M, Espay AJ, Bonanni L, Delli Pizzi S, Sensi SL. Hallucinations, somatic-functional disorders of PD-DLB as expressions of thalamic dysfunction. Mov Disord 2019; 34:1100-1111. [PMID: 31307115 DOI: 10.1002/mds.27781] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Hallucinations, delusions, and functional neurological manifestations (conversion and somatic symptom disorders) of Parkinson's disease (PD) and dementia with Lewy bodies increase in frequency with disease progression, predict the onset of cognitive decline, and eventually blend with and are concealed by dementia. These symptoms share the absence of reality constraints and can be considered comparable elements of the PD-dementia with Lewy bodies psychosis. We propose that PD-dementia with Lewy bodies psychotic disorders depend on thalamic dysfunction promoting a theta burst mode and subsequent thalamocortical dysrhythmia with focal cortical coherence to theta electroencephalogram rhythms. This theta electroencephalogram activity, also called fast-theta or pre-alpha, has been shown to predict cognitive decline and fluctuations in Parkinson's disease with dementia and dementia with Lewy bodies. These electroencephalogram alterations are now considered a predictive marker for progression to dementia. The resulting thalamocortical dysrhythmia inhibits the frontal attentional network and favors the decoupling of the default mode network. As the default mode network is involved in integration of self-referential information into conscious perception, unconstrained default mode network activity, as revealed by recent imaging studies, leads to random formation of connections that link strong autobiographical correlates to trivial stimuli, thereby producing hallucinations, delusions, and functional neurological disorders. The thalamocortical dysrhythmia default mode network decoupling hypothesis provides the rationale for the design and testing of novel therapeutic pharmacological and nonpharmacological interventions in the context of PD, PD with dementia, and dementia with Lewy bodies. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy.,Departments of Neurology and Pharmacology, Institute for Mind Impairments and Neurological Disorders, University of California - Irvine, Irvine, California, USA
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22
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Edwards MJ. Functional neurological disorder: an ethical turning point for neuroscience. Brain 2019; 142:1855-1857. [DOI: 10.1093/brain/awz194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark J Edwards
- Neuroscience Research Centre, Institute of Molecular and Cell Sciences, St George’s University of London, London, UK
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23
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Gelauff JM, Carson A, Ludwig L, Tijssen MAJ, Stone J. The prognosis of functional limb weakness: a 14-year case-control study. Brain 2019; 142:2137-2148. [DOI: 10.1093/brain/awz138] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
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.
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Affiliation(s)
- Jeannette M Gelauff
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh, UK
- University Medical Centre Groningen, University of Groningen, Department of Neurology, Hanzeplein 1, RB, The Netherlands
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh, UK
| | - Lea Ludwig
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh, UK
| | - Marina A J Tijssen
- University Medical Centre Groningen, University of Groningen, Department of Neurology, Hanzeplein 1, RB, The Netherlands
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, Edinburgh, UK
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24
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Mätzold S, Geritz J, Zeuner KE, Berg D, Paschen S, Hieke J, Sablowsky S, Ortlieb C, Bergmann P, Hofmann W, Espay AJ, Maetzler W. Functional movement disorders in neurogeriatric inpatients : Underdiagnosed, often comorbid to neurodegenerative disorders and treatable. Z Gerontol Geriatr 2019; 52:324-329. [PMID: 31139963 DOI: 10.1007/s00391-019-01562-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The proportion of patients with functional movement disorders (FMD) is particularly high in neurology clinics. Treatment options have not been consistently developed, not well evaluated and not validated. This article presents the preliminary data on the prevalence and treatment response of patients with FMD who were treated within the framework of an early rehabilitative geriatric complex treatment at a university hospital for neurology. METHODS From July 2017 to November 2018 the prevalence, demographic and clinical parameters, and response to treatment of FMD patients were documented and compared to non-FMD patients treated at the neurogeriatric ward of the University Hospital Schleswig-Holstein, in Kiel. Clinical endpoints were the Short Physical Performance Battery (SPPB) for mobility and the Barthel index for instrumented activity of daily life (iADL). RESULTS The prevalence of FMD was 11% (19/175) and predominantly observed in women (74%). Of the FMD patients nine also had a diagnosis of either idiopathic Parkinson's disease (N = 7), dementia with Lewy bodies (N = 1) or progressive supranuclear palsy (N = 1). At admission, neither the SPPB nor the iADL differed significantly between FMD and non-FMD patients. The treatment response was comparable between the groups: SPPB change was +0.3±1.8 (mean, standard deviation) in FMD and +0.4±1.9 in non-FMD patients (p = 0.83). The iADL change was +19±15 in FMD and +18±17 in non-FMD (p = 0.83). CONCLUSION The prevalence of FMD was unexpectedly high in the neurogeriatric ward of a German university hospital. There were comparable impairments and responses to multidisciplinary treatment in mobility and iADL between FMD and non-FMD geriatric patients, suggesting that specific and informed treatment provided by a multidisciplinary geriatric team is effective in geriatric FMD patients. Further studies of this underdiagnosed disorder in older age are warranted.
