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Baizabal-Carvallo JF, Alonso-Juarez M, Jankovic J. Functional Neurological Disorders Among Patients With Tremor. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230126. [PMID: 39034668 DOI: 10.1176/appi.neuropsych.20230126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Functional neurological disorders (FNDs) are increasingly recognized in the general population and neurology clinics, and there is evidence that patients with neurological disorders are more likely to have a FND. This study was designed to identify the clinical features of FNDs among patients with movement disorders when the two disorders coexist. METHODS The clinical histories and video recordings of 150 consecutive patients with tremors were examined: the types of tremor included essential tremor; essential tremor plus; dystonic tremor; tremor associated with dystonia; and drug-induced, myoclonic, orthostatic, task-specific, parkinsonian, Holmes, and unclassified tremor. Using criteria for "possible" and "probable" coexistent FND, clinical features that helped differentiate between functional and other neurological tremors were identified. RESULTS There were 27 (18%) patients with functional manifestations, and 17 (11% of full sample) of these patients had signs suggestive of comorbid functional tremor. Patients with comorbid functional manifestations were younger at presentation, and these patients had greater severity of tremor, particularly upper limb postural tremor. Functional manifestations were not more commonly observed among patients with any particular type of tremor, except for patients with Holmes tremor, who were more likely to have comorbid functional neurological manifestations. CONCLUSIONS About 18% of patients with diverse types of tremors also had comorbid functional neurological manifestations. Of the coexistent FNDs, functional tremor was the most common. Patients with co-occurring functional and other neurological tremors presented for evaluation at a younger age and had greater severity of arm tremor than those without comorbid functional neurological manifestations.
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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 (Baizabal-Carvallo, Jankovic); Department of Sciences and Engineering, University of Guanajuato, Campus León, León, México (Baizabal-Carvallo); Instituto Politécnico Nacional, Mexico City, Mexico (Alonso-Juarez)
| | - Marlene Alonso-Juarez
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston (Baizabal-Carvallo, Jankovic); Department of Sciences and Engineering, University of Guanajuato, Campus León, León, México (Baizabal-Carvallo); Instituto Politécnico Nacional, Mexico City, Mexico (Alonso-Juarez)
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston (Baizabal-Carvallo, Jankovic); Department of Sciences and Engineering, University of Guanajuato, Campus León, León, México (Baizabal-Carvallo); Instituto Politécnico Nacional, Mexico City, Mexico (Alonso-Juarez)
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Sireci F, Ragucci F, Menozzi C, Cabboi MP, Picchetto L, Bassi MC, Ghirotto L, Cavallieri F, Pedroni C, Valzania F. Exploring therapeutic interventions for functional neurological disorders: a comprehensive scoping review. J Neurol 2024; 271:3908-3927. [PMID: 38775932 DOI: 10.1007/s00415-024-12441-x] [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: 03/07/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 07/10/2024]
Abstract
Functional Neurological Disorders (FNDs) are characterized by the symptoms experienced by the individuals but also by how they express personal experiences and concerns related to the clinical condition. Access to care programs for functional neurological symptoms appears challenging and may entail circular, self-perpetuating healthcare pathways. Given the challenging and misleading interpretations around FND, in advocating for care pathways beyond medical therapies, we designed a scoping review to map recently suggested practices and interventions. We identified 31 relevant papers published between January 2018 and December 2022. Most of the literature was gathered from the US and UK healthcare experiences, with documented interventions provided by multi-professional teams or stand-alone psychotherapists. We found different care pathways addressing either motor or non-motor manifestations. Persons with Functional Motor Disorder are more likely to be referred to physical therapy first, while Persons suffering from Non-Epileptic Seizures are to mental health services. A narrow focus was given to minor components of multimodal approaches (e.g. social workers, and occupational therapists). High heterogeneity was found between assessment instruments as well, reflecting different perspectives in selecting treatment outcomes (e.g., reduction of non-epileptic events, psychological functioning, motor symptoms). Among healthcare professionals, neurologists and (neuro)psychiatrists are typically engaged in formulating and delivering diagnoses, while treatment is often administered by physiotherapists and/or psychologists. In the context of FNDs, the complex etiopathological nature of the condition, including comorbidities, suggests the recommendation of multidisciplinary treatments adopting a stepped care model progressing from standard to higher level individualized modules may better suit individual complexities.
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Affiliation(s)
- Francesca Sireci
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Federica Ragucci
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Chiara Menozzi
- Primary Care Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Maria Paola Cabboi
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Livio Picchetto
- Department of Neuroscience, Neurology Unit, S.Agostino Estense Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Cristina Pedroni
- Direzione Delle Professioni Sanitarie, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
- Laurea Magistrale in Scienze Infermieristiche e Ostetriche, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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3
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Pascarella A, Gasparini S, Bellia A, Bertolotti E, Bessi B, Cantalupo G, Centonze D, Cianci V, Cornaggia CM, Costabile F, Gambardella A, Labate A, Malacrino C, Magaudda A, Mula M, Paladin F, Pizza G, Tassinari CA, Vermiglio E, Ferlazzo E, Aguglia U. Human expressive movements: The boundary between health and disease from a contaminated perspective. Neurosci Biobehav Rev 2024; 161:105639. [PMID: 38552759 DOI: 10.1016/j.neubiorev.2024.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | | | | | | | - Gaetano Cantalupo
- Center for Research on Epilepsy in Pediatric age (CREP), Child Neuropsychiatry Unit, University Hospital of Verona, Italy; Innovation Biomedicine section, Department of Engineering for Innovation Medicine, University of Verona, Italy
| | - Diego Centonze
- Department of Systems Medicine, Laboratory of Synaptic Immunopathology, "Tor Vergata" University, Roma, Italy
| | - Vittoria Cianci
- Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Cesare M Cornaggia
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Italy
| | | | - Adriana Magaudda
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Marco Mula
- IMBE, St George's University and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK
| | - Francesco Paladin
- Venice International University, Isola di San Servolo, Venice, Italy
| | - Giovanni Pizza
- Department of Philosophy, Social Sciences and Education, Perugia University, Perugia, Italy
| | - Carlo Alberto Tassinari
- Center for Research on Epilepsy in Pediatric age (CREP), Child Neuropsychiatry Unit, University Hospital of Verona, Italy; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Elisa Vermiglio
- Department of Education and Social Services of the Mediterranean Area, Dante Alighieri University, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy; Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy.
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Van Patten R, Mordecai K, LaFrance WC. The role of neuropsychology in the care of patients with functional neurological symptom disorder. J Int Neuropsychol Soc 2024:1-8. [PMID: 38813659 DOI: 10.1017/s1355617724000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. METHODS A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. RESULTS Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. CONCLUSIONS Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | | | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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5
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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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6
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Staton A, Dawson D, Merdian H, Tickle A, Walker T. Functional neurological disorder: A qualitative study exploring individuals' experiences of psychological services. Psychol Psychother 2024; 97:138-156. [PMID: 37800641 DOI: 10.1111/papt.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Individuals with a diagnosis of FND report experiencing stigma in medical settings, however, there is a paucity of research exploring their experiences in psychological services. The aim of this research was to explore experiences of accessing UK psychological services, from the perspective of those with FND. METHODS This study utilised a qualitative approach with data collected from semi-structured interviews (n = 15) and analysed using reflexive thematic analysis. RESULTS One superordinate theme, 'the stigmatised self within the therapeutic relationship', and five interrelated subthemes were identified: 'internalised stigma and self-doubt', 'selective disclosure to professionals', 'perceptions of psychological explanations', 'having to educate the professionals' and 'attunement and trust within the therapeutic relationship'. Positive therapeutic relationships were perceived to mitigate the impact of these perceived barriers. The conceptualisation of FND and the perception of how this was responded to by services and professionals was a central tenet throughout the related themes. CONCLUSIONS Intra-personal, interpersonal and organisational stigma impact access and engagement to psychological treatment. The findings of this study highlight the need for increased training provision for practitioners with a focus on actively challenging FND stigma within services at both an individual and systemic level.
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Affiliation(s)
- Amelia Staton
- University of Nottingham, Nottingham, UK
- University of Lincoln, Lincoln, UK
| | | | | | | | - Tammy Walker
- Defence Medical Rehabilitation Centre, Loughborough, UK
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7
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Onofrj M, Russo M, Delli Pizzi S, De Gregorio D, Inserra A, Gobbi G, Sensi SL. The central role of the Thalamus in psychosis, lessons from neurodegenerative diseases and psychedelics. Transl Psychiatry 2023; 13:384. [PMID: 38092757 PMCID: PMC10719401 DOI: 10.1038/s41398-023-02691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
The PD-DLB psychosis complex found in Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) includes hallucinations, Somatic Symptom/Functional Disorders, and delusions. These disorders exhibit similar presentation patterns and progression. Mechanisms at the root of these symptoms also share similarities with processes promoting altered states of consciousness found in Rapid Eye Movement sleep, psychiatric disorders, or the intake of psychedelic compounds. We propose that these mechanisms find a crucial driver and trigger in the dysregulated activity of high-order thalamic nuclei set in motion by ThalamoCortical Dysrhythmia (TCD). TCD generates the loss of finely tuned cortico-cortical modulations promoted by the thalamus and unleashes the aberrant activity of the Default Mode Network (DMN). TCD moves in parallel with altered thalamic filtering of external and internal information. The process produces an input overload to the cortex, thereby exacerbating DMN decoupling from task-positive networks. These phenomena alter the brain metastability, creating dreamlike, dissociative, or altered states of consciousness. In support of this hypothesis, mind-altering psychedelic drugs also modulate thalamic-cortical pathways. Understanding the pathophysiological background of these conditions provides a conceptual bridge between neurology and psychiatry, thereby helping to generate a promising and converging area of investigation and therapeutic efforts.
