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McLoughlin C, McWhirter L, Pisegna K, Tijssen MAJ, Tak LM, Carson A, Stone J. Stigma in functional neurological disorder (FND) - A systematic review. Clin Psychol Rev 2024; 112:102460. [PMID: 38905960 DOI: 10.1016/j.cpr.2024.102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate stigma and Functional Neurological Disorder (FND) regarding: 1) prevalence and associated factors, 2) the nature and context of stigma in FND, and 3) stigma-reduction interventions. METHODS We searched four relevant databases from inception to December 2023, using search terms relevant to FND and stigma themes. We employed the method of synthesis by "aggregation and configuration" to synthesise and analyse the data into emergent themes. RESULTS We found 127 studies, spanning 148 countries, involving 18,886 participants. Of these, 4889 were patients, 13,123 were healthcare professionals, and 526 were caregivers. Quantitatively, stigma has been mainly studied in patients with functional seizures, and was higher than patients with epilepsy in three studies. Stigma experienced by patients is associated with poorer quality of life and caregiver burden. We found 10 themes and 29 subthemes revealing stigma as a systemic process, with intrapersonal, interpersonal and structural aspects. Few studies examined the perspective of caregivers, the public or online community. We identified six anti-stigma interventions. CONCLUSION Stigma in FND is a layered process, and affects patient quality of life and provision of care. Stigma needs to be addressed from the top structures, at governmental level, so that appropriate care pathways can be created, giving patients with FND parity of esteem with other medical conditions.
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Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Marina A J Tijssen
- UMCG Expertise Centre Movement Disorders Groningen, University of Groningen, Groningen, the Netherlands
| | - Lineke M Tak
- Dimence Alkura, Specialist center Persistent Somatic Symptoms, Nico Bolkensteinlaan 65, 7416 SE Deventer, the Netherlands
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Marotta A, Lasalvia A, Fiorio M, Zanalda E, Di Sciascio G, Palumbo C, Papola D, Barbui C, Tinazzi M. Psychiatrists' attitudes towards functional neurological disorders: results from a national survey. Front Psychiatry 2023; 14:1216756. [PMID: 37520227 PMCID: PMC10375048 DOI: 10.3389/fpsyt.2023.1216756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Functional neurological disorder (FND) presents motor, sensory, and cognitive symptoms characterized by clinical signs incongruent with known neurological disease. Together with other health professionals, like neurologists, psychiatrists can play an essential role in diagnosing and managing these disorders. Hence, understanding their opinion and clinical experience with FND is of utmost importance to catch potential educational needs and improve healthcare services for patients. This study aims at assessing the knowledge, opinion, and clinical approach of Italian psychiatrists to FND. Methods Members of the Italian Society of Psychiatry completed a 14-item web-based survey investigating their approach to FND. Results. Overall, 174 questionnaires were completed. Our main findings suggest that Italian psychiatrists have a psychogenetic conceptualization of FND. "Conversion disorders", in fact, is the term most frequently used by Italian psychiatrists to refer to FND, thus implying a psychological etiology of these disorders. Congruently with this view, psychotherapy associated with pharmacological therapy is considered the most appropriate treatment by psychiatrists, while physiotherapy is an under-recognized treatment option for FND. Discussion The present study highlights that a psychogenetic view of FND dominates among Italian psychiatrists. This could be due to out-of-date knowledge about the pathophysiology of this group of disorders. Promoting education about novel approaches to FND would be of crucial importance to improving care for patients suffering from this condition.
