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Goudarzzadeh S, Shekarabi S, Abdi M. Functional movement disorder similar to Parkinson's disease: a case report. J Med Case Rep 2024; 18:453. [PMID: 39350203 PMCID: PMC11443806 DOI: 10.1186/s13256-024-04767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/21/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION Functional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient's mental health and quality of life. CASE PRESENTATION A 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient's symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson's disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient's symptoms remained unresolved. Finally, after years of investigations, based on specialists' recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years. CONCLUSION This case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation.
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Affiliation(s)
- Sarah Goudarzzadeh
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shayan Shekarabi
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mahnaz Abdi
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Serranová T, Di Vico I, Tinazzi M, Aybek S, Bilic E, Binzer S, Bøen E, Bruggeman A, Bratanov C, Cabreira VRA, Golder D, Dunalska A, Falup-Pecurariu C, Garcin B, Gelauff J, Laffan A, Podnar S, Pareés I, Plender T, Popkirov S, Romanenko V, Schwingenschuh P, Seliverstov Y, Sjöström C, Škorvánek M, Stamelou M, Zailskas D, Edwards MJ, Stone J. Functional neurological disorder in Europe: regional differences in education and health policy. Eur J Neurol 2024; 31:e16350. [PMID: 39145716 DOI: 10.1111/ene.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited. OBJECTIVE Our aim was to provide an expert overview of the state of affairs of FND practice across Europe, focusing on education and training, access to specialized care, reimbursement and disability policies, and academic and patient-led representation of people with FND. METHODS We conducted a survey across Europe, featuring one expert per country. We asked experts to compare training and services for people with FND to those provided to people with multiple sclerosis (MS). RESULTS Responses from 25 countries revealed that only five included FND as a mandatory part of neurological training, while teaching about MS was uniformly included. FND was part of final neurology examinations in 3/17 countries, unlike MS that was included in all 17. Seventeen countries reported neurologists with an interest in FND but the estimated mean ratio of FND-interested neurologists to MS neurologists was 1:20. FND coding varied, with psychiatric coding for FND impacting treatment access and disability benefits in the majority of countries. Twenty countries reported services refusing to see FND patients. Eight countries reported an FND special interest group or network; 11 reported patient-led organizations. CONCLUSIONS FND is largely a marginal topic within European neurology training and there is limited access to specialized care and disability benefits for people with FND across Europe. We discuss how this issue can be addressed at an academic, healthcare and patient organization level.
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Affiliation(s)
- Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czechia
| | - Ilaria Di Vico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Fribourg, Switzerland
| | - Ervina Bilic
- Department of Neurology, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Erlend Bøen
- Psychosomatic and CL Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Arnout Bruggeman
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Christo Bratanov
- Neurology Department, CHU Grenoble Alpes, Grenoble, France
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Veronica Raquel Alheia Cabreira
- Neurology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Department of Clinical Brain Sciences, The University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Anna Dunalska
- Psychiatric Clinic of the Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | | | - Beatrice Garcin
- Department of Neurology, Avicenne Hospital, AP-HP, Bobigny, France
| | - Jeannette Gelauff
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aoife Laffan
- Department of Neurology, St. James's Hospital, Dublin, Ireland
| | - Simon Podnar
- Division of Neurology, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isabel Pareés
- Movement Disorders Program, Neurology Department Hospital Ruber Internacional, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | | | | | | | | | - Matej Škorvánek
- Department of Neurology, Pavol Jozef Šafárik University, Košice, Slovakia
- Department of Neurology, L. Pasteur University Hospital, Košice, Slovakia
| | - Maria Stamelou
- Parkinson's Disease and Movement Disorders DepartmentHygeia Hospital, Athens, Greece
| | - Donatas Zailskas
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and NeuroscienceKing's College London, London, UK
| | - Jon Stone
- Department of Clinical Brain Sciences, The University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Mark VW. Biomarkers and Rehabilitation for Functional Neurological Disorder. J Pers Med 2024; 14:948. [PMID: 39338202 PMCID: PMC11433361 DOI: 10.3390/jpm14090948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/21/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024] Open
Abstract
Functional neurological disorder, or FND, is widely misunderstood, particularly when considering recent research indicating that the illness has numerous biological markers in addition to its psychiatric disorder associations. Nonetheless, the long-held view that FND is a mental illness without a biological basis, or even a contrived (malingered) illness, remains pervasive both in current medical care and general society. This is because FND involves intermittent disability that rapidly and involuntarily alternates with improved neurological control. This has in turn caused shaming, perceived low self-efficacy, and social isolation for the patients. Until now, biomarker reviews for FND tended not to examine the features that are shared with canonical neurological disorders. This review, in contrast, examines current research on FND biomarkers, and in particular their overlap with canonical neurological disorders, along with the encouraging outcomes for numerous physical rehabilitation trials for FND. These findings support the perspective endorsed here that FND is unquestionably a neurological disorder that is also associated with many biological markers that lie outside of the central nervous system. These results suggest that FND entails multiple biological abnormalities that are widely distributed in the body. General healthcare providers would benefit their care for their patients through their improved understanding of the illness and recourses for support and treatment that are provided in this review.
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Affiliation(s)
- Victor W. Mark
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA; ; Tel.: +1-205-934-3499
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Sireci F, Moretti V, Cavallieri F, Ferrari S, Minardi V, Ferrari F, Balestra GL, Ghirotto L, Valzania F. "Somewhere Between an Actual Disease and a Disease": A Grounded Theory Study on Diagnosing Functional Neurological Disorders From a Multi-Informant Perspective. QUALITATIVE HEALTH RESEARCH 2024; 34:1069-1083. [PMID: 38031806 DOI: 10.1177/10497323231216346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Functional Neurological Disorders are characterized by sensory-motor or cognitive symptoms. Recent research has revealed their complex nature involving biological, psychological, and social factors. Care requires a multidisciplinary approach, which, to date, has yet to be considered. A Constructivist Grounded Theory study was conducted to understand the reasons behind this, exploring Functional Neurological Disorders diagnosis, communication, and understanding from multiple perspectives (patients and healthcare professionals). The core category was "negotiating Functional Neurological Disorders meanings and care amid a dissatisfying dichotomy," with sub-categories: i) seeking to "word" the disease, ii) exposing reductionism, and iii) a pluralist vision emerging. Diagnosing and communicating Functional Neurological Disorders is a process of negotiating meanings and care that hinges on participants' diverse ontological perspectives regarding the condition. Results highlight the difficulty in finding common ground and achieving mutual understanding among the various viewpoints, creating a challenge in establishing a unified approach to Functional Neurological Disorders care. In this context, only a few healthcare professionals emphasized the potential benefits of increased integration. A shift is required from a reductionist to an integrated biopsychosocial perspective to develop a more cohesive approach. Defining a medical paradigm through dialogue with teams and patients is essential in addressing Functional Neurological Disorders effectively. Furthermore, the required interdisciplinary approach holds the potential to mitigate the dissatisfaction arising from fragmented and compartmentalized care (the "dissatisfying dichotomy") experienced by our participants. It signifies a comprehensive strategy that could address the concerns of all involved parties and enhance the overall quality of care provided.
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Affiliation(s)
- Francesca Sireci
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Moretti
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale di Modena, Modena, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Minardi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Ferrari
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulietta Luul Balestra
- Qualitative Research Unit, Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ogunsuyi OB, Olagoke OC, Famutimi ME, Olatunde DM, Souza DOG, Oboh G, Barbosa NV, Rocha JBT. Neural acetylcholinesterase and monoamine oxidase deregulation during streptozotocin-induced behavioral, metabolic and redox modification in Nauphoeta cinerea. BMC Neurosci 2024; 25:42. [PMID: 39210265 PMCID: PMC11363635 DOI: 10.1186/s12868-024-00890-z] [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] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Genetic and environmental factors have been linked with neurodegeneration, especially in the elderly. Yet, efforts to impede neurodegenerative processes have at best addressed symptoms instead of underlying pathologies. The gap in the understanding of neuro-behavioral plasticity is consistent from insects to mammals, and cockroaches have been proven to be effective models for studying the toxicity mechanisms of various chemicals. We therefore used head injection of 74 and 740 nmol STZ in Nauphoeta cinerea to elucidate the mechanisms of chemical-induced neurotoxicity, as STZ is known to cross the blood-brain barrier. Neurolocomotor assessment was carried out in a new environment, while head homogenate was used to estimate metabolic, neurotransmitter and redox activities, followed by RT-qPCR validation of relevant cellular signaling. STZ treatment reduced the distance and maximum speed travelled by cockroaches, and increased glucose levels while reducing triglyceride levels in neural tissues. The activity of neurotransmitter regulators - AChE and MAO was exacerbated, with concurrent upregulation of glucose sensing and signaling, and increased mRNA levels of redox regulators and inflammation-related genes. Consequently, STZ neurotoxicity is conserved in insects, with possible implications for using N. cinerea to target the multi-faceted mechanisms of neurodegeneration and test potential anti-neurodegenerative agents.
