1
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Bühler J, Weber S, Loukas S, Walther S, Aybek S. Non-invasive neuromodulation of the right temporoparietal junction using theta-burst stimulation in functional neurological disorder. BMJ Neurol Open 2024; 6:e000525. [PMID: 38361967 PMCID: PMC10868242 DOI: 10.1136/bmjno-2023-000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 02/17/2024] Open
Abstract
Background Disrupted sense of agency (SoA)-the sense of being the agent of one's own actions-has been demonstrated in patients with functional neurological disorder (FND), and a key area of the corresponding neuronal network is the right temporoparietal junction (rTPJ). Several functional MRI (fMRI) studies have found hypoactivation as well as hyperactivation of the rTPJ in FND. In a proof-of-concept study, we tested whether repetitive transcranial magnetic stimulation (rTMS) over the rTPJ could restore this aberrant activity. Methods In a randomised, crossover, single-blinded, sham-controlled study design, theta-burst stimulation (tb-rTMS) was applied over the rTPJ in 23 patients with FND and 19 healthy controls (HC), with each participant undergoing three stimulatory visits (inhibitory continuous TBS (cTBS), excitatory intermittent TBS (iTBS) and sham). During fMRI, participants played a visuomotor task artificially reducing their SoA (manipulated agency, MA), repeated after each neurostimulation. We compared brain activity and behavioural SoA as primary outcomes before and after tb-rTMS and investigated the feasibility of tb-rTMS over the rTPJ in FND as secondary outcome. Results At baseline, patients showed decreased accuracy in detecting reduced agency compared with controls (p<0.001), paralleled by lower brain activation in the rTPJ during MA (p=0.037, volume of interest). A region of interest analysis on the rTPJ showed no effect of the sham condition in FND or HC (p=0.917; p=0.375) but revealed a significant effect of stimulation protocol (cTBS/iTBS, p=0.037) in patients with FND, with the excitatory protocol increasing the blood-oxygen-level-dependent (BOLD) signal, whereas this effect was not found in HC. In neither group, a behavioural effect of tb-rTMS was observed. Conclusion Aberrant processing of agency in FND was confirmed at baseline, reflected in behavioural outcome and reduced activity in the rTPJ. Tb-rTMS over this key region elicited neuronal changes in patients, paving ways for future studies exploring TMS as neurobiologically informed intervention to restore SoA in FND. We critically discuss methodological intricacies and outline further steps in this research line.
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Affiliation(s)
- Janine Bühler
- Psychosomatic Medicine, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Samantha Weber
- Psychosomatic Medicine, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Serafeim Loukas
- Psychosomatic Medicine, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Selma Aybek
- Psychosomatic Medicine, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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2
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Tayeb HO. Functional Neurological Disorder in Saudi Arabia: An Update. Cureus 2023; 15:e47607. [PMID: 38021543 PMCID: PMC10667081 DOI: 10.7759/cureus.47607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Functional neurological disorder (FND) is characterized by neurological symptoms that lack congruence with traditional neurological diagnoses. Historically viewed through a Freudian psychoanalytic lens, FND has been conceptualized as a purely psychogenic disorder. However, the contemporary biopsychosocial perspective on FND emphasizes contributions of cognitive and neural circuit dysfunction and the disabling and involuntary nature of the illness. In Saudi Arabia, evidence suggests the prevalence of FND is significant. However, clinical programs and research focused on FND have been lacking. Studies from the region indicate that practitioners may have outdated views of FND. To address this, this narrative review provides an updated perspective on FND that is relevant to Saudi Arabia and the region. It delves into the evolving perception of FND, its underlying pathophysiology, risk factors, clinical presentations, and recent diagnostic and management advances. Unique features of FND in Saudi Arabia may include a significant role for family disputes as a risk factor, prevalent supernatural perceptions of FND, high prevalence of somatization, and cognitive dysfunction, and a potential favorable prognosis. The article concludes by providing the following recommendations related to FND in Saudi Arabia and the region: i) building educational programs to update clinicians about contemporary biopsychosocial perspectives on FND; ii) emphasizing a positive diagnostic approach based on clinical findings in FND; iii) instituting multidisciplinary programs to care for FND patients; iv) supporting systematic research efforts to explore culture-specific FND risk factors, patient outcome measures, and attitudes toward the disorder; v) developing national FND clinical practice guidelines; and vi) launching awareness campaigns to reduce FND stigma.