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Affiliation(s)
- Marco Onofrj
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Inserra
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Stefano L Sensi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
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Spagnolo PA, Johnson K, Hodgkinson C, Goldman D, Hallett M. Methylome changes associated with functional movement/conversion disorder: Influence of biological sex and childhood abuse exposure. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110756. [PMID: 36958667 PMCID: PMC10205664 DOI: 10.1016/j.pnpbp.2023.110756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/25/2023]
Abstract
Epigenetic changes, such as DNA methylation (DNAm), may represent an important mechanism implicated in the etiopathogenesis of functional movement/conversion disorder (FMD). Here, we aimed to identify methylomic variations in a case-control cohort of FMD and to uncover specific epigenetic signatures associated with female sex and childhood abuse, two key risk factors for FMD and other functional neurological disorders. Genome-wide DNAm analysis was performed from peripheral blood in 57 patients with FMD and 47 healthy controls with and without childhood abuse. Using principal component analysis, we examined the association of principal components with FMD status in abused and non-abused individuals, in the entire study sample and in female subjects only. Next, we used enrichment pathway analysis to investigate the biological significance of DNAm changes and explored differences in methylation levels of genes annotated to the top enriched biological pathways shared across comparisons. We found that FMD was associated with DNAm variation across the genome and identified a common epigenetic 'signature' enriched for biological pathways implicated in chronic stress and chronic pain. However, methylation levels of genes included in the top two shared pathways hardly overlapped, suggesting that transcriptional profiles may differ as a function of childhood abuse exposure and sex among subjects with FMD. This study is unique in providing genome-wide evidence of DNAm changes in FMD and in indicating a potential mechanism linking childhood abuse exposure and female sex to differences in FMD pathophysiology. Future studies are needed to replicate our findings in independent cohorts.
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Affiliation(s)
- Primavera A Spagnolo
- Mary Horrigan Connors Center for Women's Health and Gender Biology, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kory Johnson
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Colin Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, MD, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, MD, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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9
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Baizabal-Carvallo JF, Alonso-Juarez M, Jankovic J. Contrasting features between Tourette syndrome and secondary tic disorders. J Neural Transm (Vienna) 2023; 130:931-936. [PMID: 37117738 PMCID: PMC10144877 DOI: 10.1007/s00702-023-02642-5] [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: 01/24/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
Tics are rapid, recurrent, non-rhythmic movements or emitted sounds. Tics are the hallmark of Tourette syndrome (TS); however, a number of other disorders may be associated with tics, so-called secondary tic disorders (STD). We assessed clinical history and performed blinded evaluations of video-recordings from patients with TS and STD in order to identify features that may differentiate tics associated with TS vs STD. There were 156 patients with TS and 38 with STD, 21 of whom had functional (psychogenic) tics. Patients with TS were more frequently male and had a younger age at onset. Tics in TS tend to involve muscles in the cranial-cervical area more often and have greater severity and complexity than those in patients with STD. Similar findings were observed when contrasting patients with TS with patients with functional tics only. Simple phonic tics showed the greatest diagnostic accuracy for TS, compared with STD, but marked overlap in the types of tics and comorbidities was observed between patients with TS and STD. Patients with TS were more likely males, had a younger age at onset, phonic tics and motor tics affecting predominantly the head and neck area, and had a greater complexity and severity of tics than those with STD. When these features are absent a consideration should be given to the possibility of a tic disorder other than TS.
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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.
- Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, C.P. 37320, León, Guanajuato, Mexico.
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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10
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Garcia A. Pediatric Functional Neurologic Disorders. Pediatr Clin North Am 2023; 70:589-601. [PMID: 37121644 DOI: 10.1016/j.pcl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Functional neurologic disorders are common in the pediatric population. Recently, there has been a renewed focus on functional neurologic disorders, leading to improvements in diagnosis and management. This review focuses on updates in clinical presentation, diagnosis, pathophysiology (including neuroimaging), and treatment of functional neurologic disorders in the pediatric population.
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Affiliation(s)
- Angela Garcia
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Suite 1200, Pittsburgh, PA 15201, USA.
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11
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Forejtová Z, Serranová T, Sieger T, Slovák M, Nováková L, Věchetová G, Růžička E, Edwards MJ. The complex syndrome of functional neurological disorder. Psychol Med 2023; 53:3157-3167. [PMID: 34991744 DOI: 10.1017/s0033291721005225] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with functional neurological disorders (FND) often present with multiple motor, sensory, psychological and cognitive symptoms. In order to explore the relationship between these common symptoms, we performed a detailed clinical assessment of motor, non-motor symptoms, health-related quality of life (HRQoL) and disability in a large cohort of patients with motor FND. To understand the clinical heterogeneity, cluster analysis was used to search for subgroups within the cohort. METHODS One hundred fifty-two patients with a clinically established diagnosis of motor FND were assessed for motor symptom severity using the Simplified Functional Movement Disorder Rating Scale (S-FMDRS), the number of different motor phenotypes (i.e. tremor, dystonia, gait disorder, myoclonus, and weakness), gait severity and postural instability. All patients then evaluated each motor symptom type severity on a Likert scale and completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints and HRQoL. RESULTS Significant correlations were found among the self-reported and all objective motor symptoms severity measures. All self-reported measures including HRQoL correlated strongly with each other. S-FMDRS weakly correlated with HRQoL. Hierarchical cluster analysis supplemented with gap statistics revealed a homogenous patient sample which could not be separated into subgroups. CONCLUSIONS We interpret the lack of evidence of clusters along with a high degree of correlation between all self-reported and objective measures of motor or non-motor symptoms and HRQoL within current neurobiological models as evidence to support a unified pathophysiology of 'functional' symptoms. Our results support the unification of functional and somatic syndromes in classification schemes and for future mechanistic and therapeutic research.
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Affiliation(s)
- Zuzana Forejtová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Tereza Serranová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Tomáš Sieger
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, 166 27, Czech Republic
| | - Matěj Slovák
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Lucia Nováková
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Gabriela Věchetová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, 128 21, Czech Republic
| | - Mark J Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, London, SW17 0RE, UK
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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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13
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Pathophysiology and Treatment of Functional Paralysis: Insight from Transcranial Magnetic Stimulation. Brain Sci 2023; 13:brainsci13020352. [PMID: 36831895 PMCID: PMC9954472 DOI: 10.3390/brainsci13020352] [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: 12/28/2022] [Revised: 01/26/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Functional paralysis (FP) or limb weakness is a common presentation of functional movement disorders (FMD), accounting for 18.1% of the clinical manifestations of FMD. The pathophysiology of FP is not known, but imaging studies have identified changes in structural and functional connectivity in multiple brain networks. It has been proposed that noninvasive brain stimulation techniques may be used to understand the pathophysiology of FP and may represent a possible therapeutic option. In this paper, we reviewed transcranial magnetic stimulation studies on functional paralysis, focusing on their pathophysiological and therapeutical implications. Overall, there is general agreement on the integrity of corticospinal pathways in FP, while conflicting results have been found about the net excitability of the primary motor cortex and its excitatory/inhibitory circuitry in resting conditions. The possible involvement of spinal cord circuits remains an under-investigated area. Repetitive transcranial magnetic stimulation appears to have a potential role as a safe and viable option for the treatment of functional paralysis, but more studies are needed to investigate optimal stimulation parameters and clarify its role in the context of other therapeutical options.