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Affiliation(s)
- Opeyemi B Ogunsuyi
- Departamento de Bioquímica e Biologia Molecular, Programa de Pos-graduacao em Bioquimica Toxicologica, Centro de Ciências Naturais e Exatas (CCNE), Universidade Federal de Santa Maria, Santa Maria, RS, 97105-900, Brazil
- Department of Biomedical Technology, Federal University of Technology, P.M.B. 704, Akure, Nigeria
- Drosophila Research Lab, Functional Foods and Nutraceuticals Unit, Federal University of Technology, P.M.B. 704, Akure, Nigeria
| | - Olawande C Olagoke
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Division of Translational Research and Technology Innovation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Physiology, Kampala International University, Ishaka-Bushenyi, Uganda.
| | - Mayokun E Famutimi
- Department of Biomedical Technology, Federal University of Technology, P.M.B. 704, Akure, Nigeria
- Drosophila Research Lab, Functional Foods and Nutraceuticals Unit, Federal University of Technology, P.M.B. 704, Akure, Nigeria
| | - Damilola M Olatunde
- Drosophila Research Lab, Functional Foods and Nutraceuticals Unit, Federal University of Technology, P.M.B. 704, Akure, Nigeria
- Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, Nigeria
| | - Diogo O G Souza
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
| | - Ganiyu Oboh
- Drosophila Research Lab, Functional Foods and Nutraceuticals Unit, Federal University of Technology, P.M.B. 704, Akure, Nigeria
- Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, Nigeria
| | - Nilda V Barbosa
- Departamento de Bioquímica e Biologia Molecular, Programa de Pos-graduacao em Bioquimica Toxicologica, Centro de Ciências Naturais e Exatas (CCNE), Universidade Federal de Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - João B T Rocha
- Departamento de Bioquímica e Biologia Molecular, Programa de Pos-graduacao em Bioquimica Toxicologica, Centro de Ciências Naturais e Exatas (CCNE), Universidade Federal de Santa Maria, Santa Maria, RS, 97105-900, Brazil
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
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Alshimemeri S, Alabandi F, Binabbad RS, Elmutawi HS, Alabdi GS, Gilmour G. Opinions and experience of neurologists and neurology trainees in Saudi Arabia on functional neurological disorders: a survey based study. BMC Neurol 2024; 24:302. [PMID: 39210327 PMCID: PMC11361174 DOI: 10.1186/s12883-024-03810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Functional Neurological Disorder (FND) is commonly encountered in clinical practice, causing functional impairment and poor quality of life. As there is limited data from Saudi Arabia, our study aims to explore the experience and opinions of Saudi neurologists and neurology trainees regarding FND. METHODS In our cross-sectional observational study, we included 100 neurology consultants and trainees. Data was collected using an online questionnaire from March to August 2023. RESULTS A total of one hundred neurologists participated in the survey. Although 41% of physicians encountered FND patients on a weekly basis or more frequently, only 41.7% of trainees reported receiving dedicated lectures on FND. Furthermore, only 46% of respondents felt comfortable providing a clear explanation of the FND diagnosis to their patients. While the majority (64%) used the term "Functional Neurological Disorder" in medical documentation, only 43% used this term when communicating the diagnosis to patients, with the terminology varying widely. Clinicians emphasized that inconsistent and variable neurological examinations were key indicators raising diagnostic suspicion, which aligns with the recommended reliance on detailed clinical history and neurological examination. Lastly, 61% of physicians stated that their approach to patients with FND lacked a structured management plan. CONCLUSION Our study findings emphasize that FND is commonly encountered in clinical practice and reveal a significant lack of targeted education on FND for neurology trainees. Enhancing educational programs for both trainees and practicing neurologists on this prevalent neurological condition is essential for improving patient care and outcomes.
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Affiliation(s)
- Sohaila Alshimemeri
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Fatima Alabandi
- College of Medicine, Royal College of Surgeons, Dublin, Ireland
| | - Rahaf S Binabbad
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Gabriela Gilmour
- Department of Clinical Neuroscience, Cumming School of medicine, University of Calgary, Calgary, Canada
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Schuch FB. Functional neurological disorder: A rule-in diagnosis. Emerg Med Australas 2024. [PMID: 39189401 DOI: 10.1111/1742-6723.14490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Felix B Schuch
- Psychiatry, Bundaberg Base Hospital, Bundaberg, Queensland, Australia
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Bazydlo S, Eccles FJR. Living with functional movement disorders: a tale of three battles. An interpretative phenomenological analysis. Psychol Health 2024; 39:1130-1147. [PMID: 36222457 DOI: 10.1080/08870446.2022.2130312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/05/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Functional movement disorders (FMD) have poor prognosis and high physical and psychological co-morbidity. Their pathogenesis remains unclear, clinicians often find them difficult to treat, and lack of agreement between healthcare providers and patients is common. This study aimed to explore the experiences of living with FMD to improve understanding of its impact and patients' needs. METHODS Ten participants across the UK were recruited online through a charity's social media platforms. Semi structured interviews were conducted via video calls and were audio recorded and verbatim transcripts were analysed using interpretative phenomenological analysis. RESULTS Three superordinate themes were generated from the data, representing the three battles fought by the participants: (1) intrapersonal: the tug of war with the secret agent within- the power struggle with symptoms; (2) interpersonal: navigating stigma and self-preservation; (3) systemic: pursuing hope and treatments against helplessness and passivity. CONCLUSIONS Loss of control, feelings of powerlessness and oppression by symptoms is often mirrored in participants' experiences of seeking healthcare and navigating societal stigma. Active efforts to regain influence, improve quality of life and maintain hope can be jeopardised by others' dismissive attitudes and lack of knowledge. Antonovsky's model of salutogenesis is proposed as a useful framework for facilitating empowerment in FMD service provision.
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Affiliation(s)
- Sylwia Bazydlo
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, UK
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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; 30:710-717. [PMID: 38813659 DOI: 10.1017/s1355617724000249] [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] [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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Gafaranga JP, Kayitesi ML. Functional neurological symptom disorder in a patient with hemibody weakness: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241267073. [PMID: 39071194 PMCID: PMC11282550 DOI: 10.1177/2050313x241267073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024] Open
Abstract
Functional neurological symptom disorder (FNSD) is a complex condition with multifactorial etiology in which psychological factors may play a significant role in some patients, and they are not universally present or necessary for the diagnosis. FNSD can occur in the absence of psychological distress and each patient's presentation should be evaluated individually, considering a wide range of potential contributing factors. This is the first report related to prevalence data from Rwanda. This report presents a case study of a 15-year-old female patient who presented hemibody weakness without a structural neurological explanation on the background of the direct exposure to parental conflict. she was ultimately diagnosed with an FNSD and responded effectively to five sessions of cognitive behavioral therapy. Additionally, follow-up appointments were conducted every 4 months over the course of 1 year. During this period, the patient successfully resumed her studies and demonstrated normal functioning in all essential areas of daily life. This is the first reported case in Rwanda among similar cases. Addressing these specific stressors played a crucial role in the patient's overall outcome, leading to improved quality of care and prevention of unnecessary medical costs and interventions.
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Affiliation(s)
- Jean Pierre Gafaranga
- Department of Mental Health, University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Psychiatry and Behavioral Sciences, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Hoeritzauer I. Cognitive dysfunction in functional seizures: a neurologist's perspective. Lancet Psychiatry 2024; 11:483-485. [PMID: 38879269 DOI: 10.1016/s2215-0366(24)00177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Ingrid Hoeritzauer
- Department of Clinical Neurosciences, Royal Infirmary Hospital, Edinburgh, UK; Deanery of Clinical Sciences, College of Medicine and Veterinary Medicine, Centre for Clinical Brain Sciences, Edinburgh E16 4SB, UK.
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Degen-Plöger C, Reincke A, Bolte C, Gless CA, Luedtke K, Münchau A, Zeuner KE, Weissbach A. Individualized Physiotherapy of Upper Body Functional Movement Disorder - Two Illustrative Cases. Tremor Other Hyperkinet Mov (N Y) 2024; 14:29. [PMID: 38948013 PMCID: PMC11212775 DOI: 10.5334/tohm.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 07/02/2024] Open
Abstract
Background Information on specialist physiotherapeutic treatment for functional movement disorders is scarce. Previous studies focussed on functional gait disorders and availability of descriptions of the practical application especially for other body regions is very limited. Cases We present two illustrative cases, demonstrating the key elements of physiotherapy for the treatment of functional movement disorders beyond gait difficulties. The individual applicability of the specific core elements of physiotherapy, adapted to the individual needs of each patient, are described. We also explain, how different sensory stimuli can be used to shift attention away from symptoms and thus reduce them. Moreover, we discuss how patients' agency can be encouraged and how this results in therapy key moments, contributing to a sustained improvement of symptoms. Conclusion Thus, our case series are intended to guide clinicians and therapists alike, to promote disease-specific physiotherapy for this common and treatable neuropsychiatric disorder.
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Affiliation(s)
- Christof Degen-Plöger
- Institute for Health Sciences, Department of Physiotherapy, University of Lübeck, Lübeck, Germany
| | - Annemarie Reincke
- Institute for Sports Science, Faculty of Philosophy, Christian-Albrechts-Universität of Kiel, Kiel, Germany
| | - Christina Bolte
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | | | - Kerstin Luedtke
- Institute for Health Sciences, Department of Physiotherapy, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Center of rare diseases, University Clinic Schleswig-Holstein, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Kirsten E. Zeuner
- Department of Neurology, Christian Albrechts-University of Kiel, Kiel, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Center of rare diseases, University Clinic Schleswig-Holstein, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
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Clarici A, Bulfon M, Radin Y, Panksepp J. Neuromodulation of safety and surprise in the early stages of infant development: affective homeostatic regulation in bodily and mental functions. Front Psychol 2024; 15:1395247. [PMID: 38903479 PMCID: PMC11187996 DOI: 10.3389/fpsyg.2024.1395247] [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: 03/03/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Developing a sense of internal safety and security depends mainly on others: numerous neuromodulators play a significant role in the homeostatic process, regulating the importance of proximity to a caregiver and experiencing feelings that enable us to regulate our interdependence with our conspecifics since birth. This array of neurofunctional structures have been called the SEPARATION DISTRESS system (now more commonly known as the PANIC/ GRIEF system). This emotional system is mainly involved in the production of depressive symptoms. The disruption of this essential emotional balance leads to the onset of feelings of panic followed by depression. We will focus on the neuropeptides that play a crucial role in social approach behavior in mammals, which enhance prosocial behavior and facilitate the consolidation of social bonds. We propose that most prosocial behaviors are regulated through the specific neuromodulators acting on salient intersubjective stimuli, reflecting an increased sense of inner confidence (safety) in social relationships. This review considers the neurofunctional link between the feelings that may ultimately be at the base of a sense of inner safety and the central neuromodulatory systems. This link may shed light on the clinical implications for the development of early mother-infant bonding and the depressive clinical consequences when this bond is disrupted, such as in post-partum depression, depressive feelings connected to, addiction, neurofunctional disorders, and psychological trauma.