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Affiliation(s)
- Sara Mätzold
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Johanne Hieke
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Simone Sablowsky
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Christian Ortlieb
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Werner Hofmann
- Institute of Family Medicine, Center of Geriatrics, University Hospital Schleswig-Holstein, Campus Lübeck, Neumünster and Bad Bramstedt, Germany
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany.
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Abstract
Purpose of Review Functional movement disorders are common and disabling causes of abnormal movement control. Here, we review the current state of the evidence on the use of neuroimaging in Functional movement disorders, particularly its role in helping to unravel the pathophysiology of this enigmatic condition. Recent Findings In recent years, there has been a shift in thinking about functional movement disorder, away from a focus on high-level psychological precipitants as in Freudian conversion theories, or even an implicit belief they are ‘put-on’ for secondary gain. New research has emphasised novel neurobiological models incorporating emotional processing, self-representation and agency. Summary Neuroimaging has provided new insights into functional movement disorders, supporting emerging neurobiological theories implicating dysfunctional emotional processing, self-image and sense of agency. Recent studies have also found subtle structural brain changes in patients with functional disorders, arguing against a strict functional/structural dichotomy.
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Bove F, Di Lazzaro G, Mulas D, Cocciolillo F, Di Giuda D, Bentivoglio AR. A role for accelerometry in the differential diagnosis of tremor syndromes. FUNCTIONAL NEUROLOGY 2019; 33:45-49. [PMID: 29633696 DOI: 10.11138/fneur/2018.33.1.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Accelerometry is a reliable tool for gauging the occurrence, amplitude and frequency of tremor. However, there is no consensus on criteria for accelerometric diagnosis of tremor syndromes. We enrolled 20 patients with essential tremor (ET), 20 with dystonic tremor (DT), and 20 with classic parkinsonian tremor (PD-T), all meeting accepted clinical criteria. All the patients underwent dopamine transporter imaging (by means of single-photon emission computed tomography) and triaxial accelerometric tremor analysis. The latter revealed groupwise differences in tremor frequency, peak dispersion, spectral coherence, unilaterality and resting vs action tremor amplitude. From the above, five diagnostic criteria were extrapolated for each condition. Receiver operating characteristic curves, depicting criteriabased scoring of each tremor type, showed negligible declines in specificity for scores ≥4 in patients with ET or DT and scores ≥3 in patients with PD-T, thus providing a simple scoring method (accelerometrically derived) for differential diagnosis of the principal tremor syndromes.