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Affiliation(s)
- Haythum O Tayeb
- Medicine, The Mind and Brain Studies Initiative, The Neuroscience Research Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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3
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Onofrj M, Ajdinaj P, Digiovanni A, Malek N, Martinotti G, Ferro FM, Russo M, Thomas A, Sensi SL. Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources? Front Psychiatry 2023; 14:1120981. [PMID: 37009111 PMCID: PMC10064068 DOI: 10.3389/fpsyt.2023.1120981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
In recent years, some neurologists reconsidered their approach to Medically Unexplained Symptoms and proposed Functional Neurologic Disorders (FND) as a new entity, claiming that neurology could offer alternative treatment options to the psychotherapies provided in psychiatry settings. FNDs, for this purpose, should include only the disorders listed as Conversion from the Somatic Symptom and Related Disorders (SSRD) group. The present review analyzes the rationale of this position and challenges the arguments provided for its support. The review also discusses the systematization of these disorders as provided by public health systems. It outlines risks stemming from economic support and public funding uncertainty, given their negligible epidemiological dimensions resulting from the parcellation of SSRD. The review underlines the unresolved issue of Factitious Disorders, which are in the same SSRD category of the international classification but are, nonetheless, overlooked by the theoretical proponents of the FND entity. Comorbidity with other psychiatric disorders is also analyzed. We propose a model that supports the continuum between different SSRD conditions, including Factitious Disorders. The model is based on the emergence of feigned death reflex and deception from frontal lobe dysfunction. Finally, the paper summarizes the wealth of historical psychiatric and psychodynamic approaches and critical reviews. The study also puts in context the categorization and interpretation efforts provided by the most eminent researchers of the past century.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- *Correspondence: Marco Onofrj,
| | - Paola Ajdinaj
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Naveed Malek
- Barking, Havering, and Redbridge University Hospitals NHS Trust, London, United Kingdom
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | - Filippo Maria Ferro
- 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
- 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
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
| | - Stefano Luca Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. D'Annunzio University” of Chieti-Pescara, Chieti, Italy
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4
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Varley D, Sweetman J, Brabyn S, Lagos D, van der Feltz-Cornelis C. The clinical management of functional neurological disorder: A scoping review of the literature. J Psychosom Res 2023; 165:111121. [PMID: 36549074 DOI: 10.1016/j.jpsychores.2022.111121] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To date, there have been no reviews bringing together evidence on the clinical management of functional neurological disorder (FND) and patients', caregivers', and healthcare workers' experiences. This review provides an overview of the literature focused on the clinical management of FND. METHODS Four databases were searched, and a consultation exercise was conducted to retrieve relevant records dated from September 2010 to September 2020. Articles documenting diagnostic methods, treatments or interventions, or the experiences and perspectives of patients and healthcare workers in the clinical management of FND were included. RESULTS In total, 2756 records were retrieved, with 162 included in this review. The diagnostic methods reported predominantly included positive clinical signs, v-EEG and EEG. Psychological treatments and medication were the most reported treatments. Mixed findings of the effectiveness of CBT were found. Haloperidol, physiotherapy and scripted diagnosis were found to be effective in reducing FND symptoms. Several facilitators and barriers for patients accessing treatment for FND were reported. CONCLUSION The literature describing the clinical management for FND has increased considerably in recent times. A wide variety of diagnostic tools and treatments and interventions were found, with more focus being placed on tests that confirm a diagnosis than 'rule-out' tests. The main treatment type found in this review was medication. This review revealed that there is a lack of high-quality evidence and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.