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Janiri D, Petracca M, Moccia L, Solito M, Lo Monaco MR, Cerbarano ML, Piano C, Imbimbo I, Di Nicola M, Simonetti A, Sani G, Bentivoglio AR. Functional Movement Disorders during COVID-19: Psychological Distress, Affective Temperament and Emotional Dysregulation. J Pers Med 2023; 13:jpm13020175. [PMID: 36836408 PMCID: PMC9960146 DOI: 10.3390/jpm13020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Background and objective: Functional movement disorders (FMD) represent a spectrum of psychosomatic symptoms particularly sensitive to stress. The COVID-19 pandemic has increased psychological distress worldwide and may have worsened FMD. The study aimed to confirm this hypothesis and to test whether in FMD there is a relationship between affective temperament, emotional dysregulation and psychological distress due to the pandemic. Methods: We recruited individuals with FMD, diagnosed them according to validated criteria and matched them with healthy controls (HC). Psychological distress and temperament were obtained using the Kessler-10 and the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire, respectively. We used bootstrapped mediation analysis to test the mediator role of emotional dysregulation on the effect of temperament on psychological distress. Results: The sample consisted of 96 individuals. During the pandemic, 31.3% of the patients reported the need for urgent neurological care, and 40.6% reported a subjective worsening neurological condition. Patients with FMD presented with more psychological distress during the COVID-19 pandemic (F = 30.15, df = 1, p ≤ 0.001) than HC. They also reported more emotional dysregulation (F = 15.80, df = 1, p ≤ 0.001) and more cyclothymic traits (F = 14.84, df = 1, p ≤ 0.001). Cyclothymic temperament showed an indirect effect on COVID-19-related psychological distress, mediated by deficits in emotion regulation mechanisms (Bootstrapped LLCI = 0.41, ULCI = 2.41). Conclusion: Our results suggest that emotional dysregulation may represent a dimension mediating cyclotimic temperament response to the stressful effect of the pandemic and provide insight for developing intervention policies.
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Affiliation(s)
- Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Psychiatry and Neurology, Sapienza University of Rome, 00100 Rome, Italy
| | - Martina Petracca
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630155633
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcella Solito
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Rita Lo Monaco
- Medicine of Ageing, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Luana Cerbarano
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Carla Piano
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Isabella Imbimbo
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Rita Bentivoglio
- Movement Disorders Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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15
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Perjoc RS, Roza E, Vladacenco OA, Teleanu DM, Neacsu R, Teleanu RI. Functional Neurological Disorder-Old Problem New Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1099. [PMID: 36673871 PMCID: PMC9859618 DOI: 10.3390/ijerph20021099] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Functional neurological disorder (FND) is a common issue in the pediatric population. The concept and our understanding of functional neurological disorders have changed over the past years, and new etiologic models and treatment plans have been explored. Knowledge about FND in the pediatric population, however, is lacking. The aim of this review is to provide an update on pediatric functional neurological disorder. We conducted a literature search of PubMed and SCOPUS databases and reviewed a total of 85 articles to gain insight into the current understanding of FND etiology, diagnosis, treatment, and prognosis in children and adolescents. Functional and high resolution MRI revealed abnormal connectivity and structural changes in patients with functional symptoms. The diagnostic criteria no longer require the presence of a psychological factor and instead focus on a rule-in diagnosis. Treatment of FND includes a clear communication of the diagnosis and the support of a multidisciplinary team. Although FND typically has a poor prognosis, better outcomes appear to have been achieved in children and young adults. We conclude that pediatric functional neurological disorder is a prevalent pathology and that this patient population has additional specific needs compared to the adult population.
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Affiliation(s)
- Radu-Stefan Perjoc
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Eugenia Roza
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Oana Aurelia Vladacenco
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Daniel Mihai Teleanu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency University Hospital, 050098 Bucharest, Romania
| | - Roxana Neacsu
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
| | - Raluca Ioana Teleanu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Dr. Victor Gomoiu” Children’s Hospital, 022102 Bucharest, Romania
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16
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Lessons Learned in Outpatient Physical Therapy for Motor Functional Neurological Disorder. J Neurol Phys Ther 2023; 47:52-59. [PMID: 35980727 DOI: 10.1097/npt.0000000000000415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Motor functional neurological disorder is a prevalent and costly condition at the intersection of neurology and psychiatry that is diagnosed using positive "rule-in" signs. Physical therapy is a first-line treatment and consensus recommendations exist to guide clinical care. Nonetheless, optimal outpatient treatment of adults with functional motor symptoms requires an expanded physical therapy tool kit to effectively guide care. SUMMARY OF KEY POINTS In this article, lessons learned from a physical therapist practicing in a multidisciplinary and interdisciplinary outpatient functional neurological disorder clinic are highlighted. In doing so, we discuss how use of the biopsychosocial model and neuroscience constructs can inform physical therapy interventions. The importance of team-based care and the delivery of physical therapy through video telehealth services are also outlined. RECOMMENDATIONS FOR CLINICAL PRACTICE Use of the biopsychosocial formulation to triage clinical challenges and guide longitudinal care, coupled with application of neuroscience to aid intervention selection, allows for patient-centered physical therapy treatment across the spectrum of functional motor symptoms.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A400 ).
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17
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Ricciardi L, Bologna M, Marsili L, Espay AJ. Dysfunctional Networks in Functional Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:157-176. [PMID: 37338701 DOI: 10.1007/978-3-031-26220-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Functional dystonia, the second most common functional movement disorder, is characterized by acute or subacute onset of fixed limb, truncal, or facial posturing, incongruent with the action-induced, position-sensitive, and task-specific manifestations of dystonia. We review neurophysiological and neuroimaging data as the basis for a dysfunctional networks in functional dystonia. Reduced intracortical and spinal inhibition contributes to abnormal muscle activation, which may be perpetuated by abnormal sensorimotor processing, impaired selection of movements, and hypoactive sense of agency in the setting of normal movement preparation but abnormal connectivity between the limbic and motor networks. Phenotypic variability may be related to as-yet undefined interactions between abnormal top-down motor regulation and overactivation of areas implicated in self-awareness, self-monitoring, and active motor inhibition such as the cingulate and insular cortices. While there remain many gaps in knowledge, further combined neurophysiological and neuroimaging assessments stand to inform the neurobiological subtypes of functional dystonia and the potential therapeutic applications.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
- Nuffield Department of Clinical Neurosciences, Medical Research Council Brain Network Dynamics Unit, Oxford, UK
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
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18
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Marapin RS, van der Horn HJ, van der Stouwe AMM, Dalenberg JR, de Jong BM, Tijssen MAJ. Altered brain connectivity in hyperkinetic movement disorders: A review of resting-state fMRI. Neuroimage Clin 2022; 37:103302. [PMID: 36669351 PMCID: PMC9868884 DOI: 10.1016/j.nicl.2022.103302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperkinetic movement disorders (HMD) manifest as abnormal and uncontrollable movements. Despite reported involvement of several neural circuits, exact connectivity profiles remain elusive. OBJECTIVES Providing a comprehensive literature review of resting-state brain connectivity alterations using resting-state fMRI (rs-fMRI). We additionally discuss alterations from the perspective of brain networks, as well as correlations between connectivity and clinical measures. METHODS A systematic review was performed according to PRISMA guidelines and searching PubMed until October 2022. Rs-fMRI studies addressing ataxia, chorea, dystonia, myoclonus, tics, tremor, and functional movement disorders (FMD) were included. The standardized mean difference was used to summarize findings per region in the Automated Anatomical Labeling atlas for each phenotype. Furthermore, the activation likelihood estimation meta-analytic method was used to analyze convergence of significant between-group differences per phenotype. Finally, we conducted hierarchical cluster analysis to provide additional insights into commonalities and differences across HMD phenotypes. RESULTS Most articles concerned tremor (51), followed by dystonia (46), tics (19), chorea (12), myoclonus (11), FMD (11), and ataxia (8). Altered resting-state connectivity was found in several brain regions: in ataxia mainly cerebellar areas; for chorea, the caudate nucleus; for dystonia, sensorimotor and basal ganglia regions; for myoclonus, the thalamus and cingulate cortex; in tics, the basal ganglia, cerebellum, insula, and frontal cortex; for tremor, the cerebello-thalamo-cortical circuit; finally, in FMD, frontal, parietal, and cerebellar regions. Both decreased and increased connectivity were found for all HMD. Significant spatial convergence was found for dystonia, FMD, myoclonus, and tremor. Correlations between clinical measures and resting-state connectivity were frequently described. CONCLUSION Key brain regions contributing to functional connectivity changes across HMD often overlap. Possible increases and decreases of functional connections of a specific region emphasize that HMD should be viewed as a network disorder. Despite the complex interplay of physiological and methodological factors, this review serves to gain insight in brain connectivity profiles across HMD phenotypes.
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Affiliation(s)
- Ramesh S Marapin
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Harm J van der Horn
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - A M Madelein van der Stouwe
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jelle R Dalenberg
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Bauke M de Jong
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Marina A J Tijssen
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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19
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Reid M, Mitchell SD, Mitchell KM, Sidiropoulos C. Efficacy of a 5-day, intensive, multidisciplinary, outpatient physical and occupational therapy protocol in the treatment of functional movement disorders: A retrospective study. J Neurol Sci 2022; 443:120461. [PMID: 36308845 DOI: 10.1016/j.jns.2022.120461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/17/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of rehabilitation services has been shown to be beneficial for patients with functional movement disorders (FMD). However, there is great variability in the type of rehabilitation services utilized. In the present study we aimed at determining the efficacy of an intense outpatient physical rehabilitation program as a treatment modality for patients with FMD. METHODS Eighteen participants underwent treatment in a specialized outpatient rehabilitation program utilizing a multidisciplinary approach for the treatment of FMD. Participants completed a series of tests on day one and day five of the program. RESULTS Results indicated statistically significant improvements in all but one motor and gait outcomes in patients with functional movement disorders treated with physical rehabilitation. CONCLUSION These results provide support for the continued use of physical and occupational therapy for functional movement disorder patients. Further research is needed to fully validate these findings and there remains a need for further study into multidisciplinary approaches that may be even more efficacious.