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Affiliation(s)
- Angela Marotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Zanalda
- Department of Mental Health ASL TO3 and AOU San Luigi Gonzaga, Collegno, Italy
| | | | | | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- 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
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O'Mahony B, Nielsen G, Baxendale S, Edwards MJ, Yogarajah M. Economic Cost of Functional Neurologic Disorders: A Systematic Review. Neurology 2023; 101:e202-e214. [PMID: 37339887 PMCID: PMC10351557 DOI: 10.1212/wnl.0000000000207388] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/22/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Functional neurologic disorder (FND) represents genuine involuntary neurologic symptoms and signs including seizures, weakness, and sensory disturbance, which have characteristic clinical features, and represent a problem of voluntary control and perception despite normal basic structure of the nervous system. The historical view of FND as a diagnosis of exclusion can lead to unnecessary health care resource utilization and high direct and indirect economic costs. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess these economic costs and to assess for any cost-effective treatments. METHODS We searched electronic databases (PubMed, PsycInfo, MEDLINE, EMBASE, and the National Health Service Economic Evaluations Database of the University of York) for original, primary research publications between inception of the databases and April 8, 2022. A hand search of conference abstracts was also conducted. Key search terms included "functional neurologic disorder," "conversion disorder," and "functional seizures." Reviews, case reports, case series, and qualitative studies were excluded. We performed a descriptive and qualitative thematic analysis of the resulting studies. RESULTS The search resulted in a total of 3,244 studies. Sixteen studies were included after screening and exclusion of duplicates. These included the following: cost-of-illness (COI) studies that were conducted alongside cohort studies without intervention and those that included a comparator group, for example, another neurologic disorder (n = 4); COI studies that were conducted alongside cohort studies without intervention and those that did not include a comparator group (n = 4); economic evaluations of interventions that were either pre-post cohort studies (n = 6) or randomized controlled trials (n = 2). Of these, 5 studies assessed active interventions, and 3 studies assessed costs before and after a definitive diagnosis of FND. Studies showed an excess annual cost associated with FND (range $4,964-$86,722 2021 US dollars), which consisted of both direct and large indirect costs. Studies showed promise that interventions, including provision of a definitive diagnosis, could reduce this cost (range 9%-90.7%). No cost-effective treatments were identified. Study comparison was limited by study design and location heterogeneity. DISCUSSION FND is associated with a significant use of health care resources, resulting in economic costs to both the patient and the taxpayer and intangible losses. Interventions, including accurate diagnosis, seem to offer an avenue toward reducing these costs.
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Affiliation(s)
- Brian O'Mahony
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Glenn Nielsen
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Sallie Baxendale
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Mark J Edwards
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Mahinda Yogarajah
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom.
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Mouchabac S, Lacambre M, Carle-Toulemonde G, Drapier D. [Functional neurological disorders and forensic medicine: Clinical and practical characteristics]. L'ENCEPHALE 2023:S0013-7006(23)00088-X. [PMID: 37400335 DOI: 10.1016/j.encep.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorders (FND) have long been a challenge for medicine, both on clinical and psychodynamic point of view. The medico-legal issue is often relegated to the background in medicine, and FND patients also suffer from such neglected topic. Nonetheless, despite the difficulty to properly diagnose FND and the numerous associated organic and/or psychiatric comorbidities, FND patients report a significant level of deficiency and a high alteration of quality of life when compared to other well-recognized chronic disorders such as Parkinson's disease or epilepsy. Whether it is for the estimation of a personal injury, a prejudice, after-effects following a medical accident or certain legal contexts requiring the elimination of a factitious disorder or a simulation, the uncertainty and imprecision in the medico-legal assessment can imply notable consequences on the patient. In this article, we propose to define the different medico-legal contexts in which FND can occur that of the legal expert, that of the consulting physician, that of the so-called recourse physician and finally that of the attending physician who can provide detailed medical files to the patient in order to help him/her in his/her procedures. We then explain how to use standardized objective evaluation tools validated by the learned societies and how to encourage multidisciplinary cross-evaluation. Finally, we specify how to differentiate FND from historically FND-associated disorders (factitious and simulated disorders), through the clinical criteria, considering the difficulties linked to the uncertainty in the clinical examination of these disorders in a medico-legal context. In addition to the rigorous completion of expertise missions, we aim to reduce two damaging consequences characterizing FND: diagnostic delay and the patients' suffering through stigma.
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Affiliation(s)
- Stéphane Mouchabac
- Département de psychiatrie, hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France.