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Affiliation(s)
- Danielle Varley
- Department of Health Sciences, University of York, York YO10 5DD, UK.
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Dimitris Lagos
- Hull York Medical School, University of York, York YO10 5DD, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York YO10 5DD, UK; Hull York Medical School, University of York, York YO10 5DD, UK; York Biomedical Research Institute, University of York, York YO10 5DD, UK; Institute of Health Informatics, University College London, London NW1 2DA, UK
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5
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Finkelstein SA, Adams C, Tuttle M, Saxena A, Perez DL. Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide. Semin Neurol 2022; 42:204-224. [PMID: 35189644 DOI: 10.1055/s-0042-1742773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Inpatient Psychiatry, Department of Psychiatry, Mass General Brigham Salem Hospital, Salem, Massachusetts
| | - Margaret Tuttle
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Primary Care Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aneeta Saxena
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Epilepsy Division, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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6
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Abstract
Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disability in some individuals. An early diagnosis, with subsequent access to evidence based rehabilitative and/or psychological treatments, can promote recovery-albeit not all patients respond to currently available treatments. This review presents the latest advances in the use of validated rule-in examination signs to guide diagnosis, and the range of therapeutic approaches available to care for patients with FND. The article focuses on the two most frequently identified subtypes of FND: motor (weakness and/or movement disorders) and seizure type symptoms. Twenty two studies on motor and 27 studies on seizure type symptoms report high specificities of clinical signs (64-100%), and individual signs are reviewed. Rehabilitative interventions (physical and occupational therapy) are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence based treatment across FND subtypes. The literature to date highlights heterogeneity in responses to treatment, underscoring that more research is needed to individualize treatments and develop novel interventions.
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Affiliation(s)
- Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Inselspital University Hospital, Bern, and Bern University, Bern, Switzerland
| | - David L Perez
- Divisions of Cognitive Behavioral Neurology and Neuropsychiatry, Functional Neurological Disorder Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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7
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Bonnan M. Transcranial and muscular single-pulse magnetic stimulation is efficient on motor functional neurological disorders by the feedback of induced muscle contractions - A retrospective case series. Clin Park Relat Disord 2021; 5:100112. [PMID: 34746742 PMCID: PMC8554265 DOI: 10.1016/j.prdoa.2021.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/23/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Motor functional neurological disorders (mFNDs) are improved by repetitive transcranial magnetic stimulation (rTMS), which is thought to involve cortical modulation. We examined the outcome of a rapid TMS procedure. Methods Single-center retrospective case series including 41 consecutive patients suffering from mFNDs and receiving a combination of motor-evoked potentials (MEP), TMS and/or muscle stimulation. Results MEP and additional TMS were administered in 35 patients, sometimes with rescue by muscle stimulation. Magnetic muscle stimulation was given in 6 patients, sometimes with rescue by TMS. Complete immediate recovery was obtained in 65.9 % of the 41 patients, but the outcome of mFNDs after one year was poor. Treatment by TMS (n = 19) or by muscle stimulation (n = 4) given alone were associated with 78.9 % and 75 % of complete immediate recovery, respectively. Conclusions A rapid easy-to-perform TMS procedure obtained a high rate of immediate complete recovery in mFND. Clinical recovery was improved but was also obtained by direct magnetic stimulation of the paralyzed muscles. Significance TMS-induced recovery of mFND may not involve cortical modulation but could rather occur through reinforcement of the suggestion. Magnetic-induced muscle twitches may facilitate the self-expectation of motor recovery and could unlock the motor symptoms of mFND.
