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Edwards M, Koens L, Liepert J, Nonnekes J, Schwingenschuh P, van de Stouwe A, Morgante F. Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter. Clin Neurophysiol Pract 2024; 9:69-77. [PMID: 38352251 PMCID: PMC10862411 DOI: 10.1016/j.cnp.2023.12.006] [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: 11/14/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Abstract
Functional Motor Disorders are common and disabling. Clinical diagnosis has moved from one of exclusion of other causes for symptoms to one where positive clinical features on history and examination are used to make a "rule in" diagnosis wherever possible. Clinical neurophysiological assessments have developed increasing importance in assisting with this positive diagnosis, not being used simply to demonstrate normal sensory-motor pathways, but instead to demonstrate specific abnormalities that help to positively diagnose these disorders. Here we provide a practical review of these techniques, their application, interpretation and pitfalls. We also highlight particular areas where such tests are currently lacking in sensitivity and specificity, for example in people with functional dystonia and functional tic-like movements.
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Affiliation(s)
- M.J. Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Department of Neuropsychiatry, Maudsley Hospital, London, UK
| | - L.H. Koens
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Martini Ziekenhuis, Groningen, the Netherlands
| | - J. Liepert
- Kliniken Schmieder Allensbach, Allensbach, Germany
| | - J. Nonnekes
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
- Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, the Netherlands
| | | | - A.M.M. van de Stouwe
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology, Ommelander Ziekenhuis, Scheemda, the Netherlands
| | - F. Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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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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Elanwar R, Hussein M, Magdy R, Eid RA, Yassien A, Abdelsattar AS, Alsharaway LA, Fathy W, Hassan A, Kamal YS. Physical and Mental Fatigue in Subjects Recovered from COVID-19 Infection: A Case-Control Study. Neuropsychiatr Dis Treat 2021; 17:2063-2071. [PMID: 34188476 PMCID: PMC8235935 DOI: 10.2147/ndt.s317027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Much effort has been directed toward studying COVID-19 symptoms; however, the post-COVID-19 phase remains mysterious. The aim of this work was to conduct a clinical and neurophysiological evaluation of physical and mental fatigue in COVID-19 long-haulers and to study whether markers of COVID-19 severity are able to predict the likelihood of developing postinfectious fatigue syndrome (PIFS) in such patients. PATIENTS AND METHODS This case-control study was conducted on 46 COVID-19 long-haulers who met the criteria for PIFS and 46 recovered COVID-19 subjects without any residuals. Clinical assessment of fatigue was done using a fatigue questionnaire. Repetitive nerve stimulation and single-fiber electromyography were done after excluding neuropathy and myopathy. RESULTS The median value for physical fatigue was 4 (IQR 2-7), while that for mental fatigue was 2 (IQR 0-3). Each day's increase in the period of COVID-19 illness increased the odds of PIFS in COVID-19 long-haulers 1.104-fold, and each unit increase in ferritin increased the odds of PIFS 1.006-fold. A significant decrement in at least one muscle was observed in 50% of patients. Patients with PIFS had significantly higher mean consecutive difference (MCD) in the extensor digitorum communis than the control group. There were statistically significant positive correlations between MCD values and physical, mental, and total fatigue scores. CONCLUSION Higher ferritin levels and prolonged COVID-19 infection were independent predictors of PIFS in COVID-19 long-haulers. There was electrophysiological evidence of abnormalities in the peripheral portion of the motor unit in COVID-19 long-haulers with PIFS.
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Affiliation(s)
- Rehab Elanwar
- Clinical Neurophysiology, Neurodiagnostic Research Center, Beni-Suef University, Beni-Suef, Egypt
| | - Mona Hussein
- Department of Neurology, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab Magdy
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Ragaey A Eid
- Department of Tropical Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Yassien
- Department of Critical Care Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | | | - Wael Fathy
- Department of Anaesthesia, Surgical ICU and Pain Management, Beni-SuefUniversity, Beni-Suef, Egypt
| | - Amr Hassan
- Department of Neurology, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmine S Kamal
- Department of Neurology, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates
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Kim GU, Chang MC, Kim TU, Lee GW. Diagnostic Modality in Spine Disease: A Review. Asian Spine J 2020; 14:910-920. [PMID: 33373514 PMCID: PMC7788365 DOI: 10.31616/asj.2020.0593] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Spine diseases are common and exhibit several causes, including degeneration, trauma, congenital issues, and other specific factors. Most people experience a variety of symptoms of spine diseases during their lifetime that are occasionally managed with conservative or surgical treatments. Accurate diagnosis of the spine pathology is essential for the appropriate management of spine disease, and various imaging modalities can be used for the diagnosis, including radiography, computed tomography (CT), magnetic resonance imaging (MRI), and other studies such as EOS, bone scan, single photon emission CT/CT, and electrophysiologic test. Patient (or case)-specific selection of the diagnostic modality is crucial; thus, we should be aware of basic information and approaches of the diagnostic modalities. In this review, we discuss in detail, about diagnostic modalities (radiography, CT, MRI, electrophysiologic study, and others) that are widely used for spine disease.
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Affiliation(s)
- Gang-Un Kim
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Uk Kim
- Department of Rehabilitation, Dankook University College of Medicine, Cheonan, Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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Speicher TE, Cui JW, Scharmann SD. The Role of Positional Release Therapy in Treating Recalcitrant Brachial Plexus Neuritis: A Case Report. J Athl Train 2020; 56:1124-1131. [PMID: 33351937 DOI: 10.4085/jat003-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 17-year-old female Caucasian soccer player presented with severe right shoulder pain and scapular winging due to brachial plexus neuritis. Over the course of 6 weeks, the patient received Positional Release Therapy once a week coupled with electrical modalities, massage and a daily home exercise program. The form of brachial plexus neuritis the patient was diagnosed with was Parsonage-Turner Syndrome, a rare condition often resistant to traditional physical therapy, typically persists for six months to years, at times requiring surgical intervention. This case report is unique because it is the first to utilize Positional Release Therapy for its treatment and one which resolved more quickly than typically reported.
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Affiliation(s)
- Timothy E Speicher
- President, Positional Release Therapy Institute, 1702E. 5600S. Ogden, UT 84403, (801) 689-2546-Phone, (385) 206-8657-Fax, , https://twitter.com/speichertim
| | - Jia-Wen Cui
- Institute of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Stephen D Scharmann
- Assistant Residency Director, McKay Dee Family Medicine Residency, Medical Director, Weber State University, Department of Athletic Training,
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