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Popkirov S, Jungilligens J, Michaelis R. [Understanding and explaining functional movement disorders]. DER NERVENARZT 2024; 95:499-506. [PMID: 38363298 DOI: 10.1007/s00115-024-01619-3] [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: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Functional movement disorders are not uncommon in neurological consultations, hospitals and emergency departments. Although the disorder can usually be recognized clinically, the communication of the diagnosis is often unsatisfactory. Those affected are indirectly accused of a lack of insight or openness but it is often the doctors who fail to formulate a coherent and comprehensible explanation of the underlying disorder. In this review an integrative model for the development of functional movement disorders is presented, which places the motor (and nonmotor) symptoms in a neuroscientific light. In addition, explanations and metaphors are presented that have proven helpful in conveying an understanding of the disorder.
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Affiliation(s)
- Stoyan Popkirov
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - Johannes Jungilligens
- Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - Rosa Michaelis
- Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
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2
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Berg L, Martino D, L'Erario ZP, Pringsheim T. Symptom Severity and Health Impacts of Functional Tic-Like Behaviors in Youth. Pediatr Neurol 2024; 155:68-75. [PMID: 38603984 DOI: 10.1016/j.pediatrneurol.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND We performed this study to improve understanding of the relationship between functional tic-like behaviors (FTLBs) and quality of life, loneliness, family functioning, anxiety, depression, and suicidality. METHOD This cross-sectional study assessed self-reported quality of life, disability, loneliness, depression, anxiety, family functioning, tic severity, and suicide risk in age- and birth-sex matched youth with FTLBs, Tourette syndrome (TS), and neurotypical controls. We performed specific subanalyses comparing individuals with FTLBs who identified as transgender/gender diverse (TGD) with cisgender individuals. RESULTS Eighty-two youth participated (age range 11 to 25, 90% female at birth), including 35 with FTLBs, 22 with TS, and 25 neurotypical controls. A significantly higher proportion of participants with FTLB identified as TGD (15 of 35) than TS (two of 22) and neurotypical control (three of 25) participants. Compared with neurotypical controls, individuals with FTLBs had significantly lower quality of life, greater disability, loneliness, social phobia, anxiety symptoms, depressive symptoms, and suicidality. Compared with individuals with TS, individuals with FTLBs had more school/work absences due to tics, had more depressive symptoms, were more likely to be at high risk for suicidality, and had disability in self-care and life activity domains. There were no significant differences between cisgender and TGD participants with FTLB in any of the domains assessed. CONCLUSIONS Youth with FTLB have unique health care needs and associations with anxiety, depression, sex, and gender.
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Affiliation(s)
- Lindsay Berg
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Schneider A, Weber S, Wyss A, Loukas S, Aybek S. BOLD signal variability as potential new biomarker of functional neurological disorders. Neuroimage Clin 2024; 43:103625. [PMID: 38833899 PMCID: PMC11179625 DOI: 10.1016/j.nicl.2024.103625] [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: 04/05/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Functional neurological disorder (FND) is a common neuropsychiatric condition with established diagnostic criteria and effective treatments but for which the underlying neuropathophysiological mechanisms remain incompletely understood. Recent neuroimaging studies have revealed FND as a multi-network brain disorder, unveiling alterations across limbic, self-agency, attentional/salience, and sensorimotor networks. However, the relationship between identified brain alterations and disease progression or improvement is less explored. METHODS This study included resting-state functional magnetic resonance imaging (fMRI) data from 79 patients with FND and 74 age and sex-matched healthy controls (HC). First, voxel-wise BOLD signal variability was computed for each participant and the group-wise difference was calculated. Second, we investigated the potential of BOLD signal variability to serve as a prognostic biomarker for clinical outcome in 47 patients who attended a follow-up measurement after eight months. RESULTS The results demonstrated higher BOLD signal variability in key networks, including the somatomotor, salience, limbic, and dorsal attention networks, in patients compared to controls. Longitudinal analysis revealed an increase in BOLD signal variability in the supplementary motor area (SMA) in FND patients who had an improved clinical outcome, suggesting SMA variability as a potential state biomarker. Additionally, higher BOLD signal variability in the left insula at baseline predicted a worse clinical outcome. CONCLUSION This study contributes to the understanding of FND pathophysiology, emphasizing the dynamic nature of neural activity and highlighting the potential of BOLD signal variability as a valuable research tool. The insula and SMA emerge as promising regions for further investigation as prognostic and state markers.