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8
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Gonsalvez I, Spagnolo P, Dworetzky B, Baslet G. Neurostimulation for the treatment of functional neurological disorder: A systematic review. Epilepsy Behav Rep 2021; 16:100501. [PMID: 34950864 PMCID: PMC8671519 DOI: 10.1016/j.ebr.2021.100501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 01/02/2023] Open
Abstract
Functional Neurological Disorder (FND), also known as conversion disorder, is characterized by neurological symptoms that are incompatible with any known structural disorder and best explained by a biopsychosocial model. Evidence-based treatments for FND are limited, with cognitive behavioral therapy (CBT) and physiotherapy being the most effective interventions [1]. In recent years, functional neuroimaging studies have provided robust evidence of alterations in activity and connectivity in multiple brain networks in FND. This body of evidence suggests that neurocircuitry-based interventions, such as non-invasive brain stimulation techniques (NIBS), may also represent an effective therapeutic option for patients with FND. In this systematic review, we outline the current state of knowledge of NIBS in FND, and discuss limitations and future directions that may help establish the efficacy of NIBS as a therapeutic option for FND.
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Affiliation(s)
- Irene Gonsalvez
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Primavera Spagnolo
- Mary Horrigan Connors Center for Women's Health & Gender Biology, Department of Psychiatry, Brigham and Women Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barbara Dworetzky
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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9
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Abstract
BACKGROUND Functional movement disorder (FMD), a conversion disorder characterized by involuntary movements, is difficult to treat. METHODS We aimed to assess the effects of anodal transcranial direct current stimulation (tDCS) and yoga in FMD patients (n=5). TDCS of the right temporoparietal junction, a brain region relevant in the sense of self-agency, was conducted. Subjects underwent both sham and anodal tDCS with a washout period of 3 weeks. Yoga was used as a mode of exercise, as well as in conjunction with stimulation to sustain potential changes in neural plasticity. RESULTS A total of 5 subjects completed the study [mean age: 52 (SE: 4) y, disease duration: 5 (SE: 1.6) y], undergoing both sham and anodal tDCS. Anodal tDCS does not appear to be superior to sham tDCS in alleviating symptoms and disability, but combining tDCS and yoga appears to lead to mild improvement noted on clinical observation, based on the change in the efficacy index of Clinical Global Impression found in 4 subjects. CONCLUSION Our study results suggest that anodal tDCS is not superior to sham tDCS in alleviating subjective symptoms and disability in FMD. However, interpretation of these results is limited due to the small number of stimulation sessions and number of subjects. Future studies using more frequent stimulation sessions are needed to further determine whether anodal tDCS may have a therapeutic effect in this patient group compared with sham tDCS.
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10
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Stewart B, Dean JG, Koek A, Chua J, Wabl R, Martin K, Davoodian N, Becker C, Himedan M, Kim A, Albin R, Chou KL, Kotagal V. Psychedelic-assisted therapy for functional neurological disorders: A theoretical framework and review of prior reports. Pharmacol Res Perspect 2021; 8:e00688. [PMID: 33280274 PMCID: PMC7719191 DOI: 10.1002/prp2.688] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Functional neurological disorders (FNDs), which are sometimes also referred to as psychogenic neurological disorders or conversion disorder, are common disabling neuropsychiatric disorders with limited treatment options. FNDs can present with sensory and/or motor symptoms, and, though they may mimic other neurological conditions, they are thought to occur via mechanisms other than those related to identifiable structural neuropathology and, in many cases, appear to be triggered and sustained by recognizable psychological factors. There is intriguing preliminary evidence to support the use of psychedelic‐assisted therapy in a growing number of psychiatric illnesses, including FNDs. We review the theoretical arguments for and against exploring psychedelic‐assisted therapy as a treatment for FNDs. We also provide an in‐depth discussion of prior published cases detailing the use of psychedelics for psychosomatic conditions, analyzing therapeutic outcomes from a contemporary neuroscientific vantage as informed by several recent neuroimaging studies on psychedelics and FNDs.