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Affiliation(s)
- Megan Reid
- The Recovery Project, LLC, Lansing, MI, United States of America.
| | - Steven D Mitchell
- Department of Neurology, Bronson Methodist Hospital, Kalamazoo, MI, United States of America.
| | - Katharine M Mitchell
- College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States of America.
| | - Christos Sidiropoulos
- Department of Neurology, Michigan State University, East Lansing, MI, United States of America.
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20
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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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21
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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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22
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Jungilligens J, Paredes-Echeverri S, Popkirov S, Barrett LF, Perez DL. A new science of emotion: implications for functional neurological disorder. Brain 2022; 145:2648-2663. [PMID: 35653495 PMCID: PMC9905015 DOI: 10.1093/brain/awac204] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 01/11/2023] Open
Abstract
Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic symptoms. In doing so, we address several themes for the functional neurological disorder field including: (i) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, 'panic attack without panic', dissociation, insecure attachment and the influential role of life experiences; (ii) re-interpret select neurobiological research findings in functional neurological disorder cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and (iii) discuss therapeutic implications. While we continue to support that functional neurological disorder is mechanistically and aetiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology and cognitive-affective neuroscience.
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Affiliation(s)
- Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, USA
- Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Rodríguez-Méndez DA, San-Juan D, Hallett M, Antonopoulos CG, López-Reynoso E, Lara-Ramírez R. A new model for freedom of movement using connectomic analysis. PeerJ 2022; 10:e13602. [PMID: 35975236 PMCID: PMC9375968 DOI: 10.7717/peerj.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/26/2022] [Indexed: 01/17/2023] Open
Abstract
The problem of whether we can execute free acts or not is central in philosophical thought, and it has been studied by numerous scholars throughout the centuries. Recently, neurosciences have entered this topic contributing new data and insights into the neuroanatomical basis of cognitive processes. With the advent of connectomics, a more refined landscape of brain connectivity can be analysed at an unprecedented level of detail. Here, we identify the connectivity network involved in the movement process from a connectomics point of view, from its motivation through its execution until the sense of agency develops. We constructed a "volitional network" using data derived from the Brainnetome Atlas database considering areas involved in volitional processes as known in the literature. We divided this process into eight processes and used Graph Theory to measure several structural properties of the network. Our results show that the volitional network is small-world and that it contains four communities. Nodes of the right hemisphere are contained in three of these communities whereas nodes of the left hemisphere only in two. Centrality measures indicate the nucleus accumbens is one of the most connected nodes in the network. Extensive connectivity is observed in all processes except in Decision (to move) and modulation of Agency, which might correlate with a mismatch mechanism for perception of Agency.
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Affiliation(s)
| | - Daniel San-Juan
- Epilepsy Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD, United States of America
| | - Chris G. Antonopoulos
- Department of Mathematical Sciences, University of Essex, Wivenhoe Park, United Kingdom
| | - Erick López-Reynoso
- Facultad de Ciencias, Universidad Autónoma del Estado de México, Toluca, Estado de México, México
| | - Ricardo Lara-Ramírez
- Centro de Investigación en Ciencias Biológicas Aplicadas, Universidad Autónoma del Estado de México, Toluca, Estado de México, México
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24
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Dystonia: Still a Mysterious Syndrome. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070989. [PMID: 35888079 PMCID: PMC9321350 DOI: 10.3390/life12070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
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25
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Mueller K, Růžička F, Slovák M, Forejtová Z, Dušek P, Dušek P, Jech R, Serranová T. Symptom-severity-related brain connectivity alterations in functional movement disorders. Neuroimage Clin 2022; 34:102981. [PMID: 35287089 PMCID: PMC8921488 DOI: 10.1016/j.nicl.2022.102981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 01/21/2023]
Abstract
Brain connectivity alterations were found in functional movement disorders. Hyperconnectivity in temporoparietal junction and precuneus in functional weakness. Consistent brain connectivity differences with four different centrality measures. Motor symptom severity correlates positively with connectivity in functional weakness.
Background Functional movement disorders, a common cause of neurological disabilities, can occur with heterogeneous motor manifestations including functional weakness. However, the underlying mechanisms related to brain function and connectivity are unknown. Objective To identify brain connectivity alterations related to functional weakness we assessed network centrality changes in a group of patients with heterogeneous motor manifestations using task-free functional MRI in combination with different network centrality approaches. Methods Task-free functional MRI was performed in 48 patients with heterogeneous motor manifestations including 28 patients showing functional weakness and 65 age- and sex-matched healthy controls. Functional connectivity differences were assessed using different network centrality approaches, i.e. global correlation, eigenvector centrality, and intrinsic connectivity. Motor symptom severity was assessed using The Simplified Functional Movement Disorders Rating Scale and correlated with network centrality. Results Comparing patients with and without functional weakness showed significant network centrality differences in the left temporoparietal junction and precuneus. Patients with functional weakness showed increased centrality in the same anatomical regions when comparing functional weakness with healthy controls. Moreover, in the same regions, patients with functional weakness showed a positive correlation between motor symptom severity and network centrality. This correlation was shown to be specific to functional weakness with an interaction analysis, confirming a significant difference between patients with and without functional weakness. Conclusions We identified the temporoparietal junction and precuneus as key regions involved in brain connectivity alterations related to functional weakness. We propose that both regions may be promising targets for phenotype-specific non-invasive brain stimulation.
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Affiliation(s)
- Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Filip Růžička
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Matěj Slovák
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Zuzana Forejtová
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Pavel Dušek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
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26
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Stager L, Morriss S, McKibben L, Grant M, Szaflarski JP, Fobian AD. Sense of control, selective attention and cognitive inhibition in pediatric functional seizures: A prospective case-control study. Seizure 2022; 98:79-86. [PMID: 35430472 PMCID: PMC9081274 DOI: 10.1016/j.seizure.2022.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To date, laboratory-based experimental behavioral methods have not been used to identify factors associated with pediatric functional seizures (FS), leaving a critical gap for effective treatment development. METHODS Children ages 13-18 with video-EEG-confirmed FS were matched to controls (MCs) based on income, sex, race, and age. A modified Stroop task which included a condition requiring participants to report the ink colors in which seizure symptom words were written (e.g., "shaking" in blue) measured selective attention and cognitive inhibition through response time. The magic and turbulence task assessed sense of control in three conditions (magic, lag, turbulence). Children with FS were asked to report premonitory symptoms predicting FS. RESULTS Participants included 26 children with FS and 26 MCs (Meanage=15.2, 74% female, 59% white). On Stroop, children with FS had a slower reaction time (Mean=1193.83) than MCs (Mean=949.26, p = 0.022) for seizure symptom words. Children with FS had significantly poorer sense of control in the turbulence condition of the magic and turbulence task (Mean=-3.99, SD=8.83) than MCs (Mean=-11.51, SD=7.87; t(20)=-2.61, p =0.017). Children with FS (Mean=-1.80, SD=6.54) also had significantly poorer sense of control in the magic condition than MCs (Mean=-5.57, SD=6.01; p =0.028). Ninety-eight percent of patients endorsed premonitory symptoms. CONCLUSION Compared with MCs, children with FS have (1) poorer selective attention and cognitive inhibition when presented with seizure-related information and (2) lower sense of control (i.e. poorer awareness that their control was manipulated). Premonitory symptoms were common. Sense of control, selective attention, and inhibition may be novel treatment targets for FS intervention.
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Affiliation(s)
- Lindsay Stager
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Skylar Morriss
- Department of Psychology, University of Alabama at Birmingham, United States
| | - Lauren McKibben
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, United States; Department of Anesthesiology, University of North Carolina, Chapel Hill, United States
| | - Merida Grant
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, United States
| | - Jerzy P Szaflarski
- Departments of Neurology, Neurosurgery and Neurobiology and the UAB Epilepsy Center, University of Alabama at Birmingham, United States
| | - Aaron D Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, United States.