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Affiliation(s)
- Ayla Schneider
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3010 Bern, Switzerland
| | - Samantha Weber
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3010 Bern, Switzerland; University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, 8032 Zurich, Switzerland
| | - Anna Wyss
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Graduate School for Health Sciences (GHS), University of Bern, 3006 Bern, Switzerland
| | - Serafeim Loukas
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Selma Aybek
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Faculty of Science and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.
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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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Gandolfi M, Sandri A, Menaspà Z, Avanzino L, Pelosin E, Geroin C, Vidale D, Fiorio M, Tinazzi M. How Does Postural Control in Patients with Functional Motor Disorders Adapt to Multitasking-Based Immersive Virtual Reality? Mov Disord Clin Pract 2024; 11:337-345. [PMID: 38178646 PMCID: PMC10982601 DOI: 10.1002/mdc3.13961] [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: 05/18/2023] [Revised: 10/27/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Motor symptoms in functional motor disorders (FMDs) refer to involuntary, but learned, altered movement patterns associated with aberrant self-focus, sense of agency, and belief/expectations. These conditions commonly lead to impaired posture control, raising the likelihood of falls and disability. Utilizing visual and cognitive tasks to manipulate attentional focus, virtual reality (VR) integrated with posturography is a promising tool for exploring postural control disorders. OBJECTIVES To investigate whether postural control can be adapted by manipulating attentional focus in a 3D immersive VR environment. METHODS We compared postural parameters in 17 FMDs patients and 19 age-matched healthy controls over a single session under four increasingly more complex and attention-demanding conditions: simple fixation task (1) in the real room and (2) in 3D VR room-like condition; complex fixation task in a 3D VR city-like condition (3) avoiding distractors and (4) counting them. Dual-task effect (DTE) measured the relative change in performance induced by the different attention-demanding conditions on postural parameters. RESULTS Patients reduced sway area and mediolateral center of pressure displacement velocity DTE compared to controls (all, P < 0.049), but only under condition 4. They also showed a significant reduction in the sway area DTE under condition 4 compared to condition 3 (P = 0.025). CONCLUSIONS This study provides novel preliminary evidence for the value of a 3D immersive VR environment combined with different attention-demanding conditions in adapting postural control in patients with FMDs. As supported by quantitative and objective posturographic measures, our findings may inform interventions to explore FMDs pathophysiology.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC)University of VeronaVeronaItaly
- Neurorehabilitation UnitAOUIVeronaItaly
| | - Angela Sandri
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Experimental MedicineSection of Human Physiology, University of GenoaGenoaItaly
| | - Elisa Pelosin
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Experimental MedicineSection of Human Physiology, University of GenoaGenoaItaly
| | - Christian Geroin
- Department of Surgery, Dentistry, Pediatrics and GynecologyUniversity of VeronaItaly
| | | | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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Nisticò V, Ilia N, Conte F, Broglia G, Sanguineti C, Lombardi F, Scaravaggi S, Mangiaterra L, Tedesco R, Gambini O, Priori A, Maravita A, Demartini B. Forearm bisection task suggests an alteration in body schema in patients with functional movement disorders (motor conversion disorders). J Psychosom Res 2024; 178:111610. [PMID: 38359638 DOI: 10.1016/j.jpsychores.2024.111610] [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: 06/19/2023] [Revised: 01/16/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES To explore potential alterations of the Body Schema, the implicit sensorimotor representation of one's own body, in patients with Functional Movement Disorders (FMD, Motor Conversion Disorders), characterized by neurological symptoms of altered voluntary motor function that cannot be explained by typical medical conditions. This investigation is prompted by the potential dissociation from their reportedly intact sense of ownership. METHODS 10 FMD patients and 11 healthy controls (HC) underwent the Forearm Bisection Task, aimed at assessing perceived body metrics, which consists in asking the subject, blindfolded, to repeatedly point at the perceived middle point of their dominant forearm with the index finger of their contralateral hand, and a psychometric assessment for anxiety, depression, alexithymia, and tendency to dissociation. RESULTS FMD patients bisected their forearm more proximally (with an increased shift towards their elbow equal to 7.5%) with respect to HC; average bisection point was positively associated with anxiety levels in the whole sample, and with the tendency to dissociation in the FMD group. CONCLUSIONS FMD patients perceive their forearm as shorter than HC, suggesting an alteration of their Body Schema. The Body Schema can go through short- and long-term updates in the life course, mainly related to the use of each body segment; we speculate that, despite FMD being a disorder of functional nature, characterized by variability and fluctuations in symptomatology, the lack of sense of agency over a body part might be interpreted by the nervous system as disuse and hence influence the Body Schema, as deficits of organic etiology do.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy.