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Affiliation(s)
- Benjamin Stewart
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jon G Dean
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Adriana Koek
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jason Chua
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Wabl
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kayla Martin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Mai Himedan
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Kim
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Roger Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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11
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Naro A, Pignolo L, Billeri L, Porcari B, Portaro S, Tonin P, Calabrò RS. A Case of Psychogenic Myoclonus Responding to a Novel Transcranial Magnetic Stimulation Approach: Rationale, Feasibility, and Possible Neurophysiological Basis. Front Hum Neurosci 2020; 14:292. [PMID: 32848667 PMCID: PMC7396578 DOI: 10.3389/fnhum.2020.00292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/29/2020] [Indexed: 01/11/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) can relieve motor symptoms related to psychogenic movement disorders (PMDs), but the subtending neurophysiological basis is unclear. We report on a 50-year-old woman with a diagnosis of psychogenic myoclonus in the right lower limb, who was treated with a daily session (in the late morning/early afternoon) of 1 Hz rTMS over the left premotor cortex (PMC), five times a week for 6 weeks. Clinical data and EEG at rest were collected before and immediately and 2-month after the rTMS protocol completion. The patient reported a significant reduction of involuntary movement frequency and intensity and the related disability burden up to the follow-up. In parallel, any abnormality in terms of source current density within and connectivity between the frontal and parietal areas was reset. The short follow–up period, the lack of extensive neurophysiological measures, and the lack of control treatment represent the main limitation of the study. However, low-frequency rTMS over PMC seems a safe and promising approach for the management of psychogenic myoclonus owing to the combination of cortical neuromodulation and non-specific mechanisms suggesting cognitive-behavioral effects.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Loris Pignolo
- Sant'Anna Institute, Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Bruno Porcari
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Paolo Tonin
- Sant'Anna Institute, Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
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12
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Yeo JM, Carson A, Stone J. Seeing again: treatment of functional visual loss. Pract Neurol 2019; 19:168-172. [PMID: 30872460 DOI: 10.1136/practneurol-2018-002092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2018] [Indexed: 11/03/2022]
Abstract
There is very little published literature on treatment strategies for functional visual loss. We present two people with long duration of functional visual loss who achieved complete recovery with a novel combination of therapeutic approaches. These included: (1) the clinician being transparent regarding positive signs such as optokinetic nystagmus, in order to persuade family members of the diagnosis, (2) regularly positively acknowledging everyday events that indicated visual ability, (3) using occipital transcranial magnetic stimulation to induce phosphenes as an artificial temporary visual experience and (4) using hypnotherapy to promote visual recovery. We discuss these individual therapeutic approaches in further detail including their background and rationale and include patients' reflection on their treatment experiences.
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Affiliation(s)
- Jing Ming Yeo
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.,Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
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13
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Burke MJ, Isayama R, Jegatheeswaran G, Gunraj C, Feinstein A, Lang AE, Chen R. Neurostimulation for Functional Neurological Disorder: Evaluating Longitudinal Neurophysiology. Mov Disord Clin Pract 2018; 5:561-563. [PMID: 30515447 DOI: 10.1002/mdc3.12651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Matthew J Burke
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology University of Toronto Toronto Canada.,Berenson-Allen Center for Noninvasive Brain Stimulation, Cognitive Neurology Unit, Beth Israel Deaconess Medical Center Harvard Medical School Boston USA
| | - Reina Isayama
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology University of Toronto Toronto Canada
| | - Gaayathiri Jegatheeswaran
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology University of Toronto Toronto Canada
| | - Carolyn Gunraj
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology University of Toronto Toronto Canada
| | - Anthony Feinstein
- Sunnybrook Health Sciences Center, Division of Neuropsychiatry University of Toronto Toronto Canada
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology University of Toronto Toronto Canada
| | - Robert Chen
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Division of Neurology University of Toronto Toronto Canada
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Garcin B. Motor functional neurological disorders: An update. Rev Neurol (Paris) 2018; 174:203-211. [DOI: 10.1016/j.neurol.2017.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022]
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Zeuner KE, Schmidt R, Schwingenschuh P. [Clinical and cognitive aspects of functional (psychogenic) tremor]. DER NERVENARZT 2018; 89:400-407. [PMID: 29327097 DOI: 10.1007/s00115-017-0476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Functional (psychogenic) tremor is the most common functional movement disorder. Characteristic clinical features, so called red flags, can help to make the clinical distinction of this type from other tremor disorders. The most common features include the variability of frequency and amplitude. Clinical examination should include different types of distraction including motor or cognitive tasks or testing the influence of suggestibility on tremor amplitude, frequency or direction. Patients often report sudden onset and remissions that may last for months or even years. In some cases, the tremor is only present in highly specific situations. Although functional tremor shares characteristics with voluntary actions, patients experience their abnormal movements as involuntary. Recent experimental approaches have revealed an impairment in sense of agency. The diagnosis can be supported by neurophysiological measurements including accelerometry, which achieved a sensitivity of 89.5% and a specificity of 95.9% in a validated test battery, thus providing a useful additional diagnostic tool. Psychotherapeutic treatment is indicated in patients with and without evident psychological symptoms. A specific physiotherapeutic approach for functional tremor is re-trainment.