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27
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Wissel BD, Dwivedi AK, Merola A, Chin D, Jacob C, Duker AP, Vaughan JE, Lovera L, LaFaver K, Levy A, Lang AE, Morgante F, Nirenberg MJ, Stephen C, Sharma N, Romagnolo A, Lopiano L, Balint B, Yu XX, Bhatia KP, Espay AJ. Functional neurological disorders in Parkinson disease. J Neurol Neurosurg Psychiatry 2018; 89:566-571. [PMID: 29549192 DOI: 10.1136/jnnp-2017-317378] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To ascertain demographic and clinical features of Parkinson disease (PD) associated with functional neurological features. METHODS A standardised form was used to extract data from electronic records of 53 PD patients with associated functional neurological disorders (PD-FND) across eight movement disorders centres in the USA, Canada and Europe. These subjects were matched for age, gender and disease duration to PD patients without functional features (PD-only). Logistic regression analysis was used to compare both groups after adjusting for clustering effect. RESULTS Functional symptoms preceded or co-occurred with PD onset in 34% of cases, nearly always in the most affected body side. Compared with PD-only subjects, PD-FND were predominantly female (68%), had longer delay to PD diagnosis, greater prevalence of dyskinesia (42% vs 18%; P=0.023), worse depression and anxiety (P=0.033 and 0.025, respectively), higher levodopa-equivalent daily dose (972±701 vs 741±559 mg; P=0.029) and lower motor severity (P=0.019). These patients also exhibited greater healthcare resource utilisation, higher use of [(123)I]FP-CIT SPECT and were more likely to have had a pre-existing psychiatric disorder (P=0.008) and family history of PD (P=0.036). CONCLUSIONS A subtype of PD with functional neurological features is familial in one-fourth of cases and associated with more psychiatric than motor disability and greater use of diagnostic and healthcare resources than those without functional features. Functional manifestations may be prodromal to PD in one-third of patients.
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Affiliation(s)
- Benjamin D Wissel
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Aristide Merola
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Danielle Chin
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cara Jacob
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew P Duker
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jennifer E Vaughan
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lilia Lovera
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathrin LaFaver
- Department of Neurology, University of Louisville, Louisville, Kentucky, USA
| | - Ariel Levy
- Department of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Canada.,The Department of Medicine, University of Toronto, Toronto, Canada
| | - Anthony E Lang
- Department of Neurology, Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Canada.,The Department of Medicine, University of Toronto, Toronto, Canada
| | - Francesca Morgante
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy.,Institute of Molecular and Clinical Sciences, St George's University of London, London, UK
| | | | - Christopher Stephen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy
| | - Bettina Balint
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK.,Department of Neurology, University Hospital, Heidelberg, Germany.,Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Xin X Yu
- Cleveland Clinic Center for Neurological Restoration, Cleveland, USA
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
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Frasca Polara G, Fleury V, Stone J, Barbey A, Burkhard PR, Vingerhoets F, Aybek S. Prevalence of functional (psychogenic) parkinsonism in two Swiss movement disorders clinics and review of the literature. J Neurol Sci 2018; 387:37-45. [PMID: 29571869 DOI: 10.1016/j.jns.2018.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/04/2018] [Accepted: 01/17/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Functional parkinsonism (FP) is considered rare but no studies have looked at its frequency. Case series have described high rates of comorbidity with Parkinson's disease (PD), suggesting a possible association between these conditions. OBJECTIVES To study the prevalence, epidemiology and clinical features of FP and its association with PD. METHODS We conducted a cross-sectional population-based prevalence study as well as a chart review of cases who received a diagnosis of FP over a 10-year-period in two movement disorder clinics in Switzerland. Epidemiological data regarding FP features were collected. The co-occurrence of PD, psychiatric disorders and other functional disorders were recorded. Clinical differences between FP and FP+PD groups are presented and discussed in light of a literature review. RESULTS The crude prevalence of FP was 0.64 per 100,000 in our population. FP represented 0.24% of patients with parkinsonism. Among 12 FP cases, female gender predominance (87%), mean age of onset of 45.5(±13.3 Standard deviation SD) years and prolonged diagnostic delay (mean 59±75 SD months) was found. Six patients had an additional diagnosis of PD, 83% of depression and 66% of other functional neurological disorder. In four patients with FP+PD, FP preceded PD by 6 to 56months. CONCLUSIONS These results suggest that FP should be considered in the differential diagnosis of patients presenting with parkinsonism. The high rate of co-occurrence with PD emphasizes the importance of long-term follow up of these patients. The observation that FP often precedes PD should be verified in prospective studies.