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Affiliation(s)
- Andrea Clarici
- Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Matteo Bulfon
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Yvonne Radin
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Jaak Panksepp
- College of Veterinary Medicine, Washington State University, Pullman, WA, United States
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Greenfield MJ, Fobian AD, Fargason RE, Birur B. Optimizing outcomes when treating functional neurological disorder in acute care settings: case reports depicting the value of diagnostic precision and timely and appropriate psychological interventions using an interdisciplinary framework. Front Psychiatry 2024; 15:1288828. [PMID: 38903638 PMCID: PMC11187304 DOI: 10.3389/fpsyt.2024.1288828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/24/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Unexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs. Methods The University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information. Discussion The cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions.
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Affiliation(s)
| | | | | | - Badari Birur
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, AL, United States
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15
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Boylan KA, Dworetzky BA, Baslet G, Polich G, Angela O’Neal M, Reinsberger C. Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders. Epilepsy Behav Rep 2024; 27:100682. [PMID: 38953100 PMCID: PMC11215960 DOI: 10.1016/j.ebr.2024.100682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
Functional neurological disorder (FND) is a common neurologic disorder associated with many comorbid symptoms including fatigue, pain, headache, and orthostasis. These concurrent symptoms lead patients to accumulate multiple diagnoses comorbid with FND, including fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, persistent post-concussive symptoms, and chronic pain. The role of physical activity and exercise has not been evaluated in FND populations, though has been studied in certain comorbid conditions. In this traditional narrative literature review, we highlight some existing literature on physical activity in FND, then look to comorbid disorders to highlight the therapeutic potential of physical activity. We then consider abnormalities in the autonomic nervous system (ANS) as a potential pathophysiological explanation for symptoms in FND and comorbid disorders and postulate how physical activity and exercise may provide benefit via autonomic regulation.
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Affiliation(s)
- Kelly A. Boylan
- Division of Epilepsy and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Barbara A. Dworetzky
- Division of Epilepsy and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Ginger Polich
- Department of Physical Medicine and Rehabilitation, Mass General Brigham, Boston, MA, United States
| | - M. Angela O’Neal
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Claus Reinsberger
- Division of Sports Neurology and Neurosciences, Mass General Brigham Boston, MA, United States
- Institute of Sports Medicine, Paderborn University, Warburger Str. 100, 33098 Paderborn, Germany
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16
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Milligan F, Whittingham C, Granitsitotis V, Simpson H, Woodfield J, Carson A, Stone J, Hoeritzauer I. Chronic idiopathic urinary retention: Comorbidity and outcome in 102 individuals. J Psychosom Res 2024; 181:111663. [PMID: 38643683 DOI: 10.1016/j.jpsychores.2024.111663] [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: 07/22/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Chronic Idiopathic urinary retention is poorly understood. One small study suggests higher than expected rates of functional neurological disorder and pain comorbidity which may have implications for understanding the disorder. We investigated the frequency of functional neurological disorder, chronic pain other medical and psychiatric comorbidity, triggers of urinary retention, results of urodynamic assessment, medication history, management, and outcome in patients with chronic idiopathic urinary retention. METHODS A consecutive retrospective electronic notes analysis was undertaken of patients with chronic idiopathic urinary retention presenting to a secondary care urology clinic between Jan 2018-Jan 2021, with follow-up to their most recent urological appointment. RESULTS 102 patients were identified (mean age of 41.9 years, 98% female). 25% had functional neurological disorder (n = 26), most commonly limb weakness (n = 19, 19%) and functional seizures (n = 16, 16%). Chronic pain (n = 58, 57%) was a common comorbidity. Surgical and medical riggers to urinary retention were found in almost half of patients (n = 49, 48%). 81% of patients underwent urodynamic assessment (n = 83). Most frequently no specific abnormality was reported (n = 30, 29%). Hypertonic urethral sphincter was the most identified urodynamic abnormality (n = 17, 17%). We noted high levels of opioid (n = 50, 49%) and benzodiazepine (n = 27, 26%) use. Urinary retention resolved in only a small number of patients (n = 6, 6%, median follow up 54 months), in three cases spontaneously. CONCLUSION This preliminary data suggests idiopathic urinary retention is commonly comorbid with functional neurological disorder, and chronic pain, suggesting shared mechanisms.
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Affiliation(s)
- Fintan Milligan
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | | | - Voula Granitsitotis
- Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Urology, Royal Victoria Hospital Kirkcaldy, UK.
| | - Helen Simpson
- Department of Urology, Western General Hospital, UK.
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
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Luca A, Lo Castro T, Mostile G, Donzuso G, Cicero CE, Nicoletti A, Zappia M. Personality and psychopathological characteristics in functional movement disorders. PLoS One 2024; 19:e0303379. [PMID: 38728293 PMCID: PMC11086865 DOI: 10.1371/journal.pone.0303379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Aim of the present study was to assess personality and psychopathological characteristics in patients with functional movement disorders (FMDs) compared to patients with other neurological disorders (OND). METHODS In this cross-sectional study, patients affected by clinically established FMDs and OND who attended the Neurologic Unit of the University-Hospital "Policlinico-San Marco" of Catania from the 1st of December 2021 to the 1st of June 2023 were enrolled. Personality characteristics were assessed with the Rorschach test coded according to Exner's comprehensive system and the Structured Clinical Interview for DSM-5 (SCID-II). RESULTS Thirty-one patients with FMDs (27 women; age 40.2±15.5 years; education 11.7±3.2 years; disease duration 2.3±2.5 years) and 24 patients affected by OND (18 women; age 35.8±16.3 years; education 11.9±2.9 years; disease duration 3.4±2.8 years) were enrolled. At the Rorschach, FMDs presented a significantly higher frequency of Popular (P) and sum of all Human content codes (SumH>5) responses and avoidant coping than OND. CONCLUSION FMDs presented "conformity behaviors", excessive interest in others than usual a maladaptive avoidant style of coping and a difficulty in verbalizing emotional distress. These psychopathological characteristics may favor the occurrence of FMDs.
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Affiliation(s)
- Antonina Luca
- Department of Medicine and Surgery, Kore University of Enna, Enna, Italy
| | - Tiziana Lo Castro
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Giovanni Mostile
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
- Oasi Research Institute-IRCCS Troina, Troina, Italy
| | - Giulia Donzuso
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical, Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
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Hawkes C, Dale RC, Scher S, Cornish JL, Perez DL, Santoro JD, Fernandes S, Kozlowska K. Bridging the Divide: An Integrated Neurobio-Psycho-Social Approach to Treating Antibody Negative Inflammatory Encephalitis in a School-Aged Child. Harv Rev Psychiatry 2024; 32:101-116. [PMID: 38728570 DOI: 10.1097/hrp.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Clare Hawkes
- From Kids Neuroscience Centre (Dr. Dale), The Children's Hospital at Westmead (Drs. Dale, Hawkes, and Kozlowska), Westmead, AUS; Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School (Drs. Dale and Kozlowska), and Brain and Mind Centre (Dr. Dale), University of Sydney, Sydney, AUS; Harvard Medical School (Drs. Scher, Perez, and Fernandes); McLean Hospital, Belmont, MA (Drs. Scher and Fernandes); Specialty in Psychiatry, University of Sydney School of Medicine, Sydney, AUS (Drs. Scher and Kozlowska); School of Psychological Sciences and Centre for Emotional Health, Macquarie University (Dr. Cornish); Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Dr. Perez); Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA (Dr. Santoro); Department of Neurology, Keck School of Medicine of the University of Southern California (Dr. Santoro); The Brain Dynamics Centre, The Westmead Institute for Medical Research, Westmead, AUS (Dr. Kozlowska)
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19
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Gilmour GS, Langer LK, Bhatt H, MacGillivray L, Lidstone SC. Factors Influencing Triage to Rehabilitation in Functional Movement Disorder. Mov Disord Clin Pract 2024; 11:515-525. [PMID: 38385766 PMCID: PMC11078488 DOI: 10.1002/mdc3.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Treatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage. OBJECTIVES To describe our approach and explore factors associated with triage to FMD rehabilitation. METHODS We conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed. RESULTS Sixty-six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self-agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes. CONCLUSIONS The ability to "opt-in" to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets.
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Affiliation(s)
- Gabriela S. Gilmour
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western HospitalTorontoONCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoONCanada
- Division of Neurology, Department of Clinical NeurosciencesUniversity of CalgaryCalgaryABCanada
| | - Laura K. Langer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
| | - Haseel Bhatt
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western HospitalTorontoONCanada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Integrated Movement Disorders ProgramToronto Rehabilitation Institute, University Health NetworkTorontoONCanada
| | - Lindsey MacGillivray
- Integrated Movement Disorders ProgramToronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Centre for Mental Health, University Health Network and Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - Sarah C. Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western HospitalTorontoONCanada
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoONCanada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Integrated Movement Disorders ProgramToronto Rehabilitation Institute, University Health NetworkTorontoONCanada
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20
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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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Vizza P, Marotta N, Ammendolia A, Guzzi PH, Veltri P, Tradigo G. REHABS: An Innovative and User-Friendly Device for Rehabilitation. Bioengineering (Basel) 2023; 11:5. [PMID: 38275573 PMCID: PMC11154369 DOI: 10.3390/bioengineering11010005] [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: 11/23/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Rehabilitation is a complex set of interventions involving the assessment, management, and treatment of injuries. It aims to support and facilitate an individual's recovery process by restoring a physiological function, e.g., limb movement, compromised by physical impairments, injuries or diseases to a condition as close to normal as possible. Innovative devices and solutions make the rehabilitation process of patients easier during their daily activities. Devices support physicians and physiotherapists in monitoring and measuring patients' physical improvements during rehabilitation. In this context, we report the design and implementation of a low-cost rehabilitation system, which is a programmable device designed to support tele-rehabilitation of the upper limbs. The proposed system includes a mechanism to acquire and analyze data and signals related to rehabilitation processes.