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Affiliation(s)
- K E Zeuner
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Deutschland.
| | - R Schmidt
- Psychotherapeutische Neurologie, Kliniken Schmieder, Neurologisches Fach- und Rehabilitationskrankenhaus, Konstanz, Deutschland
| | - P Schwingenschuh
- Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz, Österreich
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17
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Garcin B, Mesrati F, Hubsch C, Mauras T, Iliescu I, Naccache L, Vidailhet M, Roze E, Degos B. Impact of Transcranial Magnetic Stimulation on Functional Movement Disorders: Cortical Modulation or a Behavioral Effect? Front Neurol 2017; 8:338. [PMID: 28769869 PMCID: PMC5515822 DOI: 10.3389/fneur.2017.00338] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Recent studies suggest that repeated transcranial magnetic stimulation (TMS) improves functional movement disorders (FMDs), but the underlying mechanisms are unclear. The objective was to determine whether the beneficial action of TMS in patients with FMDs is due to cortical neuromodulation or rather to a cognitive-behavioral effect. Method Consecutive patients with FMDs underwent repeated low-frequency (0.25 Hz) magnetic stimulation over the cortex contralateral to the symptoms or over the spinal roots [root magnetic stimulation (RMS)] homolateral to the symptoms. The patients were randomized into two groups: group 1 received RMS on day 1 and TMS on day 2, while group 2 received the same treatments in reverse order. We blindly assessed the severity of movement disorders before and after each stimulation session. Results We studied 33 patients with FMDs (dystonia, tremor, myoclonus, Parkinsonism, or stereotypies). The median symptom duration was 2.9 years. The magnetic stimulation sessions led to a significant improvement (>50%) in 22 patients (66%). We found no difference between TMS and RMS. Conclusion We suggest that the therapeutic benefit of TMS in patients with FMDs is due more to a cognitive-behavioral effect than to cortical neuromodulation.
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Affiliation(s)
- Béatrice Garcin
- Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), UPMC UMRS 1127, INSERM U 1127, CNRS UMR 7225, Paris, France
| | - Francine Mesrati
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Cécile Hubsch
- Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Thomas Mauras
- Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Psychiatry Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Iulia Iliescu
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Lionel Naccache
- Institut du Cerveau et de la Moelle épinière (ICM), UPMC UMRS 1127, INSERM U 1127, CNRS UMR 7225, Paris, France.,Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Vidailhet
- Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), UPMC UMRS 1127, INSERM U 1127, CNRS UMR 7225, Paris, France
| | - Emmanuel Roze
- Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Institut du Cerveau et de la Moelle épinière (ICM), UPMC UMRS 1127, INSERM U 1127, CNRS UMR 7225, Paris, France
| | - Bertrand Degos
- Neurology Department, Parkinson's Disease Expert Centre, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,CNRS-UMR 7241/INSERM U1050, CIRB, Collège de France, UPMC, Paris, France
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