| | - Neofytos Ilia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Francesca Conte
- Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy
| | - Giovanni Broglia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Claudio Sanguineti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Francesco Lombardi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Silvia Scaravaggi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Laura Mangiaterra
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Roberta Tedesco
- Unità di Psichiatria, Servizio Psichiatrico di Diagnosi e Cura, Ospedale Civile di Legnano, ASST Ovest Milanese, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Angelo Maravita
- Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy
| | - Benedetta Demartini
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Unità di Psichiatria, Servizio Psichiatrico di Diagnosi e Cura, Ospedale Civile di Legnano, ASST Ovest Milanese, Milano, Italy
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Weber S, Bühler J, Loukas S, Bolton TAW, Vanini G, Bruckmaier R, Aybek S. Transient resting-state salience-limbic co-activation patterns in functional neurological disorders. Neuroimage Clin 2024; 41:103583. [PMID: 38422831 PMCID: PMC10944183 DOI: 10.1016/j.nicl.2024.103583] [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: 11/15/2023] [Revised: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Functional neurological disorders were historically regarded as the manifestation of a dynamic brain lesion which might be linked to trauma or stress, although this association has not yet been directly tested yet. Analysing large-scale brain network dynamics at rest in relation to stress biomarkers assessed by salivary cortisol and amylase could provide new insights into the pathophysiology of functional neurological symptoms. METHODS Case-control resting-state functional magnetic resonance imaging study of 79 patients with mixed functional neurological disorders (i.e., functional movement disorders, functional seizures, persistent perceptual-postural dizziness) and 74 age- and sex-matched healthy controls. Using a two-step hierarchical data-driven neuroimaging approach, static functional connectivity was first computed between 17 resting-state networks. Second, dynamic alterations in these networks were examined using co-activation pattern analysis. Using a partial least squares correlation analysis, the multivariate pattern of correlation between altered temporal characteristics and stress biomarkers as well as clinical scores were evaluated. RESULTS Compared to healthy controls, patients presented with functional aberrancies of the salience-limbic network connectivity. Thus, the insula and amygdala were selected as seed-regions for the subsequent analyses. Insular co-(de)activation patterns related to the salience network, the somatomotor network and the default mode network were detected, which patients entered more frequently than controls. Moreover, an insular co-(de)activation pattern with subcortical regions together with a wide-spread co-(de)activation with diverse cortical networks was detected, which patients entered less frequently than controls. In patients, dynamic alterations conjointly correlated with amylase measures and duration of symptoms. CONCLUSION The relationship between alterations in insular co-activation patterns, stress biomarkers and clinical data proposes inter-related mechanisms involved in stress regulation and functional (network) integration. In summary, altered functional brain network dynamics were identified in patients with functional neurological disorder supporting previously raised concepts of impaired attentional and interoceptive processing.
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Affiliation(s)
- Samantha Weber
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, 8032 Zurich, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3010 Bern, Switzerland; Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Janine Bühler
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3010 Bern, Switzerland
| | - Serafeim Loukas
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Division of Development and Growth, Department of Pediatrics, University of Geneva, 1211 Geneva, Switzerland
| | - Thomas A W Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; Department of Radiology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Giorgio Vanini
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Rupert Bruckmaier
- Veterinary Physiology, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland
| | - Selma Aybek
- Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland; Faculty of Science and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
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Morimoto K, Sekiguchi K, Matsumoto R. Sensory nerve action potential in patients with functional neurological disorders with sensory manifestations. Front Neurol 2023; 14:1259887. [PMID: 38020646 PMCID: PMC10630917 DOI: 10.3389/fneur.2023.1259887] [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: 07/20/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Functional neurological disorder (FND) has various clinical manifestations. Even though diagnostic criteria for FND have been proposed, FND characteristics with sensory manifestations have not been elucidated. Therefore, we aimed to investigate the association between sensory nerve action potential (SNAP) amplitudes and FND with sensory manifestations. Methods We included 76 outpatients with FND with sensory manifestations whose nerve conduction studies were performed retrospectively. Additionally, we defined 121 patients with other neurological diseases who did not have peripheral neuropathy as disease controls. The SNAP amplitudes were compared between the two groups. We also explored the relationship between SNAP amplitudes and FND-specific clinical symptoms in patients with FND. Results No differences were observed in SNAP amplitudes adjusted for age between patients with FND who had sensory manifestations and disease control patients. Additionally, no differences were observed between patients with FND who had and did not have FND-specific clinical symptoms. Conclusion The SNAP amplitude in patients with FND who had sensory manifestations was equivalent to that in controls.