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Affiliation(s)
- Patrizia Vizza
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (A.A.); (P.H.G.)
| | - Nicola Marotta
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (A.A.); (P.H.G.)
| | - Pietro Hiram Guzzi
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (A.A.); (P.H.G.)
| | | | - Giuseppe Tradigo
- Department of Theoretical and Applied Sciences, University e-Campus, 22060 Novedrate, Italy;
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22
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Regnath F, Biersack K, Jäger N, Glasauer S, Lehnen N. Not a general, symptom-unspecific, transdiagnostic marker for functional symptoms: sensorimotor processing of head control is intact in chronic pain. Front Neurol 2023; 14:1294702. [PMID: 38174100 PMCID: PMC10762802 DOI: 10.3389/fneur.2023.1294702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Functional disorders are prevalent in all medical fields and pose a tremendous public health problem, with pain being one of the most common functional symptoms. Understanding the underlying, potentially unifying mechanism in functional (pain) disorders is instrumental in facilitating timely diagnosis, stigma reduction, and adequate treatment options. Neuroscientific models of perception suggest that functional symptoms arise due to dysregulated sensorimotor processing in the central nervous system, with brain-based predictions dominating the eventual percept. Experimental evidence for this transdiagnostic mechanism has been established in various functional symptoms. The goal of the current study was to investigate whether erroneous sensorimotor processing is an underlying transdiagnostic mechanism in chronic (functional) pain. Method A total of 13 patients with chronic (functional) pain [three patients with chronic (functional) pain disorder, F45.40, ICD-10; 10 patients with chronic pain disorder with somatic and psychological factors, F45.41, ICD-10]; and 15 healthy controls performed large combined eye-head gaze shifts toward visual targets, naturally and with increased head moment of inertia. We simultaneously measured participants' eye and head movements to assess head oscillations at the end of the gaze shift, which are an established indicator of (transdiagnostic) sensorimotor processing deficits of head control. Results Using a Bayesian analysis protocol, we found that patients with chronic (functional) pain and control participants stabilized their heads equally well (Bayes Factor 01 = 3.7, Bayes Factor exclusion = 5.23; corresponding to substantial evidence) during all sessions of the experiment. Conclusion Our results suggest that patients with chronic (functional) pain do not show measurable symptom-unspecific sensorimotor processing deficits. We discuss outcome parameter choice, organ system specificity, and selection of patient diagnoses as possible reasons for this result and recommend future avenues for research.
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Affiliation(s)
- Franziska Regnath
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
- TUM Graduate School, Graduate Center of Medicine and Health (GC MH), Technical University of Munich, Munich, Germany
| | - Katharina Biersack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
- TUM Graduate School, Graduate Center of Medicine and Health (GC MH), Technical University of Munich, Munich, Germany
| | - Nina Jäger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
- TUM Graduate School, Graduate Center of Medicine and Health (GC MH), Technical University of Munich, Munich, Germany
| | - Stefan Glasauer
- Computational Neuroscience, Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
| | - Nadine Lehnen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
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23
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Van Patten R, Bellone JA. The neuropsychology of functional neurological disorders. J Clin Exp Neuropsychol 2023; 45:957-969. [PMID: 38441076 DOI: 10.1080/13803395.2024.2322798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Center for Neurorestoration & Neurotechnology, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - John A Bellone
- Department of Behavioral Health, Kaiser Permanente, San Bernardino, CA, USA
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24
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Suwa B. [The historical diagnosis of 'hysterical scoliosis']. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:1005-1010. [PMID: 37563422 DOI: 10.1007/s00132-023-04414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Until the beginning of the 20th century, 'hysterical scoliosis' could be considered an established diagnosis in Middle Europe's German-speaking countries. The responsible physicians claimed that certain cases of scoliosis were caused solely by psychological factors, and they did not distinguish between real scoliosis (e.g. with neuromuscular cause) and abnormal posture caused by psychological reasons. Instead, 'hysterical scoliosis' was obviously believed to be a real scoliosis caused by psychologically induced contractures. OBJECTIVE This study critically discusses the historical diagnosis 'hysterical scoliosis' from today's point of view. MATERIALS AND METHODS This work is based on historical research (including journals and literature) approximately from the time around 1900. Furthermore, it is also based on recently discovered original material. RESULTS The original material is a correspondence between H. Schlesinger and G. Muskat, who published an article about 'hysterical scoliosis' in Schlesinger's journal. CONCLUSIONS Obviously, the underlying medical concepts of 'hysterical scoliosis' were wrong and led to clear diagnostic problems and inaccuracies. 'Hysterical scoliosis' can be considered one of adolescent psychiatry's early fashionable illnesses around the year 1900.
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Affiliation(s)
- Beato Suwa
- , Gartenweg 24, 39164, Wanzleben OT Hohendodeleben, Deutschland.
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25
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Wolters AF, Snijders AH, Bloem BR. Video case: A new phenotype within the spectrum of functional orofacial movement disorders. J Neurol 2023; 270:6159-6162. [PMID: 37615750 DOI: 10.1007/s00415-023-11949-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Amée F Wolters
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Anke H Snijders
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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26
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Huang Y, Li Y, Pan H, Han L. Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide. J Glob Health 2023; 13:04160. [PMID: 38018250 PMCID: PMC10685084 DOI: 10.7189/jogh.13.04160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Background We aimed to determine the incidence and disability-adjusted life-years (DALYs) of neurological disorders worldwide from 1990 to 2019. Methods We obtained age-standardised incidence and DALY rates of neurological disorders in 204 countries and territories from 1990 to 2019 from the Global Burden of Disease (GBD) database. We determined trends stratified by age, sex, region, country, and Social Development Index (SDI) and the risk factors contributing to DALYs associated with these neurological disorders. Results The largest increases in the age-standardised incidence rates of neurological disorders in 1990-2019 occurred in four regions (East Asia: estimated annual percentage change (EAPC) = 0.19, tropical Latin America: EAPC = 0.07, Southern Latin America: EAPC = 0.03, Western Europe: EAPC = 0.03) and three countries (China: EAPC = 0.20, Ecuador: EAPC = 0.13, Italy: EAPC = 0.13). We observed the largest increases in age-standardised incidence rates for Parkinson disease, idiopathic epilepsy, and bipolar disorder, and in age-standardised DALY rates for Alzheimer disease and other dementias. High-SDI regions showed the highest EAPC for age-standardised incidence rates of Parkinson disease, depression, and motor neuron disease, and age-standardised DALY rates of neurological disorders. Conclusions There is a need to control the increase in age-standardised incidence rates of neurological disorders in East Asia, tropical Latin America, Southern Latin America, and Western Europe, particularly in China, Ecuador, and Italy.
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Affiliation(s)
- Yi Huang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yongan Li
- Department of Neurology, Suzhou Xiangcheng People's Hospital, Jiangsu, China
| | - Haiyan Pan
- The First Dongguan Affiliated Hospital,Guangdong Medical University
- School of Public Health, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Liyuan Han
- Center for Cardiovascular and Cerebrovascular Epidemiology and Translational Medicine, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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McLoughlin J. Concussion Rehabilitation and the Application of Ten Movement Training Principles. Cureus 2023; 15:e46520. [PMID: 37927640 PMCID: PMC10625311 DOI: 10.7759/cureus.46520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Concussion awareness continues to grow in all aspects of healthcare, including the areas of prevention, acute care, and ongoing rehabilitation. Most of the concussion research to date has focussed on the challenges around screening and diagnosing what can be a complex mix of brain impairments that overlay with additional pre-existing comorbidities. While we expect further progress in concussion diagnosis, progress also continues to be made around proactive rehabilitation, with the emergence of interventions that can enhance the recovery process, maximise function and independence with a return to study, work, and play. Traditionally, optimal multimodal assessments of concussion have treated the physical, cognitive, and psychological domains of brain injury separately, which supports diagnosis, and informs appropriate follow-up care. Due to the complex nature of brain injury, multimodal assessments direct care toward professionals from many different disciplines including medicine, physiotherapy, psychology, neuropsychology, ophthalmology, and exercise physiology. In addition, these professionals may work in different fields such as sports, neurorehabilitation, vestibular, musculoskeletal, community, vocational, and general practice clinical settings. Rehabilitation interventions for concussions employed in practice are also likely to use a blend of theoretical principles from motor control, cognitive, and psychological sciences. This scale of diversity can make information dissemination, collaboration, and innovation challenging. The Ten Movement Training Principles (MTPs) have been proposed as a usable and relevant concept to guide and support clinical reasoning in neurorehabilitation. When applied to concussion rehabilitation, these same 10 principles provide a comprehensive overview of key rehabilitation strategies for current and future practice. Future collaborations can use these training principles to support clinical and research innovations including the rapid rise of technologies in this growing field of rehabilitation practice.
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Affiliation(s)
- James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, AUS
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28
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Zhu Z, Yin L. A mini-review: recent advancements in temporal interference stimulation in modulating brain function and behavior. Front Hum Neurosci 2023; 17:1266753. [PMID: 37780965 PMCID: PMC10539552 DOI: 10.3389/fnhum.2023.1266753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Numerous studies have assessed the effect of Temporal Interference (TI) on human performance. However, a comprehensive literature review has not yet been conducted. Therefore, this review aimed to search PubMed and Web of Science databases for TI-related literature and analyze the findings. We analyzed studies involving preclinical, human, and computer simulations, and then discussed the mechanism and safety of TI. Finally, we identified the gaps and outlined potential future directions. We believe that TI is a promising technology for the treatment of neurological movement disorders, due to its superior focality, steerability, and tolerability compared to traditional electrical stimulation. However, human experiments have yielded fewer and inconsistent results, thus animal and simulation experiments are still required to perfect stimulation protocols for human trials.