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27
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Sojka P, Slovák M, Věchetová G, Jech R, Perez DL, Serranová T. Bridging structural and functional biomarkers in functional movement disorder using network mapping. Brain Behav 2022; 12:e2576. [PMID: 35429407 PMCID: PMC9120728 DOI: 10.1002/brb3.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are gaps in our neurobiological understanding of functional movement disorder (FMD). OBJECTIVES We investigated gray matter volumetric profiles in FMD, and related findings to resting-state functional connectivity (rsFC) profiles using Human Connectome Project data. METHODS Volumetric differences between 53 FMD patients and 50 controls were examined, as well as relationships between individual differences in FMD symptom severity and volumetric profiles. Atrophy network mapping was also used to probe whether FMD-related structural alterations preferentially impacted brain areas with dense rsFC. RESULTS Compared to controls without neurological comorbidities (albeit with mild depression and anxiety as a group), the FMD cohort did not show any volumetric differences. Across patients with FMD, individual differences in symptom severity negatively correlated with right supramarginal and bilateral superior temporal gyri volumes. These findings remained significant adjusting for FMD subtype or antidepressant use, but did not remain statistically significant adjusting for depression and anxiety scores. Symptom severity-related structural alterations mapped onto regions with dense rsFC-identifying several disease epicenters in default mode, ventral attention, and salience networks. CONCLUSIONS This study supports that FMD is a multinetwork disorder with an important role for the temporoparietal junction and its related connectivity in the pathophysiology of this condition. More research is needed to explore the intersection of functional neurological symptoms and mood.
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Affiliation(s)
- Petr Sojka
- Department of Psychiatry, Faculty of MedicineMasaryk University and University Hospital BrnoBrnoCzech Republic
| | - Matěj Slovák
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
| | - Gabriela Věchetová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
| | - David L. Perez
- Functional Neurological Disorder UnitCognitive Behavioral Neurology DivisionDepartment of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Division of NeuropsychiatryDepartment of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Tereza Serranová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
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28
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Silveri MC, Di Tella S, Lo Monaco MR, Petracca M, Tondinelli A, Antonucci G, Pozzi G, Di Lazzaro G, Calabresi P, Bentivoglio AR. Theory of mind: A clue for the interpretation of functional movement disorders. Acta Neurol Scand 2022; 145:571-578. [PMID: 35112347 PMCID: PMC9303374 DOI: 10.1111/ane.13585] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
Objectives Functional movement disorders (FMD) refer to a heterogeneous group of manifestations incongruent with known neurological diseases. Functional neuroimaging studies in FMD indicate the overlap between cerebral regions in which abnormal activation occurs and those considered crucial for theory of mind (ToM), the ability to attribute mental states. The aim of this study was to explore whether FMD might be related to ToM disorders to the extent that they reduce the ability to make inferences about the mental states underlying motor behaviour during social interaction. Materials & Methods Eighteen subjects with FMD and 28 matched healthy controls (HC) were given a ToM battery. The severity of FMD was rated by the Simplified‐FMD Rating Scale (S‐FMDRS). Dissociative symptoms were evaluated by the Dissociative Experiences Scale (DES‐II). Results FMD scored worse than the HC in most ToM tasks: second‐order False Beliefs (p = .005), Faux‐Pas Recognition Test (p < .001) and Reading the Mind in the Eyes Test (p = .020); control questions elicited normal scores. The DES‐II indicated dissociative‐borderline psychopathology and negatively correlated with accuracy on the second‐order False Belief (Spearman's rho = −.444; p = .032); the positive correlation between DES‐II and severity of motor symptoms (S‐FMDRS) approached significance (Spearman's rho test = .392; p = .054). ToM disorders were not correlated with S‐FMDRS, due to the typical variability in FMD over time with regard to the severity of symptoms and the district of body involved. Conclusions Our results are consistent with the hypothesis that FMD are related to ToM deficits, and future studies are needed to define the specific nature of this relationship.
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Affiliation(s)
- Maria Caterina Silveri
- Department of Psychology Università Cattolica del Sacro Cuore Milan Italy
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
| | - Sonia Di Tella
- Department of Psychology Università Cattolica del Sacro Cuore Milan Italy
| | - Maria Rita Lo Monaco
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
- Institute of Internal Medicine and Geriatrics Università Cattolica del Sacro Cuore Rome Italy
| | - Martina Petracca
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
| | - Alice Tondinelli
- Department of Psychology Università Cattolica del Sacro Cuore Milan Italy
| | - Gabriella Antonucci
- Department of Psychology Sapienza Università di Roma and IRCCS Fondazione Santa Lucia Rome Italy
| | - Gino Pozzi
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
- Department of Neurosciences Section of Psychiatry Università Cattolica del Sacro Cuore Rome Italy
| | - Giulia Di Lazzaro
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
- Department of Systems Medicine University Tor Vergata Rome Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
- Institute of Neurology Università Cattolica del Sacro Cuore Rome Italy
| | - Anna Rita Bentivoglio
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS Rome Italy
- Institute of Neurology Università Cattolica del Sacro Cuore Rome Italy
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29
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Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol 2022; 21:537-550. [PMID: 35430029 PMCID: PMC9107510 DOI: 10.1016/s1474-4422(21)00422-1] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 01/12/2023]
Abstract
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Four entities-functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder-show similarities in aetiology and pathophysiology and are variants of a disorder at the interface between neurology and psychiatry. All four entities have distinctive features and can be diagnosed with the support of clinical neurophysiological studies and other biomarkers. The pathophysiology of functional neurological disorder includes overactivity of the limbic system, the development of an internal symptom model as part of a predictive coding framework, and dysfunction of brain networks that gives movement the sense of voluntariness. Evidence supports tailored multidisciplinary treatment that can involve physical and psychological therapy approaches.
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30
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Diagnosis and Initial Treatment of Functional Movement Disorders in Children. Semin Pediatr Neurol 2022; 41:100953. [PMID: 35450668 DOI: 10.1016/j.spen.2022.100953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
Abstract
Functional movement disorders (FMD) are complex neurobehavioral disorders that can be a significant source of disability for both children and their caregivers. While FMD in the adult population is better characterized, the aim of this paper is to review the pertinent clinical and historical features, diagnostic criteria, and multi-disciplinary management of FMD in the pediatric population. We highlight recent trends in pediatric FMD, including the increase in functional tic-like behaviors that has been observed during the COVID-19 pandemic.
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31
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Polich G, Zalanowski S, Maney J, Perez DL, Baslet G, Maggio J, O’Neal MA, Dworetzky B, Herman S. Development of an inpatient rehabilitation pathway for motor functional neurological disorders: Initial reflections. NeuroRehabilitation 2022; 50:231-243. [DOI: 10.3233/nre-228006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND: Emerging research supports a primary role for rehabilitation therapy alongside psychoeducation and psychotherapy in the treatment of functional neurological disorder (FND). OBJECTIVE: While consensus recommendations for physical therapists, occupational therapists, and speech and language pathologists treating FND have been published, specific recommendations for multidisciplinary FND care delivered on an inpatient rehabilitation unit are yet to be established. METHODS: This report describes one inpatient rehabilitation facility’s efforts to design and implement a clinical pathway for patients with acute-onset motor FND—patients recently hospitalized for work-up of new neurological symptoms subsequently deemed functional. RESULTS: Detailed descriptions on defining admission criteria and delivering consensus- and evidence-based multidisciplinary inpatient rehabilitation are provided. CONCLUSIONS: In the context of prospective research studies, considerably more work is needed to delineate the optimal duration and intensity of inpatient rehabilitation treatment for the management of patients with motor FND.
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Affiliation(s)
- Ginger Polich
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Julie Maney
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - David L. Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julie Maggio
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Mary A. O’Neal
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Barbara Dworetzky
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Seth Herman
- Department of Physical Medicine and Rehabilitation, California Rehabilitation Institute, Los Angeles, CA, USA
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Hebb C, Raynor G, Perez DL, Nappi-Kaehler J, Polich G. The use of rhythmic auditory stimulation for functional gait disorder: A case report. NeuroRehabilitation 2022; 50:219-229. [DOI: 10.3233/nre-228005] [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: Functional gait disorders (FGD) are a common and disabling condition. Consensus-based rehabilitation techniques for treating FGD and other functional neurological disorder presentations at large utilize a variety of therapeutic strategies, including distraction, novel approaches to movement, entrainment, stress/hypervigilance modulation, and psychotherapy. CASE REPORT: Here we present a case of a 24-year-old woman with a complex history of anxiety, depression, left frontal astrocytoma, postural orthostatic tachycardia syndrome (POTS) and FGD. During a multidisciplinary inpatient rehabilitation stay for FGD, the patient underwent rhythmic auditory stimulation (RAS) delivered by a neurologic music therapist in conjunction with physical therapy, occupational therapy, and psychotherapy. RESULTS: The RAS intervention appeared to play a significant role in symptom resolution for this patient. Improvement in the patient’s truncal displacement, foot dragging, and well as overall gait speed occurred following serial RAS trials performed over a single treatment session. Benefits persisted immediately following the intervention and upon subsequent reassessment. Although at four-year follow-up the patient’s FGD symptoms remained resolved, fatigue continued to limit her ambulatory capacity and overall endurance. CONCLUSION: RAS represents a unique therapeutic approach for treating FGD, complementary to existing consensus-based rehabilitation recommendations, and may warrant further consideration by the field.