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Affiliation(s)
| | - Kenji Sekiguchi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
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Asadi-Pooya AA, Hallett M, Mirzaei Damabi N, Fazelian Dehkordi K. Genetics of Functional Seizures; A Scoping Systematic Review. Genes (Basel) 2023; 14:1537. [PMID: 37628589 PMCID: PMC10454456 DOI: 10.3390/genes14081537] [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: 07/07/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Evidence on the genetics of functional seizures is scarce, and the purpose of the current scoping systematic review is to examine the existing evidence and propose how to advance the field. METHODS Web of science and MEDLINE were searched, from their initiation until May 2023. The following key words were used: functional neurological disorder(s), psychogenic neurological disorder(s), functional movement disorder(s), psychogenic movement disorder(s), functional seizures(s), psychogenic seizure(s), nonepileptic seizure(s), dissociative seizure(s), or psychogenic nonepileptic seizure(s), AND, gene, genetic(s), polymorphism, genome, epigenetics, copy number variant, copy number variation(s), whole exome sequencing, or next-generation sequencing. RESULTS We identified three original studies. In one study, the authors observed that six (5.9%) patients with functional seizures carried pathogenic/likely pathogenic variants. In another study, the authors observed that, in functional seizures, there was a significant correlation with genes that are over-represented in adrenergic, serotonergic, oxytocin, opioid, and GABA receptor signaling pathways. In the third study, the authors observed that patients with functional seizures, as well as patients with depression, had significantly different genotypes in FKBP5 single nucleotide polymorphisms compared with controls. CONCLUSION Future genetic investigations of patients with functional seizures would increase our understanding of the pathophysiological and neurobiological problems underlying this common neuropsychological stress-associated condition.
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Affiliation(s)
- Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz 71438, Iran; (N.M.D.); (K.F.D.)
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Mark Hallett
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD 20892, USA;
| | - Nafiseh Mirzaei Damabi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz 71438, Iran; (N.M.D.); (K.F.D.)
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Demartini B, Nisticò V, Benayoun C, Cigognini AC, Ferrucci R, Vezzoli A, Dellanoce C, Gambini O, Priori A, Mrakic-Sposta S. Glutamatergic dysfunction, neuroplasticity, and redox status in the peripheral blood of patients with motor conversion disorders (functional movement disorders): a first step towards potential biomarkers discovery. Transl Psychiatry 2023; 13:212. [PMID: 37330537 DOI: 10.1038/s41398-023-02500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
Functional movement disorders (FMD) are characterized by the presence of neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. First evidence showed that, compared to healthy controls (CTR), FMD patients presented increased levels of glutamate+glutamine in the anterior cingulate cortex/medial prefrontal cortex, and decreased levels of glutamate in the cerebrospinal fluid, suggesting that a glutamatergic dysfunction might play a role in FMD pathophysiology. In this study, 12 FMD patients and 20 CTR were recruited and underwent venous blood sampling and urine collection: levels of glutamate, BDNF, dopamine, oxidative stress, creatinine, neopterin, and uric acid were analyzed. Participants also underwent a psychometric assessment investigating depression, anxiety, and alexithymia. We found that levels of glutamate, BDNF, and dopamine were significantly lower in the blood of FMD patients than CTR. Glutamate and dopamine levels were positively associated with levels of alexithymia. Our findings give further evidence that glutamatergic dysfunction might be involved in the pathophysiology of FMD, possibly representing a biomarker of disease; moreover, since glutamatergic and dopaminergic systems are closely interconnected, our results might have a relevance in terms of treatment options for FMD patients.
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Affiliation(s)
- Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy.
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy.
| | - Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy.
- Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy.
| | - Caroline Benayoun
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Anna Chiara Cigognini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Roberta Ferrucci
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Alessandra Vezzoli
- Institute of Clinical Physiology - Milan, National Research Council (CNR), Milano, Italy
| | - Cinzia Dellanoce
- Institute of Clinical Physiology - Milan, National Research Council (CNR), Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Simona Mrakic-Sposta
- Institute of Clinical Physiology - Milan, National Research Council (CNR), Milano, Italy
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11
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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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12
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Maywald M, Pogarell O, Levai S, Paolini M, Tschentscher N, Rauchmann BS, Krause D, Stöcklein S, Goerigk S, Röll L, Ertl-Wagner B, Papazov B, Keeser D, Karch S, Chrobok A. Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder. Neuroimage Clin 2023; 37:103330. [PMID: 36696807 PMCID: PMC9879992 DOI: 10.1016/j.nicl.2023.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal, or palpitation as well as neurological symptoms like vertigo, stance and gait disorders. Furthermore, previous studies have shown a bidirectional link between vestibulo-spatial and anxiety neural networks. So far, there have been no neuroimaging-studies comparing these groups. OBJECTIVES The aim of this explorative study was to investigate differences and similarities of neural correlates between these two patient groups and to compare their findings with a healthy control group. METHODS 63 participants, divided in two patient groups (ANX = 20 and PPPD = 14) and two sex and age matched healthy control groups (HC-A = 16, HC-P = 13) were included. Anxiety and dizziness related pictures were shown during fMRI-measurements in a block-design in order to induce emotional responses. All subjects filled in questionnaires regarding vertigo (VSS, VHQ), anxiety (STAI), depression (BDI-II), alexithymia (TAS), and illness-perception (IPQ). After modelling the BOLD response with a standard canonical HRF, voxel-wise t-tests between conditions (emotional-negative vs neutral stimuli) were used to generate statistical contrast maps and identify relevant brain areas (pFDR < 0.05, cluster size >30 voxels). ROI-analyses were performed for amygdala, cingulate gyrus, hippocampus, inferior frontal gyrus, insula, supramarginal gyrus and thalamus (p ≤ 0.05). RESULTS Patient groups differed from both HC groups regarding anxiety, dizziness, depression and alexithymia scores; ratings of the PPPD group and the ANX group did differ significantly only in the VSS subscale 'vertigo and related symptoms' (VSS-VER). The PPPD group showed increased neural responses in the vestibulo-spatial network, especially in the supramarginal gyrus (SMG), and superior temporal gyrus (STG), compared to ANX and HC-P group. The PPPD group showed increased neural responses compared to the HC-P group in the anxiety network including amygdala, insula, lentiform gyrus, hippocampus, inferior frontal gyrus (IFG) and brainstem. Neuronal responses were enhanced in visual structures, e.g. fusiform gyrus, middle occipital gyrus, and in the medial orbitofrontal cortex (mOFC) in healthy controls compared to patients with ANX and PPPD, and in the ANX group compared to the PPPD group. CONCLUSIONS These findings indicate that neuronal responses to emotional information in the PPPD and the ANX group are comparable in anxiety networks but not in vestibulo-spatial networks. Patients with PPPD revealed a stronger neuronal response especially in SMG and STG compared to the ANX and the HC group. These results might suggest higher sensitivity and poorer adaptation processes in the PPPD group to anxiety and dizziness related pictures. Stronger activation in visual processing areas in HC subjects might be due to less emotional and more visual processing strategies.
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Affiliation(s)
- Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Levai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Boris Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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13
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Sudden Onset Tic and Tic-Like Presentations in Older Adolescents and Adults. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022; 9:146-155. [PMCID: PMC9667005 DOI: 10.1007/s40474-022-00263-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
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14
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The recent surge of functional movement disorders: social distress or greater awareness? Curr Opin Neurol 2022; 35:485-493. [PMID: 35787596 DOI: 10.1097/wco.0000000000001074] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To analyze the interrelated factors that have led to the striking increase in functional movement disorders in recent years, with a focus on functional tic-like behaviours (FTLB). RECENT FINDINGS The sudden onset of FTLB has been widely observed in several countries since the beginning of the SARS-CoV-2 pandemic, whereas it was previously very rarely reported. Pandemic-related FTLB typically occur in young females, share complex, disabling and tic-lookalike patterns, and are usually triggered by the exposure to videos portraying tic-like behaviours on social media. Both pandemic-related FTLB and prepandemic FTLB are associated with high levels of depression and anxiety. FTLB related to the pandemic highlight the role of social media in the psychopathological behaviours of our time. SUMMARY We suggest FTLB are due to a combination of predisposing factors (high genetic and epigenetic risk for anxiety and depression, negative past experiences) and precipitating factors (pandemic and its impact on mental health, exposure to certain social media content). These factors of vulnerability may increase the risk of developing behavioural and emotional problems in youth, such as FTLB. Early diagnosis and appropriate treatment of psychiatric comorbidities seem to be predictors of positive prognosis.