| | - Mathieu Lacambre
- Département urgence et post-urgence psychiatrique, Coordination de la filière psychiatrie légale, pôle urgences, CHU de Lapeyronie, Montpellier, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, Toulouse, France
| | - Dominique Drapier
- Département de psychiatrie adulte, CH Guillaume-Régnier, université de Rennes 1, centre d'investigation clinique CIC Inserm 1414, Rennes, France
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Dinoto A, Marcuzzo E, Chiodega V, Dall'Ora F, Mariotto S, Tinazzi M. Neurofilament light chain: a promising diagnostic biomarker for functional motor disorders. J Neurol 2023; 270:1754-1758. [PMID: 36370187 DOI: 10.1007/s00415-022-11480-6] [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: 10/06/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Functional motor disorders (FMDs) are disabling neurological conditions characterized by abnormal movements which are inconsistent and incongruent with recognized neurological diseases. Aim of this study is to investigate whether FMDs are related to structural axonal damage. METHODS Consecutive patients with a definite diagnosis of FMD with no other neurological/psychiatric comorbidities (pure FMDs) and age-matched healthy controls (HCs) were recruited in a tertiary center and demographic/clinical data were collected. Serum neurofilament light chain (NfL) assessment was performed with ultrasensitive paramagnetic bead-based enzyme-linked immunosorbent assay. RESULTS 34 patients with FMDs and 34 HCs were included. NfL levels were similar (p = 0.135) in FMDs (median 8.3 pg/mL, range 2-33.7) and HCs (median 6.1 pg/mL, range 2.7-15.6). The area under curve (0.606, 95% CI 0.468-0.743) confirmed that NfL concentration was not different in the two groups. NfL values were similar in patients with paroxysmal vs persistent disease course (p = 0.301), and isolated vs combined symptoms (p = 0.537). NfL levels were associated with age (p < 0.0001), but not with disease duration (p = 0.425), number of CNS acting drugs (p = 0.850), or clinical features (p = 0.983). DISCUSSION Our preliminary data show that NfL levels are similar in patients with FMDs and HCs, indicating the lack of neuroaxonal damage. These results have relevant pathogenic and clinical implications and suggest that serum NfL may be a promising diagnostic biomarker, potentially useful to differentiate functional vs structural neurological disorders.
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Affiliation(s)
- Alessandro Dinoto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Enrico Marcuzzo
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Vanessa Chiodega
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Francesco Dall'Ora
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy.
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy.
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Begley R, Farrell L, Lyttle N, Alty J, Curran D, Williams S, Graham CD. Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions. Br J Health Psychol 2023; 28:604-618. [PMID: 36626907 DOI: 10.1111/bjhp.12643] [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: 09/06/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making. DESIGN/METHODS We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists (n = 18) and psychiatrists (n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision-making vignette task and self-report measures of explicit attitudes on FND-legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition. RESULTS Participants self-reported strong explicit FND-legitimate and MS-legitimate attitudes but demonstrated an implicit FND-illegitimate/MS-legitimate bias. Deeper examination provided by the IRAP data indicated pro-FND-legitimate attitudes, but no bias for or against FND-illegitimate-contrasting the pro-MS-legitimate, anti-MS-illegitimate attitudes for the comparator condition. Attitudes about FND-illegitimacy were negatively associated with likelihood of referral to physical interventions such as physiotherapy. Medical doctors had lower treatment optimism and stronger explicit attitudes that FND is illegitimate than psychologists. CONCLUSIONS At an implicit level, clinicians are uncertain about the illegitimacy of FND, and such attitudes are associated with lower likelihood of referral to physiotherapy in particular. Improved education on FND among health care professionals is indicated.
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Affiliation(s)
- Roisin Begley
- Department of Psychology, Queen's University Belfast, Belfast, UK
| | - Lynn Farrell
- Psychology Department, National College of Ireland, Dublin, Ireland
| | - Nigel Lyttle
- Adult Acute Neuropsychology Services, Belfast Health and Social Care Trust, Belfast, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia.,Neurology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Curran
- Department of Psychology, Queen's University Belfast, Belfast, UK
| | - Stefan Williams
- Neurology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Ercoli T, Tinazzi M, Geroin C, Marcuzzo E, Erro R, Cuoco S, Ceravolo R, Mazzucchi S, Pilotto A, Padovani A, Romito LM, Eleopra R, Zappia M, Nicoletti A, Dallocchio C, Arbasino C, Bono F, Spano G, Demartini B, Gambini O, Modugno N, Olivola E, Bonanni L, Albanese A, Ferrazzano G, Tessitore A, Lopiano L, Calandra-Buonaura G, Petracca M, Morgante F, Esposito M, Pisani A, Manganotti P, Tesolin L, Teatini F, Stocchi F, Defazio G. Do demographic and clinical features and comorbidities affect the risk of spread to an additional body site in functional motor disorders? J Neural Transm (Vienna) 2022; 129:1271-1276. [PMID: 35972697 PMCID: PMC9468120 DOI: 10.1007/s00702-022-02537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study is to assess changes in the body distribution and the semeiology of functional motor disorder (FMD) in patients who reported only one or more than one body site affected at FMD onset. Data were obtained from the Italian Registry of Functional Motor Disorders, which included patients with a diagnosis of clinically definite FMDs. The relationship between FMD features and spread to other body sites was estimated by multivariate Cox regression analysis. We identified 201 (49%) patients who reported only one body site affected at FMD onset and 209 (51%) who reported multiple body sites affected at onset. FMD spread from the initial site to another site in 43/201 (21.4%) patients over 5.7 ± 7.1 years in those with only one site affected at FMD onset; FMD spread to an another body site in 29/209 (13.8%) over 5.5 ± 6.5 years. The spread of FMD was associated with non-motor functional symptoms and psychiatric comorbidities only in the patients with one body site affected at FMD onset. Our findings provide novel insight into the natural history of FMD. The number of body sites affected at onset does not seem to have a consistent influence on the risk of spread. Furthermore, our findings suggest that psychiatric comorbidities and non-motor functional symptoms may predict the spread of FMD symptoms, at least in patients with one body site affected at onset.