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Affiliation(s)
- Caitlin Hebb
- MedRhythms, Inc., Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Geoffrey Raynor
- Department of Psychiatry, Brigham’s and Women’s Hospital, Boston, MA, USA
| | - David L. Perez
- Department of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ginger Polich
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham’s and Women’s Hospital, Boston, MA, USA
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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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Oriuwa C, Mollica A, Feinstein A, Giacobbe P, Lipsman N, Perez DL, Burke MJ. Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review. J Neurol Neurosurg Psychiatry 2022; 93:280-290. [PMID: 35115389 DOI: 10.1136/jnnp-2021-327025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
Functional neurological disorder and somatic symptom disorder are complex neuropsychiatric conditions that have been linked to circuit-based dysfunction of brain networks. Neuromodulation is a novel therapeutic strategy capable of modulating relevant brain networks, making it a promising potential candidate for the treatment of these patient populations. We conducted a systematic review of Medline, Embase and PsycINFO up to 4 March 2021. Trials investigating neuromodulation devices for the treatment of functional neurological disorder or somatic symptom disorder were selected. Extracted variables included study design, demographic and clinical characteristics, psychiatric comorbidity, neurostimulation protocols, clinical outcome measures and results. 404 studies were identified with 12 meeting inclusion criteria. 221 patients were treated in the included studies with mean study sample size of 18 (4-70). Five studies were randomised clinical trials. Functional motor symptoms (six weakness, four movement disorders) were the most studied subpopulations. Transcranial magnetic stimulation (TMS) was the most frequently used device (10 studies), followed by electroconvulsive therapy (one study) and direct-current stimulation (one study). Treatment protocols varied in intended therapeutic mechanism(s): eight studies aimed to modulate underlying network dysfunction, five aimed to demonstrate movement (one also leveraged the former) and three boosted their primary mechanism with enhanced suggestion/expectation. All but one study reported positive results; however, methodological/outcome heterogeneity, mixed study quality and small sample sizes precluded quantitative meta-analysis. Neuromodulation, particularly TMS for the treatment of functional motor symptoms, shows preliminary promise in a growing line of research. Larger, sham-controlled studies are needed to further establish efficacy and better understand therapeutic mechanisms.
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Affiliation(s)
- Chika Oriuwa
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Adriano Mollica
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anthony Feinstein
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David L Perez
- Department of Neurology, Cognitive Behavioural Neurology Division, Functional Neurological Disorder Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Neuropsychiatry Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada .,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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35
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Schwingenschuh P, Espay AJ. Functional tremor. J Neurol Sci 2022; 435:120208. [DOI: 10.1016/j.jns.2022.120208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 10/18/2022]
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36
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Psychological interventions for treating functional motor symptoms: Scoping review of the literature. Clin Psychol Rev 2022; 94:102146. [DOI: 10.1016/j.cpr.2022.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022]
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Ertan D, Aybek S, LaFrance WC, Kanemoto K, Tarrada A, Maillard L, El-Hage W, Hingray C. Functional (psychogenic non-epileptic/dissociative) seizures: why and how? J Neurol Neurosurg Psychiatry 2022; 93:144-157. [PMID: 34824146 DOI: 10.1136/jnnp-2021-326708] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind-body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We also presented different models of FS based on psychological and neuroanatomical understanding, multilevel models and integrative understanding of FS. This work should help professionals to better understand current views on the multifactorial mechanisms involved in the development of FS. Shedding light on the different FS profiles in terms of aetiopathogenesis will help guide how best to direct therapy, based on these different underlying mechanisms.
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Affiliation(s)
- Deniz Ertan
- CRAN,UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, France.,Unité de recherche clinique, Établissement Médical de La Teppe, Tain-l'Hermitage, France
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland.,Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - W Curt LaFrance
- Psychiatry and Neurology, Brown Medical School Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kousuke Kanemoto
- Neuropsychiatric Department, Aichi Medical University, Nagakute, Aichi, Japan
| | - Alexis Tarrada
- Neurology Department, CHRU de Nancy, Nancy, Lorraine, France.,University Psychiatry Department, Centre Psychothérapique de Nancy, Laxou, Lorraine, France
| | - Louis Maillard
- CRAN,UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, France.,Neurology Department, CHRU de Nancy, Nancy, Lorraine, France
| | - Wissam El-Hage
- Department of Psychiatry, CHRU Tours, Tours, Centre, France
| | - Coraline Hingray
- Neurology Department, CHRU de Nancy, Nancy, Lorraine, France .,University Psychiatry Department, Centre Psychothérapique de Nancy, Laxou, Lorraine, France
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Chastan N, Etard O, Parain D, Gerardin P, Fouldrin G, Derambure P, Tard C, Gillibert A, Nathou C, Delval A, Welter ML, Guillin O. Repetitive transcranial magnetic stimulation for patients with functional paralysis: a randomized controlled study. Eur J Neurol 2022; 29:1293-1302. [PMID: 35098613 DOI: 10.1111/ene.15264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been proposed to treat functional neurological disorders. Here, we aim to assess the efficacy of rTMS to treat functional paralysis in a controlled randomized trial. METHODS Patients received 2 sessions of active or sham 0.25 Hz rTMS (60 stimuli each), with a one-day interval, applied over the motor cortex contralateral to the paralysis. The primary outcome was the number of patients with an increase in motor score between baseline and after the second rTMS session, rated by two investigators blinded to the treatment allocation. Secondary outcomes were changes in global and fine motor scores between groups after rTMS, and occurrence of adverse events. RESULTS Sixty-two patients (46 female; mean [SD] age, 35.2 [13.9] years) were enrolled and randomized. Thirteen out of 32 (41%) and 11/30 (37%) patients had increased motor strength after active or sham rTMS, respectively (p=0.80). Changes in both global and fine motor scores after rTMS relative to baseline were also not significantly different between treatment groups (median difference in the global motor score 0.62 [0.83] and 0.37 [0.61], and fine motor scores 0.12 [0.18] and 0.08 [0.11], in active and sham rTMS groups, respectively, p=0.14). We observed six serious adverse events, consisting of 3 cephalalgia in the active group and 2 cephalalgia and 1 asthenia in the sham group. CONCLUSIONS Two sessions of sham or active low frequency rTMS were effective to improve functional paralysis, suggesting a placebo effect of this non-invasive brain stimulation technique.
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Affiliation(s)
- Nathalie Chastan
- Department of Neurophysiology and Clinical Investigation Center 1404, Rouen University Hospital, Rouen, France.,Normandy University, UNICAEN, INSERM U1075, Caen, France
| | - Olivier Etard
- Université de Normandie, ISTS, EA 7466, GIP Cyceron, Caen, France and CHU de Caen, Service des Explorations Fonctionnelles du Système Nerveux, Caen, France
| | - Dominique Parain
- Department of Neurophysiology and Clinical Investigation Center 1404, Rouen University Hospital, Rouen, France
| | | | - Gaël Fouldrin
- Department of Psychiatry, Rouen University Hospital, Rouen, France
| | - Philippe Derambure
- U1171, Department of Neurophysiology, Lille University Hospital, Lille, France
| | - Céline Tard
- U1171, Department of Neurophysiology, Lille University Hospital, Lille, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Clément Nathou
- CHU de Caen, Service de Psychiatrie adulte, Centre Esquirol, 14000, Caen, France
| | - Arnaud Delval
- U1171, Department of Neurophysiology, Lille University Hospital, Lille, France
| | - Marie-Laure Welter
- Department of Neurophysiology and Clinical Investigation Center 1404, Rouen University Hospital, Rouen, France.,Brain Institute, INSERM U1127, Paris, France
| | - Olivier Guillin
- Department of Psychiatry, Rouen University Hospital, Rouen, France
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Deuschl G, Becktepe JS, Dirkx M, Haubenberger D, Hassan A, Helmich R, Muthuraman M, Panyakaew P, Schwingenschuh P, Zeuner KE, Elble RJ. The clinical and electrophysiological investigation of tremor. Clin Neurophysiol 2022; 136:93-129. [DOI: 10.1016/j.clinph.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 01/18/2023]
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Prato A, Saia F, Milana MC, Scerbo M, Barone R, Rizzo R. Functional tic-like behaviours during the COVID-19 pandemic: Follow-up over 12 months. Front Pediatr 2022; 10:1003825. [PMID: 36699317 PMCID: PMC9869029 DOI: 10.3389/fped.2022.1003825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Functional tics are included in the wide spectrum of functional movement disorders (FMDs). Their distinction from organic tics is challenging because they both phenomenologically present common features. During the COVID-19 pandemic, there has been an increase in functional tic-like behaviours in vulnerable children and adolescents after social media exposure. This study explores the phenomenology and course of a cohort of newly diagnosed functional tic-like behaviors. METHODS We analysed clinical data of 243 patients affected by tic disorders collected at outpatient Tourette Clinic, Child and Adolescent Neurology and Psychiatry Unit, Catania University. Among the clinical cohort with functional tic-like behaviors, we evaluated the clinical course of symptoms at follow-up visits after 6 and 12 months. RESULTS Among the cohort of 243 patients referred for evaluation at our centre, 11 were diagnosed with functional tic-like behaviours. The majority of participants with functional tic-like behaviours were female with a mean age of 15 years old and presented an explosive symptom's onset. At follow-up visit after 12 months, patients with functional tic-like behaviors showed a significant variation in the severity of tics and anxiety symptoms. Conversely, depressive, and obsessive-compulsive symptoms did not significantly differ during the follow-up. CONCLUSION Our data suggest that several characteristics in clinical course and their phenomenology can help clinicians to distinguish functional tic-like behaviours from organic tics. Our results also suggest a better outcome for tics and anxiety symptoms respect on other comorbidities. A prompt diagnosis and management not only of tics but also comorbidities are recommended, as generally conventional pharmacotherapy for tics does not have positive effects on these patients.