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15
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Nisticò V, Goeta D, Iacono A, Tedesco R, Giordano B, Faggioli R, Priori A, Gambini O, Demartini B. Clinical overlap between functional neurological disorders and autism spectrum disorders: a preliminary study. Neurol Sci 2022; 43:5067-5073. [PMID: 35511383 PMCID: PMC9349073 DOI: 10.1007/s10072-022-06048-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022]
Abstract
Functional neurological disorders (FNDs) and autism spectrum disorders (ASDs) share common features in terms of deficits in emotion regulation and recognition, sensory sensitivity, proprioception and interoception. Nevertheless, few studies have assessed their overlap. We recruited 21 patients with FNDs, 30 individuals with ASDs without intellectual disabilities and 45 neurotypical adults (NA). Participants completed: the Autism Quotient (AQ); the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R); and a questionnaire assessing functional neurological symptoms (FNS). ASDs participants also completed the Sensory Perception Quotient-Short Form (SPQ-SF35), assessing sensory sensitivity. In the FNDs sample, no patient scored above the clinical cut-off at the AQ and the 19% scored above the cut-off at the RAADS-R, a prevalence similar to the one we found in NA (15.6%; both p > 0.05). The 86.7% of participants with ASDs reported at least one FNS, a prevalence significantly higher than the NA one (35.6%, p < 0.001). In the ASDs sample, tactile hypersensitivity was found to be a risk factor for functional weakness (OR = 0.74, p = 0.033) and paraesthesia (OR = 0.753, p = 0.019). In conclusions, FNDs individuals did not present autistic traits more than NA, but ASDs individuals presented a higher number of FNSs than NA; this rate was associated with higher sensory sensitivity, especially in the touch domain.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,Dipartimento di Psicologia, Università degli Studi di Milano Bicocca, Milan, Italy
| | - Diana Goeta
- U.O. di Psichiatria, Presidio San Carlo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Adriano Iacono
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy
| | - Roberta Tedesco
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy
| | - Barbara Giordano
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy.,U.O. di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Raffaella Faggioli
- U.O. di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,U.O. di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Presidio San Paolo, via A. di Rudinì, 8, 20142, Milano, Italy. .,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy. .,U.O. di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy.
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16
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Sojka P, Slovák M, Věchetová G, Jech R, Perez DL, Serranová T. Bridging structural and functional biomarkers in functional movement disorder using network mapping. Brain Behav 2022; 12:e2576. [PMID: 35429407 PMCID: PMC9120728 DOI: 10.1002/brb3.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are gaps in our neurobiological understanding of functional movement disorder (FMD). OBJECTIVES We investigated gray matter volumetric profiles in FMD, and related findings to resting-state functional connectivity (rsFC) profiles using Human Connectome Project data. METHODS Volumetric differences between 53 FMD patients and 50 controls were examined, as well as relationships between individual differences in FMD symptom severity and volumetric profiles. Atrophy network mapping was also used to probe whether FMD-related structural alterations preferentially impacted brain areas with dense rsFC. RESULTS Compared to controls without neurological comorbidities (albeit with mild depression and anxiety as a group), the FMD cohort did not show any volumetric differences. Across patients with FMD, individual differences in symptom severity negatively correlated with right supramarginal and bilateral superior temporal gyri volumes. These findings remained significant adjusting for FMD subtype or antidepressant use, but did not remain statistically significant adjusting for depression and anxiety scores. Symptom severity-related structural alterations mapped onto regions with dense rsFC-identifying several disease epicenters in default mode, ventral attention, and salience networks. CONCLUSIONS This study supports that FMD is a multinetwork disorder with an important role for the temporoparietal junction and its related connectivity in the pathophysiology of this condition. More research is needed to explore the intersection of functional neurological symptoms and mood.