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Affiliation(s)
- Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
| | - Enrico Marcuzzo
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le Scuro 10, 37134, Verona, Italy
| | - Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Sofia Cuoco
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, SA, Italy
| | - Roberto Ceravolo
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Center for NeuroDegenerative Diseases Parkinson and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,FERB Onlus, Ospedale S. Isidoro, Trescore Balneario, Bergamo, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Michele Romito
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Zappia
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Carlo Dallocchio
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Carla Arbasino
- Department of Medical Area, Neurology Unit, ASST Pavia, Pavia, Italy
| | - Francesco Bono
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Giorgio Spano
- Botulinum Toxin Center, Neurology Unit A.O.U. Mater Domini, Catanzaro, Italy
| | - Benedetta Demartini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Orsola Gambini
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti-Pescara, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgery Sciences, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - Leonardo Lopiano
- Department of Neuroscience-Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Martina Petracca
- Movement Disorder Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | | | - Antonio Pisani
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health Services, University of Trieste, Trieste, Italy
| | - Lucia Tesolin
- Functional Movement Disorders Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Francesco Teatini
- Functional Movement Disorders Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Fabrizio Stocchi
- University and Institute of Research and Medical Care San Raffaele Roma, Rome, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Kola S, LaFaver K. Updates in Functional Movement Disorders: from Pathophysiology to Treatment Advances. Curr Neurol Neurosci Rep 2022; 22:305-311. [PMID: 35441333 PMCID: PMC9017419 DOI: 10.1007/s11910-022-01192-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review This review discusses advances in functional movement disorders (FMD) over the past 3 years, with a focus on risk factors, diagnosis, pathophysiology, neuroimaging studies, and treatment. Recent Findings The past decade has brought a revived interest in functional movement disorders, with a growing number of studies exploring pathophysiological mechanisms. Here, we review recent studies demonstrating changes in attention, emotional and sensorimotor function in FMD. Through international collaborative efforts, progress has been made in defining biomarkers and outcome measures, an important prerequisite towards standardization of diagnosis and reporting of outcomes in clinical trials. Of particular interest are neuroimaging studies demonstrating functional and structural changes in motor and emotional brain circuits, deepening our understanding of FMD as a neurocircuit disorder and potentially paving the way towards new treatments. Currently available treatment modalities have shown successful outcomes via outpatient, inpatient, and virtual delivery. Summary The last 3 years have seen tremendous efforts to better understand, diagnose, and treat FMD. The disease model has been broadened to include a biopsychosocial formulation, and insights on the pathophysiology on FMD are informing treatment efforts. Several international multidisciplinary research collaborations are underway to define biomarkers and best outcome measures, highlighting the path towards improved standardization of future treatment trials. Additionally, the rise of telemedicine during the COVID-19 pandemic has reduced geographic barriers and paved the way for virtual therapy sessions and self-guided programs. Supplementary Information The online version contains supplementary material available at 10.1007/s11910-022-01192-9.
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Affiliation(s)
- Sushma Kola
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathrin LaFaver
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Saratoga Hospital Medical Group - Neurology, 6 Care Ln, Saratoga Springs, NY, 12866, USA.
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