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Affiliation(s)
- Giulia Frasca Polara
- Movement Disorder Unit, Hôpitaux Universitaires Genevois (HUG), Geneva, Switzerland.
| | - Vanessa Fleury
- Movement Disorder Unit, Hôpitaux Universitaires Genevois (HUG), Geneva, Switzerland
| | - Jon Stone
- Dpt Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
| | - Anita Barbey
- Movement Disorder Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Universitätsklinik für Neurologie, InselSpital, Bern, Switzerland
| | - Pierre R Burkhard
- Movement Disorder Unit, Hôpitaux Universitaires Genevois (HUG), Geneva, Switzerland
| | - François Vingerhoets
- Movement Disorder Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Selma Aybek
- Movement Disorder Unit, Hôpitaux Universitaires Genevois (HUG), Geneva, Switzerland; Universitätsklinik für Neurologie, InselSpital, Bern, Switzerland.
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Somatization in Parkinson's Disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:18-26. [PMID: 28522290 DOI: 10.1016/j.pnpbp.2017.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 05/13/2017] [Indexed: 11/21/2022]
Abstract
The current systematic review study is aimed at critically analyzing from a clinimetric viewpoint the clinical consequence of somatization in Parkinson's Disease (PD). By focusing on the International Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive electronic literature research strategy on ISI Web-of-Science, PsychINFO, PubMed, EBSCO, ScienceDirect, MEDLINE, Scopus, and Google Scholar databases. Out of 2.926 initial records, only a total of 9 studies were identified as clearly relevant and analyzed in this systematic review. The prevalence of somatization in PD has been found to range between 7.0% and 66.7%, with somatoform disorders acting as clinical factor significantly contributing to predict a progressive cognitive impairment. We highlighted that somatization is a highly prevalent comorbidity affecting PD. However, the clinical consequence of such psychiatric symptom should be further evaluated by replacing the clinically inadequate diagnostic label of psychogenic parkinsonism with the psychosomatic concept of persistent somatization as conceived by the Diagnostic Criteria for Psychosomatic Research (DCPR).
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Vidailhet M, Roze E, Jinnah HA. A simple way to distinguish essential tremor from tremulous Parkinson’s disease. Brain 2017; 140:1820-1822. [DOI: 10.1093/brain/awx140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Onofrj M, Carrozzino D, D’Amico A, Di Giacomo R, Delli Pizzi S, Thomas A, Onofrj V, Taylor JP, Bonanni L. Psychosis in parkinsonism: an unorthodox approach. Neuropsychiatr Dis Treat 2017; 13:1313-1330. [PMID: 28553118 PMCID: PMC5439966 DOI: 10.2147/ndt.s116116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Psychosis in Parkinson's disease (PD) is currently considered as the occurrence of hallucinations and delusions. The historical meaning of the term psychosis was, however, broader, encompassing a disorganization of both consciousness and personality, including behavior abnormalities, such as impulsive overactivity and catatonia, in complete definitions by the International Classification of Diseases-10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Our review is aimed at reminding that complex psychotic symptoms, including impulsive overactivity and somatoform disorders (the last being a recent controversial entity in PD), were carefully described in postencephalitic parkinsonism (PEP), many decades before dopaminergic treatment era, and are now described in other parkinsonisms than PD. Eminent neuropsychiatrists of the past century speculated that studying psychosis in PEP might highlight its mechanisms in other conditions. Yet, functional assessments were unavailable at the time. Therefore, the second part of our article reviews the studies of neural correlates of psychosis in parkinsonisms, by taking into account both theories on the narrative functions of the default mode network (DMN) and hypotheses on DMN modulation.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Aurelio D’Amico
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Roberta Di Giacomo
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Stefano Delli Pizzi
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
| | - Astrid Thomas
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Valeria Onofrj
- Department of Bioimaging, University Cattolica del Sacro Cuore, Rome, Italy
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Ageing and Vitality Newcastle University Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
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Abstract
Functional tremor is the commonest reported functional movement disorder. A confident clinical diagnosis of functional tremor is often possible based on the following "positive" criteria: a sudden tremor onset, unusual disease course, often with fluctuations or remissions, distractibility of the tremor if attention is removed from the affected body part, tremor entrainment, tremor variability, and a coactivation sign. Many patients show excessive exhaustion during examination. Other somatizations may be revealed in the medical history and patients may show additional functional neurologic symptoms and signs. In cases where the clinical diagnosis remains challenging, providing a "laboratory-supported" level of certainty aids an early positive diagnosis. In rare cases, in which the distinction from Parkinson's disease is difficult, dopamine transporter single-photon emission computed tomography (DAT-SPECT) can be indicated.