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Affiliation(s)
| | - Lijun Yin
- School of Sport, Shenzhen University, Shenzhen, China
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29
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Watson MM, Kerr WT, Bean M, Strom L. Functional Seizure Clinics: A Proposed Financially Viable Solution to the Neurologist Supply and Demand Mismatch. Neurol Clin Pract 2023; 13:e200179. [PMID: 37529298 PMCID: PMC10389173 DOI: 10.1212/cpj.0000000000200179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 08/03/2023]
Abstract
Background and Objectives Projections from recent studies suggest that by 2025, there will not be enough neurologists to meet the demand in 41 states. In this study, we investigate the financial impact and improved access to care for persons with epilepsy that is possible by implementing a multidisciplinary treatment clinic for persons with functional seizures (FS), previously referred to as psychogenic nonepileptic seizures, thus separating those patients out of an epilepsy clinic. Methods This observational retrospective study used real-time data of 156 patients referred to an FS clinic integrated into a tertiary care epilepsy center to simulate its effect on epilepsy division access and finances. Access was measured using simulations of the number of return patient visits (RPVs) and new patient visits (NPVs) of patients with FS to a dedicated epilepsy clinic, based on survey results inquiring about the standard of care without the FS clinic. Finances were simulated using the resultant access multiplied by respective wRVU and reimbursement per CPT code. Results Treatment of 156 patients with FS in a multidisciplinary FS clinic resulted in 343 newly opened NPVs, reimbursement of $102,000, and 1,200 wRVUs in our dedicated epilepsy clinic. There were 686 RPVs, $103,000 in reimbursement, and 1,320 wRVUs. Relative to the total number of NPVs with epilepsy clinic epileptologists, 343 NPVs represent a biennial 15.5% increase in available new patient visit slots. Discussion Our findings describe the financial viability of integrating a treatment clinic for persons with FS by directing them to FS-specialized treatment and thereby increasing access for patients with probable epilepsy to the dedicated epilepsy clinic. This study provides a potential solution to the national mismatch in the supply and demand of neurologists and an initial framework to use for those who wish to establish or integrate FS services in their institution.
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Affiliation(s)
- Meagan M Watson
- Department of Neurology (MMW, MB, LS), University of Colorado, Aurora; and Department of Neurology (WTK), University of Michigan, Ann Arbor
| | - Wesley T Kerr
- Department of Neurology (MMW, MB, LS), University of Colorado, Aurora; and Department of Neurology (WTK), University of Michigan, Ann Arbor
| | - Meagan Bean
- Department of Neurology (MMW, MB, LS), University of Colorado, Aurora; and Department of Neurology (WTK), University of Michigan, Ann Arbor
| | - Laura Strom
- Department of Neurology (MMW, MB, LS), University of Colorado, Aurora; and Department of Neurology (WTK), University of Michigan, Ann Arbor
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Mavroudis I, Chatzikonstantinou S, Petridis F, Palade OD, Ciobica A, Balmus IM. Functional Overlay Model of Persistent Post-Concussion Syndrome. Brain Sci 2023; 13:1028. [PMID: 37508960 PMCID: PMC10377031 DOI: 10.3390/brainsci13071028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Persistent post-concussion syndrome (PPCS) is a complex and debilitating condition that can develop after head concussions or mild traumatic brain injury (mTBI). PPCS is characterized by a wide range of symptoms, including headaches, dizziness, fatigue, cognitive deficits, and emotional changes, that can persist for months or even years after the initial injury. Despite extensive research, the underlying mechanisms of PPCS are still poorly understood; furthermore, there are limited resources to predict PPCS development in mTBI patients and no established treatment. Similar to PPCS, the etiology and pathogenesis of functional neurological disorders (FNDs) are not clear neither fully described. Nonspecific multifactorial interactions that were also seen in PPCS have been identified as possible predispositions for FND onset and progression. Thus, we aimed to describe a functional overlay model of PPCS that emphasizes the interplay between functional and structural factors in the development and perpetuation of PPCS symptoms. Our model suggests that the initial brain injury triggers a cascade of physiological and psychological processes that disrupt the normal functioning of the brain leading to persistent symptoms. This disruption can be compounded by pre-existing factors, such as genetics, prior injury, and psychological distress, which can increase the vulnerability to PPCS. Moreover, specific interventions, such as cognitive behavioral therapy, neurofeedback, and physical exercise can target the PPCS treatment approach. Thus, the functional overlay model of PPCS provides a new framework for understanding the complex nature of this condition and for developing more effective treatments. By identifying and targeting specific functional factors that contribute to PPCS symptoms, clinicians and researchers can improve the diagnosis, management, and ultimately, outcomes of patients with this condition.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, Leeds LS2 9JT, UK
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | | | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Octavian Dragos Palade
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, 20th Carol I Avenue, 700506 Iasi, Romania
- Centre of Biomedical Research, Romanian Academy, B dul Carol I, No. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Splaiul Independentei nr. 54, Sector 5, 050094 Bucuresti, Romania
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, "Alexandru Ioan Cuza" University of Iasi, Alexandru Lapusneanu Street, No. 26, 700057 Iasi, Romania
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31
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Dusara K, Davies S, Lee Y. Functional neurological disorder: a review. Br Dent J 2023; 235:112-116. [PMID: 37500857 DOI: 10.1038/s41415-023-6054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/09/2023] [Accepted: 05/26/2023] [Indexed: 07/29/2023]
Abstract
Functional neurological disorder is a common condition which may present to dental professionals. The dental team need to be aware of its varying presentation and the impact this can have on dental management. An overview on functional neurological disorder will be provided, as well as information regarding three patient cases.
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Affiliation(s)
- Karishma Dusara
- Speciality Trainee in Special Care Dentistry, CDS-CIC Bedfordshire, United Kingdom.
| | - Steve Davies
- Specialist in Special Care Dentistry, CDS-CIC Bedfordshire, United Kingdom
| | - Yee Lee
- Consultant in Special Care Dentistry, CDS-CIC Bedfordshire, United Kingdom
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Rauline G, Hingray C, Carle-Toulemonde G, Hubsch C, El Hage W, Conejero I, Samalin L, Garcin B, Gharib A. [Validated care programs for patients with functional neurological disorders]. L'ENCEPHALE 2023:S0013-7006(23)00087-8. [PMID: 37400332 DOI: 10.1016/j.encep.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. Diagnostic delay may lead to no treatment, inappropriate treatment or even iatrogenic symptoms. Yet, several treatments significantly reduce physical symptoms and improve functioning in FND patients even though not all patients respond to the currently available treatments. This review aims to describe the range of evidence-based rehabilitative and/or psychological therapeutic approaches available for FND patients. The most effective treatments are multidisciplinary and coordinated; using an outpatient or inpatient setting. Building a network of FND-trained healthcare professionals around the patient is an essential aspect of optimal patient management. Indeed, a supportive environment coupled with a collaborative therapeutic relationship improves understanding of FND and appears to help patients engage in appropriate treatments. Patients need to be invested in their own care and have to understand that recovery may depend on their commitment. The conventional treatment combines psychoeducation, physical rehabilitation and psychotherapy (cognitive and behavioral therapy, hypnosis, psychodynamic interpersonal therapy). Early referral of patients to physical therapy is recommended; however, the optimal parameters of treatment, duration and intensity are unknown and seem to vary with the severity and chronicity of symptoms. The goal is to minimize self-awareness by diverting attention or by stimulating automatically generated movements with non-specific and gradual exercises. The use of compensatory technical aids should be avoided as much as possible. Psychotherapeutic management should encourage self-evaluation of cognitive distortions, emotional reactions and maladaptive behaviors while empowering the patient in managing symptoms. Symptom management can use anchoring strategies to fight against dissociation. The aim is to connect to the immediate environment and to enrich one's sensoriality. The psychological interventions should then be adapted to the individual psychopathology, cognitive style and personality functioning of each patient. There is currently no known curative pharmacological treatment for FND. The pharmacological approach rather consists of progressively discontinuing medication that was introduced by default and that could lead to undesirable side effects. Finally, neurostimulation (transcranial magnetic stimulation, transcranial direct current stimulation) can be effective on motor FND.
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Affiliation(s)
| | - Coraline Hingray
- Pôle universitaire du Grand Nancy, CPN/unité neuropsychiatrique, CHRU de Nancy, Nancy, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, Toulouse, France
| | - Cécile Hubsch
- Parkinson Unit, Department of Neurology, Hospital Foundation Adolphe-de-Rothschild, Paris, France
| | - Wissam El Hage
- CHRU de Tours, clinique psychiatrique universitaire, Tours, France
| | - Ismaël Conejero
- Département de psychiatrie adulte, CHU de Nîmes, Nîmes, France
| | - Ludovic Samalin
- Département de psychiatrie, CHU de Clermont-Ferrand, université de Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Béatrice Garcin
- Service de neurologie, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France
| | - Axelle Gharib
- Centre bipol-AIR 9, rue Abraham-Bloch, 69007 Lyon, France.
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Villanueva-Flores F, Garcia-Atutxa I, Santos A, Armendariz-Borunda J. Toward a New Generation of Bio-Scaffolds for Neural Tissue Engineering: Challenges and Perspectives. Pharmaceutics 2023; 15:1750. [PMID: 37376198 DOI: 10.3390/pharmaceutics15061750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/04/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Neural tissue engineering presents a compelling technological breakthrough in restoring brain function, holding immense promise. However, the quest to develop implantable scaffolds for neural culture that fulfill all necessary criteria poses a remarkable challenge for material science. These materials must possess a host of desirable characteristics, including support for cellular survival, proliferation, and neuronal migration and the minimization of inflammatory responses. Moreover, they should facilitate electrochemical cell communication, display mechanical properties akin to the brain, emulate the intricate architecture of the extracellular matrix, and ideally allow the controlled release of substances. This comprehensive review delves into the primary requisites, limitations, and prospective avenues for scaffold design in brain tissue engineering. By offering a panoramic overview, our work aims to serve as an essential resource, guiding the creation of materials endowed with bio-mimetic properties, ultimately revolutionizing the treatment of neurological disorders by developing brain-implantable scaffolds.