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Affiliation(s)
- Petr Sojka
- Department of Psychiatry, Faculty of MedicineMasaryk University and University Hospital BrnoBrnoCzech Republic
| | - Matěj Slovák
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
| | - Gabriela Věchetová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
| | - David L. Perez
- Functional Neurological Disorder UnitCognitive Behavioral Neurology DivisionDepartment of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Division of NeuropsychiatryDepartment of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Tereza Serranová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague1st Faculty of Medicine and General University HospitalPragueCzech Republic
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17
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Paleari V, Nisticò V, Nardocci N, Canevini MP, Priori A, Gambini O, Zorzi G, Demartini B. Socio-demographic characteristics and psychopathological assessment in a sample of 13 paediatric patients with functional neurological disorders: A preliminary report. Clin Child Psychol Psychiatry 2022; 27:492-503. [PMID: 34743581 DOI: 10.1177/13591045211055084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This observational study aims to characterize, from a socio-demographic and psychopathological perspective, a sample of children with Functional Neurological Disorders (FND). Thirteen paediatric patients (below 18 years old) with FND and their parents completed a battery of anamnestic and neuropsychological tests, assessing socio-demographic status, cognitive level, behavioural and emotional issues, depression, anxiety, alexithymic traits and dissociative symptoms. Five patients presented movement disorders (tremor, myoclonus and gait disorder), three patients psychogenic non-epileptic seizures and five patients sensitivity disturbances (pain, anaesthesia and paraesthesia). Cognitive profile was normal in 11 patients; academic performance was good in nine patients, but three had a diagnosis of Specific Learning Difficulty or Attention Deficit Hyperactivity Disorder. Precipitating events occurred in 11 patients. At the self-report questionnaires, mean scores close to the clinical cut off were documented with respect to affective and somatic problems. At the parent-report questionnaires, clinically significant mean scores were observed in the subscales assessing anxious-depressive symptoms and somatic complaints. We speculate that paediatric FND patients, although acknowledging the relevance of somatic symptoms, have difficulties in recognizing internal emotional states (that, instead, are easily recognized by their parents). The case of one FND patient was described. These preliminary data might help identifying different clinical phenotypes of paediatric FND.
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Affiliation(s)
- Vittoria Paleari
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,U.O. Neuropsichiatria Infantile Fondazione IRCCS, 9328Istituto Neurologico Carlo Besta, Milano, Italia
| | - Veronica Nisticò
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy
| | - Nardo Nardocci
- U.O. Neuropsichiatria Infantile Fondazione IRCCS, 9328Istituto Neurologico Carlo Besta, Milano, Italia
| | - Maria Paola Canevini
- U.O. Neuropsichiatria Infantile ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy.,III Clinica Neurologica, ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
| | - Giovanna Zorzi
- U.O. Neuropsichiatria Infantile Fondazione IRCCS, 9328Istituto Neurologico Carlo Besta, Milano, Italia
| | - Benedetta Demartini
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milano, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milano, Italy
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18
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Schwingenschuh P, Espay AJ. Functional tremor. J Neurol Sci 2022; 435:120208. [DOI: 10.1016/j.jns.2022.120208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 10/18/2022]
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19
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Nisticò V, Rossi RE, D'Arrigo AM, Priori A, Gambini O, Demartini B. Functional neuroimaging in Irritable Bowel Syndrome: a systematic review highlights common brain alterations with Functional Movement Disorders. J Neurogastroenterol Motil 2022; 28:185-203. [PMID: 35189600 PMCID: PMC8978134 DOI: 10.5056/jnm21079] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/03/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by recurring abdominal pain and altered bowel habits without detectable organic causes. This study aims to provide a comprehensive overview of the literature on functional neuroimaging in IBS and to highlight brain alterations similarities with other functional disorders - functional movement disorders in particular. We conducted the bibliographic search via PubMed in August 2020 and included 50 studies following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for systematic reviews. Overall, our findings showed an aberrant activation and functional connectivity of the insular, cingulate, sensorimotor and frontal cortices, the amygdala and the hippocampus, suggesting an altered activity of the homeostatic and salience network and of the autonomous nervous system. Moreover, glutamatergic dysfunction in the anterior insula and hypothalamic pituitary axis dysregulation were often reported. These alterations seem to be very similar to those observed in patients with functional movement disorders. Hence, we speculate that different functional disturbances might share a common pathophysiology and we discussed our findings in the light of a Bayesian model framework.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Roberta E Rossi