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Affiliation(s)
- Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy.,Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Federica Saia
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Maria Chiara Milana
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Miriam Scerbo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Rita Barone
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
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41
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Martindale JM, Mink JW. The Rise of Functional Tic-Like Behaviors: What Do the COVID-19 Pandemic and Social Media Have to Do With It? A Narrative Review. Front Pediatr 2022; 10:863919. [PMID: 35899132 PMCID: PMC9309505 DOI: 10.3389/fped.2022.863919] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been a rise in explosive onset of tic-like behaviors during the COVID-19 pandemic. Historically, this is an uncommon phenomenology of functional movement disorders across all ages. Both the psychological burden of the pandemic and social media usage have been implicated in the rise of these tic-like behaviors. METHODS This paper provides a narrative review of the literature on chronic tic disorders, functional tics, and mass functional illness with particular focus on the key distinguishing features, role of social media, and the role of COVID-19. RESULTS The COVID-19 pandemic has profoundly affected the mental health of many individuals, including children, adolescents, and their caregivers. Implementation of lockdowns, lifestyle disruptions, school closures, and social distancing have driven a surge in social media and digital technology use. The combination of predisposing factors, the psychological burden of the COVID-19 pandemic, and social media are implicated in the rise and spread of tic-like behaviors; which may represent a modern-day form of mass functional illness. While many of the features overlap with functional tics, there are emerging distinctive features that are important to recognize. A more encompassing term, Functional Tic-Like Behaviors, is used to better reflect multiple contributing factors. CONCLUSION Knowledge of these differences is essential to mitigate downstream health effects and poor outcomes.
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Affiliation(s)
- Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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42
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Frisaldi E, Shaibani A, Trucco M, Milano E, Benedetti F. What is the role of placebo in neurotherapeutics? Expert Rev Neurother 2021; 22:15-25. [PMID: 34845956 DOI: 10.1080/14737175.2022.2012156] [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: 10/19/2022]
Abstract
INTRODUCTION The widespread use of the word 'placebo' in the medical literature emphasizes the importance of this phenomenon in modern biomedical sciences. Neuroscientific research over the past thirty years shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and can be robust in both laboratory and clinical settings. AREAS COVERED Here the authors describe the biological mechanisms and the clinical implications of placebo effects with particular emphasis on neurology and psychiatry, for example in pain, movement disorders, depression. In these conditions, a number of endogenous systems have been identified, such as endogenous opioids, endocannabinoids, and dopamine, which contribute to the placebo-induced benefit. EXPERT OPINION Every effort should be made to maximize the placebo effect and reduce its evil twin, the nocebo effect, in medical practice. This does not require the administration of a placebo, but rather the enhancement of the effects of pharmacological and nonpharmacological treatments through a good doctor-patient interaction.
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Affiliation(s)
- Elisa Frisaldi
- Neuroscience Department, University of Turin Medical School, Turin, Italy
| | - Aziz Shaibani
- Nerve & Muscle Center of Texas, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Marco Trucco
- Division of Physical and Rehabilitation Medicine, San Camillo Medical Center, Turin, Italy
| | - Edoardo Milano
- Division of Physical and Rehabilitation Medicine, San Camillo Medical Center, Turin, Italy
| | - Fabrizio Benedetti
- Neuroscience Department, University of Turin Medical School, Turin, Italy.,Medicine and Physiology of Hypoxia, Plateau Rosà, Switzerland
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Piramide N, Sarasso E, Tomic A, Canu E, Petrovic IN, Svetel M, Basaia S, Dragasevic Miskovic N, Kostic VS, Filippi M, Agosta F. Functional MRI connectivity of the primary motor cortex in functional dystonia patients. J Neurol 2021; 269:2961-2971. [PMID: 34773159 DOI: 10.1007/s00415-021-10879-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Functional movement disorders include a wide spectrum of clinically documented movement disorders without an apparent organic substrate. OBJECTIVE To explore the functional connectivity (FC) of the primary motor (M1) cortex in functional dystonia (FD) patients relative to healthy controls, with a focus on different clinical phenotypes. METHODS Forty FD patients (12 fixed [FixFD]; 28 mobile [MobFD]) and 43 healthy controls (14 young FixFD-age-matched [yHC]; 29 old MobFD-age-matched [oHC]) underwent resting state fMRI. A seed-based FC analysis was performed using bilateral M1 as regions of interest. RESULTS Compared to controls, FD patients showed reduced FC between left M1 and left dorsal anterior cingulate cortex, and between right M1 and left M1, premotor/supplementary motor area (SMA), dorsal posterior cingulate cortex (PCC), and bilateral precuneus. Relative to yHC, FixFD patients showed reduced FC between M1 and precuneus bilaterally. Compared to oHC, MobFD patients revealed reduced FC between right M1 and left M1, premotor/SMA, dorsal-PCC, bilateral primary sensory cortices and parieto-occipital areas, and increased FC of right M1 with right associative visual cortex and bilateral ventral-PCC. FixFD patients, relative to MobFD, showed lower FC between the right M1 and right associative visual area, and bilateral precuneus and ventral-PCC. CONCLUSIONS This study suggests an altered brain FC of the motor circuit with areas involved in emotional processes and sense of agency in FD. FixFD patients showed FC abnormalities mainly in areas related to sense of agency, while MobFD in regions involved in sensorimotor functions (reduced FC) and emotional processing (increased FC).
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Affiliation(s)
- Noemi Piramide
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Aleksandra Tomic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Igor N Petrovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Svetel
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Vladimir S Kostic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
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Adewusi J, Levita L, Gray C, Reuber M. Subjective versus objective measures of distress, arousal and symptom burden in patients with functional seizures and other functional neurological symptom disorder presentations: A systematic review. Epilepsy Behav Rep 2021; 16:100502. [PMID: 34917921 PMCID: PMC8669370 DOI: 10.1016/j.ebr.2021.100502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
Symptoms and functioning can be measured subjectively using self-report measures or objectively, based on physiological changes. This raises the question whether subjective and objective measures are closely correlated and - if not - whether one is more accurate or meaningful than the other, especially in patients with Functional Seizures (FS) or other Functional Neurological Symptom Disorders (FND), where subjective and objective observations may be thought particularly likely to deviate. This systematic review explores these questions focussing on measures of distress, arousal and symptom burden. Eighteen studies (12 FS, 6 other FND) capturing 396 FND patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r's = -0.74-0.59, p's < 0.05). The small number of studies and diverse methodologies do not provide conclusive answers to the questions posed. Given that subjective and objective measures capture different aspects of current state or function, a combination of measurement approaches is likely to provide optimal information about patients' health state. In view of the attentional and perceptual alterations implicated in FND, the difference between objective and subjective measures may represent an interesting observation in its own right.
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Affiliation(s)
- Joy Adewusi
- Academic Neurology Unit, University of Sheffield, UK
- Department of Psychology, The University of Sheffield, Sheffield, UK
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Sheffield, UK
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
- Academic Neurology Unit, University of Sheffield, UK
| | - Liat Levita
- Academic Neurology Unit, University of Sheffield, UK
- Department of Psychology, The University of Sheffield, Sheffield, UK
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Sheffield, UK
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
- Academic Neurology Unit, University of Sheffield, UK
| | - Cordelia Gray
- Academic Neurology Unit, University of Sheffield, UK
- Department of Psychology, The University of Sheffield, Sheffield, UK
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Sheffield, UK
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
- Academic Neurology Unit, University of Sheffield, UK
| | - Markus Reuber
- Corresponding author at: Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road. Sheffield S10 2JF, UK.