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Affiliation(s)
- Francisca Villanueva-Flores
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Campus Chihuahua, Av. Heroico Colegio Militar 4700, Nombre de Dios, Chihuahua 31300, Chihuahua, Mexico
| | - Igor Garcia-Atutxa
- Máster en Bioinformática y Bioestadística, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Arturo Santos
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Campus Guadalajara, Av. Gral Ramón Corona No 2514, Colonia Nuevo México, Zapopan 45201, Jalisco, Mexico
| | - Juan Armendariz-Borunda
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Campus Guadalajara, Av. Gral Ramón Corona No 2514, Colonia Nuevo México, Zapopan 45201, Jalisco, Mexico
- Instituto de Biología Molecular en Medicina y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Jalisco, Mexico
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Cope SR, Smith JG, El-Leithy S, Vanzan S, Pentland C, Pick S, Golder D, Hogwood P, Turner K, Billings J, Edwards MJ. MODIFI: protocol for randomised feasibility study of eye-movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND). BMJ Open 2023; 13:e073727. [PMID: 37270188 PMCID: PMC10255051 DOI: 10.1136/bmjopen-2023-073727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/26/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Functional neurological disorder (FND) refers to an involuntary loss of control over and/or aberrant perception of the body. Common presenting symptoms are functional (non-epileptic) seizures, and functional motor disorder, for example, walking difficulties, weakness or tremor. Greater access to effective treatments would lead to reduced distress and disability; and reduce unnecessary healthcare costs.This study will examine eye-movement desensitisation and reprocessing therapy (EMDR) as a treatment for FND. EMDR is an evidence-based treatment for post-traumatic stress disorder (PTSD), but its use for other conditions is growing. An FND-specific EMDR protocol will be tested, and if the intervention proves feasible with promising clinical outcomes, progression to a substantive study could take place. METHODS AND ANALYSIS Fifty adult patients diagnosed with FND will be recruited. It will be a single-blind randomised controlled trial with two arms: EMDR (plus standard neuropsychiatric care; NPC) and standard NPC. The two groups will be compared at baseline (T0), 3 months (T1), 6 months (T2) and 9 months (T3). Measures of feasibility include safety, recruitment, retention, treatment adherence and acceptability. Clinical outcome measures will assess health-related functioning/quality of life, ratings of FND symptoms and severity, depression, anxiety, PTSD, dissociation, service utilisation and other costs. Improvement and satisfaction ratings will also be assessed. Feasibility outcomes will be summarised using descriptive statistics. Exploratory analyses using (linear/logistic) mixed-effect models will examine the rate of change in the groups' clinical outcome measures across the four time-points.After the intervention period, a sample of participants, and clinicians, will be invited to attend semistructured interviews. The interviews will be analysed using reflexive thematic analysis. ETHICS AND DISSEMINATION This study has been approved by the NHS West Midlands-Edgbaston Research Ethics Committee. Study findings will be published in open access peer-reviewed journals, presented at conferences, and communicated to participants and other relevant stakeholders. TRIAL REGISTRATION NCT05455450 (www. CLINICALTRIALS gov).
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Affiliation(s)
- Sarah R Cope
- South West London and St George's Mental Health NHS Trust, Tooting, UK
| | - Jared G Smith
- Population Health Research Institute, St George's University of London, London, UK
- Clinical Research Unit, South West London and St George's Mental Health NHS Trust, London, UK
| | - Sharif El-Leithy
- Traumatic Stress Service, South West London and St George's Mental Health NHS Trust, London, UK
| | - Serena Vanzan
- Clinical Research Unit, South West London and St George's Mental Health NHS Trust, London, UK
| | - Caitlin Pentland
- Clinical Research Unit, South West London and St George's Mental Health NHS Trust, London, UK
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | | | - Kati Turner
- South West London and St George's Mental Health NHS Trust, Tooting, UK
| | - Jo Billings
- Department of Psychiatry, University College London, London, UK
| | - Mark J Edwards
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Yang S, Kim SH, Kang M, Joo JY. Harnessing deep learning into hidden mutations of neurological disorders for therapeutic challenges. Arch Pharm Res 2023:10.1007/s12272-023-01450-5. [PMID: 37261600 DOI: 10.1007/s12272-023-01450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
The relevant study of transcriptome-wide variations and neurological disorders in the evolved field of genomic data science is on the rise. Deep learning has been highlighted utilizing algorithms on massive amounts of data in a human-like manner, and is expected to predict the dependency or druggability of hidden mutations within the genome. Enormous mutational variants in coding and noncoding transcripts have been discovered along the genome by far, despite of the fine-tuned genetic proofreading machinery. These variants could be capable of inducing various pathological conditions, including neurological disorders, which require lifelong care. Several limitations and questions emerge, including the use of conventional processes via limited patient-driven sequence acquisitions and decoding-based inferences as well as how rare variants can be deduced as a population-specific etiology. These puzzles require harnessing of advanced systems for precise disease prediction, drug development and drug applications. In this review, we summarize the pathophysiological discoveries of pathogenic variants in both coding and noncoding transcripts in neurological disorders, and the current advantage of deep learning applications. In addition, we discuss the challenges encountered and how to outperform them with advancing interpretation.
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Affiliation(s)
- Sumin Yang
- Department of Pharmacy, College of Pharmacy, Hanyang University, Rm 407, Bldg.42, 55 Hanyangdaehak-Ro, Sangnok-Gu Ansan, Ansan, Gyeonggi-Do, 15588, Republic of Korea
| | - Sung-Hyun Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Rm 407, Bldg.42, 55 Hanyangdaehak-Ro, Sangnok-Gu Ansan, Ansan, Gyeonggi-Do, 15588, Republic of Korea
| | - Mingon Kang
- Department of Computer Science, University of Nevada, Las Vegas, NV, 89154, USA
| | - Jae-Yeol Joo
- Department of Pharmacy, College of Pharmacy, Hanyang University, Rm 407, Bldg.42, 55 Hanyangdaehak-Ro, Sangnok-Gu Ansan, Ansan, Gyeonggi-Do, 15588, Republic of Korea.
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Issak S, Kanaan R, Nielsen G, Fini NA, Williams G. Functional Gait Disorders: Clinical presentations, Phenotypes and Implications for treatment. Brain Inj 2023; 37:437-445. [PMID: 36617694 DOI: 10.1080/02699052.2023.2165158] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Functional Gait Disorders (FGD) are a common presentation of motor-Functional Neurological Disorders (motor-FND) that affect walking ability. AIM To provide a narrative review of the current literature on FGD. METHODS A narrative overview of published literature was undertaken, based on a systematic search of relevant databases, authoritative texts and citation tracking. RESULTS FGD is multidimensional and disabling, with numerous phenotypes described in the literature, including 'knee buckling,' 'astasia-abasia' and 'excessive slowness.' Motor symptoms such as weakness or tremor, and non-motor symptoms, such as pain and fatigue may contribute to the disability and distress in FGD. Phenotypic features and clinical signs are seen in FGD that demonstrate inconsistency and incongruity with structural disease. A limited number of treatment studies have specifically focussed on FGD, however, reporting of outcomes from motor-FND cohorts has demonstrated short and long-term improvements in walking ability through multidisciplinary rehabilitation. CONCLUSIONS The relative contribution of motor and non-motor symptoms in FGD remains unknown, but it is likely that non-motor symptoms increase the illness burden and should be considered during assessment and treatment. Recommended treatment for FGD involves multidisciplinary rehabilitation, but optimum treatment elements are yet to be determined.
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Affiliation(s)
- Sara Issak
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Epworth Healthcare, Melbourne, Australia
| | - Richard Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia
| | - Glenn Nielsen
- Neurosciences Research Centre, Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Natalie A Fini
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Gavin Williams
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Epworth Healthcare, Melbourne, Australia
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37
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Barth R, Gegusch M. [Functional Neurological Disorders - A Common but Often Unrecognized Diagnosis]. PRAXIS 2023; 112:329-334. [PMID: 37042404 DOI: 10.1024/1661-8157/a003997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Functional Neurological Disorders - A Common but Often Unrecognized Diagnosis Abstract: Functional neurological disorders are frequent and diverse in the clinical presentation. Psychological factors are part of the development and perpetuation of symptoms; psychiatric comorbidities may be present, but are not an obligatory diagnostic criterion. The diagnosis is primarily made on the basis of anamnesis and positive clinical signs. The commonness and reversibility of the symptoms should be emphasised in the clinical consultation, and the positive clinical signs should be demonstrated. Science-based explanations as well as the bio-psycho-social model can help patients to understand their diagnosis, which is relevant for a successful therapeutic outcome. It is recommended to use the neutral and descriptive term "functional neurological disorder". Treatment of the potentially reversible disease will be interdisciplinary and multimodal.