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Affiliation(s)
- P Schwingenschuh
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - G Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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33
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Wilshire CE, Ward T. Psychogenic Explanations of Physical Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2016; 11:606-631. [DOI: 10.1177/1745691616645540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause. In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions. First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable “organic” diagnosis, so a causal role cannot be inferred. Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience. Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable “organic” illnesses, there is currently no evidence to support this claim. Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed. We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses.
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34
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l-dopa-induced off: Functional overlay in Parkinson disease. J Neurol Sci 2016; 365:1-2. [DOI: 10.1016/j.jns.2016.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 11/20/2022]
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35
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Dreissen YEM, Cath DC, Tijssen MAJ. Functional jerks, tics, and paroxysmal movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:247-258. [PMID: 27719843 DOI: 10.1016/b978-0-12-801772-2.00021-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Functional jerks are among the most common functional movement disorders. The diagnosis of functional jerks is mainly based on neurologic examination revealing specific positive clinical signs. Differentiation from other jerky movements, such as tics, organic myoclonus, and primary paroxysmal dyskinesias, can be difficult. In support of a functional jerk are: acute onset in adulthood, precipitation by a physical event, variable, complex, and inconsistent phenomenology, suggestibility, distractibility, entrainment and a Bereitschaftspotential preceding the movement. Although functional jerks and tics share many similarities, characteristics differentiating tics from functional jerks are: urge preceding the tic, childhood onset, rostrocaudal development of the symptoms, a positive family history of tics, attention-deficit hyperactivity disorder or obsessive-compulsive symptoms, and response to dopamine antagonist medication. To differentiate functional jerks from organic myoclonus, localization of the movements can give direction. Further features in support of organic myoclonus include: insidious onset, simple and consistent phenomenology, and response to benzodiazepines or antiepileptic medication. Primary paroxysmal dyskinesias and functional jerks share a paroxysmal nature. Leading in the differentiation between the two are: a positive family history, in combination with video recordings revealing a consistent symptom pattern in primary paroxysmal dyskinesias. In this chapter functional jerks and their differential diagnoses will be discussed in terms of epidemiology, symptom characteristics, disease course, psychopathology, and supportive neurophysiologic tests.
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Affiliation(s)
- Y E M Dreissen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - D C Cath
- Department of Clinical and Health Psychology, Utrecht University/Altrecht, Utrecht, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands.
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36
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Stone J. Functional neurological disorders: the neurological assessment as treatment. Pract Neurol 2015; 16:7-17. [DOI: 10.1136/practneurol-2015-001241] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 11/03/2022]
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37
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Colosimo C. Psychogenic tremor in Parkinson's disease. Acta Neurol Belg 2015; 115:829-30. [PMID: 25855561 DOI: 10.1007/s13760-015-0464-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Carlo Colosimo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
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38
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Stone J, Pal S, Blackburn D, Reuber M, Thekkumpurath P, Carson A. Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic. J Alzheimers Dis 2015; 48 Suppl 1:S5-S17. [DOI: 10.3233/jad-150430] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK
| | - Daniel Blackburn
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Markus Reuber
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Parvez Thekkumpurath
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK
- Department of Rehabilitation Medicine and Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