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Kramer G, Bos EH, Edwards MJ, Tijssen MAJ, Rosmalen JGM. Daily fluctuations of negative affect are only weakly associated with tremor symptoms in functional and organic tremor patients. J Psychosom Res 2021; 150:110627. [PMID: 34619408 DOI: 10.1016/j.jpsychores.2021.110627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/27/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a long-standing research history on the presumed psychological origin of functional movement disorders. Most studies do not address the heterogeneity in functional movement disorders and do not distinguish between risk factors, causes and consequences. We studied the associations between negative affect and objective as well as subjective symptom levels in patients with functional and organic tremor. METHODS Thirty-three patients with a functional (14) or organic tremor (19) completed a web-based diary on subjective symptom burden and negative affect, five times a day for 30 days (total number of observations = 4759). During the same period, the participants wore an accelerometer to objectively record tremor. Vector autoregressive modelling was used to determine the time-lagged and contemporaneous associations between negative affect and objective/subjective tremor symptoms, both on an individual and a group level. RESULTS In contrast to previous literature, patients with a functional or organic tremor showed a weak contemporaneous association between negative affect and objective/subjective tremor symptoms (on average r = 0.038 and 0.174 respectively). Time-lagged associations between negative affect and objective/subjective tremor symptoms were mixed in effect and direction and only present in a subset of patients, with no differences between patients with functional or organic tremor. CONCLUSIONS Negative affect is only weakly associated with objective/subjective tremor symptoms, both on the contemporaneous and time-lagged associations, and these associations were mainly similar between patients with functional or organic tremor. These results argue against a strong influence of daily stress on tremor symptoms in patients with a functional or organic tremor.
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Affiliation(s)
- Gerrit Kramer
- University of Groningen, University Medical Center Groningen, Department of Neurology, Expertise Center Movement Disorders Groningen, Groningen, the Netherlands
| | - Elisabeth H Bos
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Mark J Edwards
- St George's University of London, Institute of Molecular and Clinical Sciences, Motor Control and Movement Disorder Group, London, United Kingdom
| | - Marina A J Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Expertise Center Movement Disorders Groningen, Groningen, the Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, the Netherlands.
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Paredes-Echeverri S, Maggio J, Bègue I, Pick S, Nicholson TR, Perez DL. Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis. J Neuropsychiatry Clin Neurosci 2021; 34:30-43. [PMID: 34711069 PMCID: PMC8813876 DOI: 10.1176/appi.neuropsych.21010025] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising yet inconsistently identified neural circuit profiles have been observed in patients with FND, suggesting that gaps remain in our systems-level neurobiological understanding. As such, other important physiological variables, including autonomic, endocrine, and inflammation findings, need to be contextualized for a more complete mechanistic picture. METHODS The investigators conducted a systematic review and meta-analysis of available case-control and cohort studies of FND. PubMed, PsycINFO, and Embase databases were searched for studies from January 1, 1900, to September 1, 2020, that investigated autonomic, endocrine, and inflammation markers in patients with FND. Sixty-six of 2,056 screened records were included in the review, representing 1,699 patients; data from 20 articles were used in the meta-analysis. RESULTS Findings revealed that children and adolescents with FND, compared with healthy control subjects (HCs), have increased resting heart rate (HR); there is also a tendency toward reduced resting HR variability in patients with FND across the lifespan compared with HCs. In adults, peri-ictal HR differentiated patients with functional seizures from those with epileptic seizures. Other autonomic and endocrine profiles for patients with FND were heterogeneous, with several studies highlighting the importance of individual differences. CONCLUSIONS Inflammation research in FND remains in its early stages. Moving forward, there is a need for the use of larger sample sizes to consider the complex interplay between functional neurological symptoms and behavioral, psychological, autonomic, endocrine, inflammation, neuroimaging, and epigenetic/genetic data. More research is also needed to determine whether FND is mechanistically (and etiologically) similar or distinct across phenotypes.
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Affiliation(s)
- Sara Paredes-Echeverri
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie Maggio
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Indrit Bègue
- Adult Psychiatry Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Laboratory for Clinical and Experimental Psychopathology, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Susannah Pick
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom
| | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom
| | - David L. Perez
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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47
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Perez DL, Aybek S, Popkirov S, Kozlowska K, Stephen CD, Anderson J, Shura R, Ducharme S, Carson A, Hallett M, Nicholson TR, Stone J, LaFrance WC, Voon V. A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. J Neuropsychiatry Clin Neurosci 2021; 33:14-26. [PMID: 32778007 DOI: 10.1176/appi.neuropsych.19120357] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Selma Aybek
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Stoyan Popkirov
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Kasia Kozlowska
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Christopher D Stephen
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jordan Anderson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Robert Shura
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Simon Ducharme
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Alan Carson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Mark Hallett
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Timothy R Nicholson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jon Stone
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Valerie Voon
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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Rauschenberger L, Knorr S, Pisani A, Hallett M, Volkmann J, Ip CW. Second hit hypothesis in dystonia: Dysfunctional cross talk between neuroplasticity and environment? Neurobiol Dis 2021; 159:105511. [PMID: 34537328 DOI: 10.1016/j.nbd.2021.105511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 01/08/2023] Open
Abstract
One of the great mysteries in dystonia pathophysiology is the role of environmental factors in disease onset and development. Progress has been made in defining the genetic components of dystonic syndromes, still the mechanisms behind the discrepant relationship between dystonic genotype and phenotype remain largely unclear. Within this review, the preclinical and clinical evidence for environmental stressors as disease modifiers in dystonia pathogenesis are summarized and critically evaluated. The potential role of extragenetic factors is discussed in monogenic as well as adult-onset isolated dystonia. The available clinical evidence for a "second hit" is analyzed in light of the reduced penetrance of monogenic dystonic syndromes and put into context with evidence from animal and cellular models. The contradictory studies on adult-onset dystonia are discussed in detail and backed up by evidence from animal models. Taken together, there is clear evidence of a gene-environment interaction in dystonia, which should be considered in the continued quest to unravel dystonia pathophysiology.
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Affiliation(s)
- Lisa Rauschenberger
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Susanne Knorr
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
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Frey J, Hess CW, Kugler L, Wajid M, Wagle Shukla A. Transcranial Magnetic Stimulation in Tremor Syndromes: Pathophysiologic Insights and Therapeutic Role. Front Neurol 2021; 12:700026. [PMID: 34512517 PMCID: PMC8426899 DOI: 10.3389/fneur.2021.700026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a painless, non-invasive, and established brain stimulation technique to investigate human brain function. Over the last three decades, TMS has shed insight into the pathophysiology of many neurological disorders. Tremor is an involuntary, rhythmic oscillatory movement disorder commonly related to pathological oscillations propagated via the cerebello-thalamo-cortical pathway. Although tremor is the most common movement disorder and recent imaging studies have enhanced our understanding of the critical pathogenic networks, the underlying pathophysiology of different tremor syndromes is complex and still not fully understood. TMS has been used as a tool to further our understanding of tremor pathophysiology. In addition, repetitive TMS (rTMS) that can modulate brain functions through plasticity effects has been targeted to the tremor network to gain potential therapeutic benefits. However, evidence is available for only a few studies that included small patient samples with limited clinical follow-up. This review aims to discuss the role of TMS in advancing the pathophysiological understanding as well as emerging applications of rTMS for treating individual tremor syndromes. The review will focus on essential tremor, Parkinson's disease tremor, dystonic tremor syndrome, orthostatic tremor, and functional tremor.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Christopher W Hess
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Liam Kugler
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Manahil Wajid
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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50
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Effective connectivity between emotional and motor brain regions in people with psychogenic nonepileptic seizures (PNES). Epilepsy Behav 2021; 122:108085. [PMID: 34166951 DOI: 10.1016/j.yebeh.2021.108085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize the effective connectivity (EC) between the emotion and motor brain regions in patients with psychogenic nonepileptic seizures (PNES), based on resting-state spectral dynamic causal modeling (spDCM). METHODS Twenty-three patients with PNES and twenty-five healthy control (HC) subjects underwent resting-state fMRI scanning. The coupling parameters indicating the causal interactions between eight brain regions associated with emotion, executive control, and motion were estimated for both groups, using resting-state fMRI spDCM. RESULTS Compared to the HC subjects, in patients with PNES: (i) the left insula (INS) and left and right inferior frontal gyri (IFG) are more inhibited by the amygdala (AMYG), anterior cingulate cortex (ACC), and precentral gyrus (PCG); (ii) the left AMYG has greater inhibitory effects on the INS, IFG, dorsolateral prefrontal cortex (DLPFC), PCG, and supplementary motor area (SMA); (iii) the left ACC has more inhibitory effects on the INS and IFG; (iv) the right ACC is more inhibited by the INS and IFG, and has a less inhibitory effect on the SMA and PCG; and (v) the left caudate (CAU) had increased inhibitory effects on the AMYG and IFG and a more excitatory effect on the SMA. CONCLUSION Our results suggest that in patients with PNES, the emotion-processing regions have inhibitory effects on the executive control areas and motor regions. Our findings may provide further insight into the influence of emotional arousal on functional movements and the underlying mechanisms of involuntary movements during functional seizures. Furthermore, they may suggest that emotion regulation through cognitive behavioral psychotherapies can be a potentially effective treatment modality.
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