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Affiliation(s)
- Rike Barth
- Universtitätsklinik für Neurologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Michaela Gegusch
- Klinik für Neurologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
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Ducroizet A, Zimianti I, Golder D, Hearne K, Edwards M, Nielsen G, Coebergh J. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci 2023; 110:116-125. [PMID: 36871491 DOI: 10.1016/j.jocn.2023.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
Functional Neurological Disorder (FND) is common and is often accompanied by multiple comorbid symptoms and conditions. There have been no large-scale studies exploring the change of its clinical manifestations and comorbidities. We used an online survey to assess FND patient characteristics, changes to fatigue, sleep and pain and comorbid symptoms and diagnoses, as well as treatment strategies. The survey was shared via the charities FND Action and FND Hope. 527 participants were included in the analysis. Most (97.3%) reported experiencing more than one core FND symptom. Many respondents reported associated pain (78.1%), fatigue (78.0%) and sleep disturbances (46.7%) before FND diagnosis which often increased thereafter. Rates of obesity were higher (36.9%) than in the general population. Obesity was associated with increased pain, fatigue and sleep difficulties. There was frequent weight gain after diagnosis. 50.0% of participants reported having other diagnoses prior to FND, while in 43.3% new comorbidities arise after FND diagnosis. Many respondents reported being dissatisfied with their care, expressing a wish for further follow-up from mental health (32.7%) and/or neurological services (44.3%). This large online survey further supports the phenotypic complexity of FND. High rates of pain, fatigue and sleep disturbance exist before diagnosis but monitoring for change is worthwhile. Our study identified major gaps in service provision; we highlight the importance of an open mind regarding change in symptoms; this could aid the early identification and management of co-morbidities, including obesity and migraine, which possibly have a negative impact on FND.
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Affiliation(s)
- Alexandra Ducroizet
- Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | | | - Mark Edwards
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
| | - Glenn Nielsen
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK; Department of Neurology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Jan Coebergh
- Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK; Department of Neurology, St. George's Hospital NHS Foundation Trust, London, UK.
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Gilmour GS, Lidstone SC. Moving Beyond Movement: Diagnosing Functional Movement Disorder. Semin Neurol 2023; 43:106-122. [PMID: 36893796 DOI: 10.1055/s-0043-1763505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Functional movement disorder (FMD) is a complex neuropsychiatric syndrome, encompassing abnormal movements and weakness, and is a common cause of potentially disabling neurological symptoms. It is vital to recognize that FMD is a syndrome, with nonmotor manifestations negatively affecting a patient's quality of life. This review highlights a diagnostic algorithm, where a history suggestive of FMD is combined with the presence of positive signs on examination and appropriate investigations to make the diagnosis. Positive signs indicate internal inconsistency such as variability and distractibility, and clinical findings that are incongruent with other known neurological disease. Importantly, the clinical assessment acts as the first opportunity to allow patients to understand FMD as the cause for their symptoms. Accurate and early diagnosis of FMD is necessary given that it is a treatable and potentially reversible cause of disability, with significant risk of iatrogenic harm associated with misdiagnosis.
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Affiliation(s)
- Gabriela S Gilmour
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada.,Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Wang T, Xu H, Dong R, Wu S, Guo Y, Wang D. Effectiveness of targeting the NLRP3 inflammasome by using natural polyphenols: A systematic review of implications on health effects. Food Res Int 2023; 165:112567. [PMID: 36869555 DOI: 10.1016/j.foodres.2023.112567] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/13/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Globally, inflammation and metabolic disorders pose serious public health problems and are major health concerns. It has been shown that natural polyphenols are effective in the treatment of metabolic diseases, including anti-inflammation, anti-diabetes, anti-obesity, neuron-protection, and cardio-protection. NLRP3 inflammasome, which are multiprotein complexes located within the cytosol, play an important role in the innate immune system. However, aberrant activation of the NLRP3 inflammasome were discovered as essential molecular mechanisms in triggering inflammatory processes as well as implicating it in several major metabolic diseases, such as type 2 diabetes mellitus, obesity, atherosclerosis or cardiovascular disease. Recent studies indicate that natural polyphenols can inhibit NLRP3 inflammasome activation. In this review, the progress of natural polyphenols preventing inflammation and metabolic disorders via targeting NLRP3 inflammasome is systemically summarized. From the viewpoint of interfering NLRP3 inflammasome activation, the health effects of natural polyphenols are explained. Recent advances in other beneficial effects, clinical trials, and nano-delivery systems for targeting NLRP3 inflammasome are also reviewed. NLRP3 inflammasome is targeted by natural polyphenols to exert multiple health effects, which broadens the understanding of polyphenol mechanisms and provides valuable guidance to new researchers in this field.
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Affiliation(s)
- Taotao Wang
- Department of Clinical Nutrition, Affiliated Hospital of Jiangsu University, 212000 Zhenjiang, China
| | - Hong Xu
- School of Grain Science and Technology, Jiangsu University of Science and Technology, 212100 Zhenjiang, China
| | - Ruixia Dong
- College of Horticulture, Jinling Institute of Technology, 211169 Nanjing, China
| | - Shanshan Wu
- College of Agriculture & Biotechnology, Zhejiang University, 310058 Hanzhou, China
| | - Yuanxin Guo
- School of Grain Science and Technology, Jiangsu University of Science and Technology, 212100 Zhenjiang, China.
| | - Dongxu Wang
- School of Grain Science and Technology, Jiangsu University of Science and Technology, 212100 Zhenjiang, China.
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Saunders C, Treufeldt H, Rask MT, Pedersen HF, Rask C, Burton C, Frostholm L. Explanations for functional somatic symptoms across European treatment settings: A mixed methods study. J Psychosom Res 2023; 166:111155. [PMID: 36680846 DOI: 10.1016/j.jpsychores.2023.111155] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Engaging patients in treatment for functional somatic symptoms (FSS) relies on a shared understanding of the mechanisms underlying the complaints. Despite this, little is known about the explanatory models used in daily clinical practice. We aim to examine the approaches healthcare professionals use to explain FSS across European healthcare settings. METHODS This is an exploratory mixed methods study, combining sequential qualitative and quantitative analyses. 3 types of data were collected: a survey of Health-Care Professionals (HCPs) with special interest in FSS from 16 European countries (n = 186), Patient Education Material collected systematically from survey respondents (n = 72) and semi-structured Interviews with HCPs (n = 14). Survey results are summarized descriptively. Qualitative data was thematically coded following template analysis methods. Findings were integrated through mixed-methods triangulation. RESULTS Five main explanatory models for FSS that are used across treatment settings and diagnostic constructs were represented in the data. The 'Multisystem Stress' Approach explains FSS through physiological stress responses within a bio-psycho-social paradigm. 'Sensitized Alarm' and 'Malfunctioning software' are both approaches derived from the neurosciences. Explanations related to 'Embodied Experience' are often used within integrated psychosomatic therapies. In the person-centred 'Symptoms' approach, HCPs aim for co-constructed, individualized explanations. These approaches, which rely on different models of mind-body-environment are complementary and are used flexibly by skilled HCPs. CONCLUSION Taken together the explanatory models described might form the basis of a curriculum of medical explanation with the potential to equip clinicians to form more collaborative relationships with patients across healthcare.
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Affiliation(s)
- Chloe Saunders
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark.
| | - Hõbe Treufeldt
- Academic Unit of Primary Care, University of Sheffield, UK
| | - Mette Trøllund Rask
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark
| | - Heidi Frølund Pedersen
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark
| | - Charlotte Rask
- Faculty of Health, Aarhus University Hospital, Denmark; Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark
| | - Chris Burton
- Academic Unit of Primary Care, University of Sheffield, UK
| | - Lisbeth Frostholm
- Faculty of Health, Aarhus University Hospital, Denmark; Department for Functional Disorders and Psychosomatic Medicine, Aarhus University Hospital, Denmark
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Dietary energy restriction in neurological diseases: what's new? Eur J Nutr 2023; 62:573-588. [PMID: 36369305 DOI: 10.1007/s00394-022-03036-1] [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: 03/15/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
Energy-restricted diet is a specific dietary regimen, including the continuous energy-restricted diet and the intermittent energy-restricted diet. It has been proven effective not only to reduce weight and extend the lifespan in animal models, but also to regulate the development and progression of various neurological diseases such as epilepsy, cerebrovascular diseases (stroke), neurodegenerative disorders (Alzheimer's disease and Parkinson's disease) and autoimmune diseases (multiple sclerosis). However, the mechanism in this field is still not clear and a systematic neurological summary is still missing. In this review, we first give a brief summary of the definition and mainstream strategies of energy restrictions. We then review evidence about the effects of energy-restricted diet from both animal models and human trials, and update the current understanding of mechanisms underlying the biological role of energy-restricted diet in the fight against neurological diseases. Our review thus contributes to the modification of dietary regimen and the search for special diet mimics.
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Waugh RE, Parker JA, Hallett M, Horovitz SG. Classification of Functional Movement Disorders with Resting-State Functional Magnetic Resonance Imaging. Brain Connect 2023; 13:4-14. [PMID: 35570651 PMCID: PMC9942186 DOI: 10.1089/brain.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Functional movement disorder (FMD) is a type of functional neurological disorder characterized by abnormal movements that patients do not perceive as self-generated. Prior imaging studies show a complex pattern of altered activity, linking regions of the brain involved in emotional responses, motor control, and agency. This study aimed to better characterize these relationships by building a classifier using a support vector machine to accurately distinguish between 61 FMD patients and 59 healthy controls using features derived from resting-state functional magnetic resonance imaging. Materials and Methods: First, we selected 66 seed regions based on prior related studies, then we calculated the full correlation matrix between them before performing recursive feature elimination to winnow the feature set to the most predictive features and building the classifier. Results: We identified 29 features of interest that were highly predictive of the FMD condition, classifying patients and controls with 80% accuracy. Several key features included regions in the right sensorimotor cortex, left dorsolateral prefrontal cortex, left cerebellum, and left posterior insula. Conclusions: The features selected by the model highlight the importance of the interconnected relationship between areas associated with emotion, reward, and sensorimotor integration, potentially mediating communication between regions associated with motor function, attention, and executive function. Exploratory machine learning was able to identify this distinctive abnormal pattern, suggesting that alterations in functional linkages between these regions may be a consistent feature of the condition in many FMD patients. Clinical-Trials.gov ID: NCT00500994 Impact statement Our research presents novel results that further elucidate the pathophysiology of functional movement disorder (FMD) with a machine learning model that classifies FMD and healthy controls correctly 80% of the time. Herein, we demonstrate how known differences in resting-state functional magnetic resonance imaging connectivity in FMD patients can be leveraged to better understand the complex pattern of neural changes in these patients. Knowing that there are measurable predictable differences in brain activity in patients with FMD may help both clinicians and patients conceptualize and better understand the illness at the point of diagnosis and during treatment. Our methods demonstrate how an effective combination of machine learning and qualitative approaches to analyzing functional brain connectivity can enhance our understanding of abnormal patterns of brain activity in FMD patients.