- Gastro-intestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy
| | - Andrea M D'Arrigo
- Department of Neurology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,III Clinica Neurologica, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milan, Italy.,Unità di Psichiatria 52, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy
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20
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Remission of functional motor symptoms following esketamine administration in a patient with treatment-resistant depression: a single-case report. Int Clin Psychopharmacol 2022; 37:21-24. [PMID: 34825899 DOI: 10.1097/yic.0000000000000378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Functional movement disorders (FMD) involve a broad range of abnormal involuntary movements not consistent with neurological diseases. These conditions often occur in combination with mood and anxiety disorders and are associated with poor clinical outcomes. We report the case of a 57-year-old woman diagnosed with treatment-resistant depression (TRD) and comorbid FMD treated with weekly intranasal administrations of esketamine over a six-month follow-up period. A comprehensive clinical and psychometric assessment was carried out at different time points. After 2 months of treatment, a complete remission of motor and axial functional disturbances (athetosis, trunk torsion and genuflections) was detectable, along with a progressive improvement in depressive symptoms during follow-up until full remission. According to novel lines of evidence, glutamatergic transmission might play a role in the pathophysiology of FMD through aberrant limbic-motor interactions. We report that treatment with esketamine, a noncompetitive N-methyl-d-aspartate glutamatergic receptor antagonist, was associated with remission of FMD symptoms in a patient with TRD. Pharmacological compounds modulating brain glutamatergic activity may be of potential benefit in the clinical management of FMD.
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Corticolimbic Modulation via Intermittent Theta Burst Stimulation as a Novel Treatment for Functional Movement Disorder: A Proof-of-Concept Study. Brain Sci 2021; 11:brainsci11060791. [PMID: 34203993 PMCID: PMC8232716 DOI: 10.3390/brainsci11060791] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022] Open
Abstract
Neuroimaging studies suggest that corticolimbic dysfunctions, including increased amygdala reactivity to emotional stimuli and heightened fronto-amygdala coupling, play a central role in the pathophysiology of functional movement disorders (FMD). Transcranial magnetic stimulation (TMS) has the potential to probe and modulate brain networks implicated in neuropsychiatric disorders, including FMD. Therefore, the objective of this proof-of-concept study was to investigate the safety, tolerability and preliminary efficacy of fronto-amygdala neuromodulation via targeted left prefrontal intermittent theta burst stimulation (iTBS) on brain and behavioral manifestations of FMD. Six subjects with a clinically defined diagnosis of FMD received three open-label iTBS sessions per day for two consecutive study visits. Safety and tolerability were assessed throughout the trial. Amygdala reactivity to emotionally valenced stimuli presented during an fMRI task and fronto-amygdala connectivity at rest were evaluated at baseline and after each stimulation visit, together with subjective levels of arousal and valence in response to affective stimuli. The FMD symptom severity was assessed at baseline, during treatment and 24 h after the last iTBS session. Multiple doses of iTBS were well-tolerated by all participants. Intermittent TBS significantly decreased fronto-amygdala connectivity and influenced amygdala reactivity to emotional stimuli. These neurocircuitry changes were associated to a marked reduction in FMD symptom severity. Corticolimbic modulation via iTBS represents a promising treatment for FMD that warrants additional research.
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Posttraumatic functional movement disorders and litigation. Acta Neurol Belg 2021; 121:643-647. [PMID: 33772740 DOI: 10.1007/s13760-021-01660-y] [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: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
The concept of functional movement disorders has evolved considerably over the past few decades. More specifically, the views on the relation with psychological stressors or personality disorders have substantially changed, emphasizing a shift from the previously dominant dualistic scheme. This evolution is reflected in adaptations to diagnostic criteria and management approaches. Functional movement disorders which arise in a close temporal relationship with a peripheral trauma are specifically challenging with respect to diagnosis and treatment, but similar considerations seem to apply. The relationship of functional disorders with trauma appears to be much closer than is often thought. Clinical and pathophysiological research has identified shared factors underlying functional posttraumatic as well as primary movement disorders. These evolving insights impact on discussions in terms of litigation for compensation after trauma. The literature is reviewed and the consequences for argumentation in litigation are outlined, including ethical and legal considerations. Finally, we formulate a number of recommendations.
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