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Baizabal-Carvallo JF, Fekete R. Recognizing uncommon presentations of psychogenic (functional) movement disorders. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:279. [PMID: 25667816 PMCID: PMC4303603 DOI: 10.7916/d8vm4b13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/23/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psychogenic or functional movement disorders (PMDs) pose a challenge in clinical diagnosis. There are several clues, including sudden onset, incongruous symptoms, distractibility, suggestibility, entrainment of symptoms, and lack of response to otherwise effective pharmacological therapies, that help identify the most common psychogenic movements such as tremor, dystonia, and myoclonus. METHODS In this manuscript, we review the frequency, distinct clinical features, functional imaging, and neurophysiological tests that can help in the diagnosis of uncommon presentations of PMDs, such as psychogenic parkinsonism, tics, and chorea; facial, palatal, and ocular movements are also reviewed. In addition, we discuss PMDs at the extremes of age and mass psychogenic illness. RESULTS Psychogenic parkinsonism (PP) is observed in less than 10% of the case series about PMDs, with a female-male ratio of roughly 1:1. Lack of amplitude decrement in repetitive movements and of cogwheel rigidity help to differentiate PP from true parkinsonism. Dopamine transporter imaging with photon emission tomography can also help in the diagnostic process. Psychogenic movements resembling tics are reported in about 5% of PMD patients. Lack of transient suppressibility of abnormal movements helps to differentiate them from organic tics. Psychogenic facial movements can present with hemifacial spasm, blepharospasm, and other movements. Some patients with essential palatal tremor have been shown to be psychogenic. Convergence ocular spasm has demonstrated a high specificity for psychogenic movements. PMDs can also present in the context of mass psychogenic illness or at the extremes of age. DISCUSSION Clinical features and ancillary studies are helpful in the diagnosis of patients with uncommon presentations of psychogenic movement disorders.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA ; University of Guanajuato, Mexico
| | - Robert Fekete
- Department of Neurology, New York Medical College, Valhalla, NY, USA
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40
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Stone J. Functional neurological disorders: The neurological assessment as treatment. Neurophysiol Clin 2014; 44:363-73. [PMID: 25306077 DOI: 10.1016/j.neucli.2014.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 12/27/2013] [Accepted: 01/04/2014] [Indexed: 10/25/2022] Open
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41
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Plouvier AOA, Hameleers RJMG, van den Heuvel EAJ, Bor HH, Olde Hartman TC, Bloem BR, van Weel C, Lagro-Janssen ALM. Prodromal symptoms and early detection of Parkinson's disease in general practice: a nested case-control study. Fam Pract 2014; 31:373-8. [PMID: 24869632 DOI: 10.1093/fampra/cmu025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Timely diagnosis of Parkinson's disease (PD), facilitating early intervention, depends largely on the GP's awareness of early symptomatology. For general practice, it is unknown which prodromal symptoms (symptoms preceding the typical motor symptoms of PD) demand the GP's alertness. OBJECTIVE To assess prodromal symptoms that should alert the GP to the possibility of PD in primary care patients. METHODS A nested case-control study was carried out in a population of approximately 12000 patients registered in the Continuous Morbidity Registration database affiliated with the University of Nijmegen in the Netherlands. The database pools subject data from four primary care practices. The subjects comprised all 86 patients diagnosed with PD between 1972 and 2007, and 78 controls, matched by sex, age, socioeconomic status and primary care practice. The primary measures of outcome were the prodromal symptoms presenting in the two years prior to the diagnosis of PD. The number (and type) of referrals and diagnostic tests were also assessed. RESULTS In the two-year period prior to diagnosis, PD patients more often presented with functional somatic symptoms, constipation, hyperhidrosis and sleep disorders than controls. Patients also more frequently experienced more than one prodromal symptom and were more often referred within the primary care team or to a medical specialist. CONCLUSIONS Prodromal symptoms of PD are encountered in general practice. GPs should be alert when patients present with multiple prodromal symptoms in a two-year period, especially considering the benefits of early intervention, and the future possibilities for disease-modifying therapy.
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Affiliation(s)
| | | | | | - Hans H Bor
- Department of Primary and Community Care and
| | | | - Bastiaan R Bloem
- Department of Neurology and Parkinson Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands and
| | - Chris van Weel
- Department of Primary and Community Care and Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
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42
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Onofrj M. Functional or somatoform disorders in Parkinson's Disease? Mov Disord 2013; 28:1907. [DOI: 10.1002/mds.25714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/16/2013] [Accepted: 09/08/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marco Onofrj
- Neurology, Dept. Neuroscience and Imaging; Aging Research Center, CeSI; University Foundation, University of Chieti-Pescara; Chieti Italy
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43
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Parees I, Saifee TA, Edwards MJ. Functional motor or somatoform disorders in PD? Mov Disord 2013; 28:1907. [DOI: 10.1002/mds.25712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/08/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Isabel Parees
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; Queen Square London UK
| | - Tabish A. Saifee
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; Queen Square London UK
| | - Mark J. Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; Queen Square London UK
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