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Affiliation(s)
- Rebecca E. Waugh
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Jacob A. Parker
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Silvina G. Horovitz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Varley D, Sweetman J, Brabyn S, Lagos D, van der Feltz-Cornelis C. The clinical management of functional neurological disorder: A scoping review of the literature. J Psychosom Res 2023; 165:111121. [PMID: 36549074 DOI: 10.1016/j.jpsychores.2022.111121] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To date, there have been no reviews bringing together evidence on the clinical management of functional neurological disorder (FND) and patients', caregivers', and healthcare workers' experiences. This review provides an overview of the literature focused on the clinical management of FND. METHODS Four databases were searched, and a consultation exercise was conducted to retrieve relevant records dated from September 2010 to September 2020. Articles documenting diagnostic methods, treatments or interventions, or the experiences and perspectives of patients and healthcare workers in the clinical management of FND were included. RESULTS In total, 2756 records were retrieved, with 162 included in this review. The diagnostic methods reported predominantly included positive clinical signs, v-EEG and EEG. Psychological treatments and medication were the most reported treatments. Mixed findings of the effectiveness of CBT were found. Haloperidol, physiotherapy and scripted diagnosis were found to be effective in reducing FND symptoms. Several facilitators and barriers for patients accessing treatment for FND were reported. CONCLUSION The literature describing the clinical management for FND has increased considerably in recent times. A wide variety of diagnostic tools and treatments and interventions were found, with more focus being placed on tests that confirm a diagnosis than 'rule-out' tests. The main treatment type found in this review was medication. This review revealed that there is a lack of high-quality evidence and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.
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Affiliation(s)
- Danielle Varley
- Department of Health Sciences, University of York, York YO10 5DD, UK.
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Dimitris Lagos
- Hull York Medical School, University of York, York YO10 5DD, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York YO10 5DD, UK; Hull York Medical School, University of York, York YO10 5DD, UK; York Biomedical Research Institute, University of York, York YO10 5DD, UK; Institute of Health Informatics, University College London, London NW1 2DA, UK
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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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Choudhary N, Tewari D, Nabavi SF, Kashani HRK, Lorigooini Z, Filosa R, Khan FB, Masoudian N, Nabavi SM. Plant based food bioactives: A boon or bane for neurological disorders. Crit Rev Food Sci Nutr 2022; 64:3279-3325. [PMID: 36369694 DOI: 10.1080/10408398.2022.2131729] [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] [Indexed: 11/14/2022]
Abstract
Neurological disorders are the foremost occurring diseases across the globe resulting in progressive dysfunction, loss of neuronal structure ultimately cell death. Therefore, attention has been drawn toward the natural resources for the search of neuroprotective agents. Plant-based food bioactives have emerged as potential neuroprotective agents for the treatment of neurodegenerative disorders. This comprehensive review primarily focuses on various plant food bioactive, mechanisms, therapeutic targets, in vitro and in vivo studies in the treatment of neurological disorders to explore whether they are boon or bane for neurological disorders. In addition, the clinical perspective of plant food bioactives in neurological disorders are also highlighted. Scientific evidences point toward the enormous therapeutic efficacy of plant food bioactives in the prevention or treatment of neurological disorders. Nevertheless, identification of food bioactive components accountable for the neuroprotective effects, mechanism, clinical trials, and consolidation of information flow are warranted. Plant food bioactives primarily act by mediating through various pathways including oxidative stress, neuroinflammation, apoptosis, excitotoxicity, specific proteins, mitochondrial dysfunction, and reversing neurodegeneration and can be used for the prevention and therapy of neurodegenerative disorders. In conclusion, the plant based food bioactives are boon for neurological disorders.
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Affiliation(s)
- Neeraj Choudhary
- Department of Pharmacognosy, Adesh Institute of Pharmacy and Biomedical Sciences, Adesh University, Bathinda, Punjab, India
| | - Devesh Tewari
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Seyed Fazel Nabavi
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
- Nutringredientes Research Center, Federal Institute of Education, Science and Technology (IFCE), Baturite, Ceara, Brazil
| | - Hamid Reza Khayat Kashani
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rosanna Filosa
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
- Department of Science and Technology, University of Sannio, 82100, Benevento, Italy
| | - Farheen Badrealam Khan
- Department of Biology, College of Science, The United Arab Emirates University, Al Ain, 15551 United Arab Emirates
| | - Nooshin Masoudian
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
| | - Seyed Mohammad Nabavi
- Advanced Medical Pharma (AMP-Biotec), Biopharmaceutical Innovation Centre Via Cortenocera, 82030, San Salvatore Telesino, (BN), Italy
- Nutringredientes Research Center, Federal Institute of Education, Science and Technology (IFCE), Baturite, Ceara, Brazil
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Gandolfi M, Sandri A, Geroin C, Bombieri F, Riello M, Menaspà Z, Bonetto C, Smania N, Tinazzi M. Improvement in motor symptoms, physical fatigue, and self-rated change perception in functional motor disorders: a prospective cohort study of a 12-week telemedicine program. J Neurol 2022; 269:5940-5953. [PMID: 35809125 PMCID: PMC9552134 DOI: 10.1007/s00415-022-11230-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Functional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need. AIM To compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs. METHODS The study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2). RESULTS Improvement at 3-month follow-up assessment of motor symptoms (p < 0.001), physical fatigue (p = 0.028), and self-rated change perception (p = 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control. CONCLUSIONS Long-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy.
| | - Angela Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Christian Geroin
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Federica Bombieri
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Marianna Riello
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy.
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Othman A, Cecchini A, Eftaiha A, Nwosisi N, Pierce D. Functional Neurological Symptom Disorder (FND) Leading to the Development of Deep Vein Thrombosis (DVT). Cureus 2022; 14:e26378. [PMID: 35911352 PMCID: PMC9336865 DOI: 10.7759/cureus.26378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/05/2022] Open
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Kletenik I, Holden SK, Sillau SH, O'Connell N, MacGillivray L, Mack J, Haddock B, Ashworth Dirac M, David AS, Nicholson TR, Attaripour Isfahani SN, Maurer CW, Lidstone SC, Hallett M, LaFaver K, Berman BD, Stone J. Gender disparity and abuse in functional movement disorders: a multi-center case-control study. J Neurol 2022; 269:3258-3263. [PMID: 35098346 PMCID: PMC10202134 DOI: 10.1007/s00415-021-10943-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine gender differences in rates of sexual and physical abuse in functional movement disorders compared to controls and evaluate if the gender disparity of functional movement disorders is associated with abuse history. METHODS We performed a retrospective case-control study of self-reported trauma data from 696 patients (512 women) with functional movement disorders from six clinical sites compared to 141 controls (98 women) and population data. Chi-square was used to assess gender and disorder associations; logistic regression was used to model additive effects of abuse and calculate the attributable fraction of abuse to disorder prevalence. RESULTS Higher rates of sexual abuse were reported by women (35.3%) and men (11.5%) with functional movement disorders compared to controls (10.6% of women; 5.6% of men). History of sexual abuse increased the likelihood of functional movement disorders among women by an odds ratio of 4.57 (95% confidence interval 2.31-9.07; p < 0.0001) and physical abuse by an odds ratio of 2.80 (95% confidence interval 1.53-5.12; p = 0.0007). Population attributable fraction of childhood sexual abuse to functional movement disorders in women was 0.12 (0.05-0.19). No statistically significant associations were found in men, but our cohort of men was underpowered despite including multiple sites. CONCLUSIONS Our study suggests that violence against women may account for some of the gender disparity in rates of functional movement disorders. Most people with functional movement disorders do not report a history of abuse, so it remains just one among many relevant risk factors to consider.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicola O'Connell
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - Lindsey MacGillivray
- Division of Psychiatry, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Joel Mack
- Department of Psychiatry, Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, OR, USA
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Beatrix Haddock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Departments of Health Metrics and Family Medicine, University of Washington, Seattle, WA, USA
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Carine W Maurer
- Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kathrin LaFaver
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, Movement Disorder Division, University of Louisville, Louisville, KY, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Utianski RL, Duffy JR. Understanding, Recognizing, and Managing Functional Speech Disorders: Current Thinking Illustrated With a Case Series. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1205-1220. [PMID: 35290099 DOI: 10.1044/2021_ajslp-21-00366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Functional speech disorders (FSDs), a subtype of functional neurological disorders, are distinguishable from neurogenic motor speech disorders based on their clinical features, clinical course, and response to treatment. However, their differential diagnosis and management can be challenging. FSDs are not well understood, but growing evidence suggests a biopsychosocial basis distinct from structural lesions that cause neurogenic motor speech disorders. METHOD AND RESULTS Following an overview of FSDs, four patients are described to illustrate the range of clinical manifestations, biopsychosocial contexts, and responses to treatment of FSDs. The path to differential diagnosis is discussed, with particular attention to positive features that led to the FSD diagnosis. Approaches to education, counseling, and management are discussed. CONCLUSIONS This case series demonstrates that FSDs can present with a variety of manifestations including dysfluencies, articulation errors, dysphonia, rate and prosodic abnormalities, and combinations of disruptions in speech subsystems. FSDs may present in the context of known recent or remote physical or psychosocial trauma or, as in many cases, in the absence of an identifiable triggering event. FSDs are recognizable by positive clinical features and should not be considered a diagnosis of exclusion. With appropriate identification, counseling, and treatment, FSDs may resolve, sometimes rapidly; in some cases, treatment may be prolonged or ineffective.
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