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Mark VW. Functional neurological disorder: Extending the diagnosis to other disorders, and proposing an alternate disease term—Attentionally-modifiable disorder. NeuroRehabilitation 2022; 50:179-207. [DOI: 10.3233/nre-228003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed.
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Affiliation(s)
- Victor W. Mark
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Paholpak P, Li-Jung L, Carr DR, Jimenez E, Barrows RJ, Sabodash V, Mendez MF. Prolonged Visual Facial Grasp in Frontotemporal Dementia. J Alzheimers Dis 2018; 53:327-35. [PMID: 27163801 DOI: 10.3233/jad-150864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gaze and eye contact is a critical aspect of social interaction. Patients with behavioral variant frontotemporal dementia (bvFTD) may exhibit abnormally prolonged stare toward human faces. OBJECTIVE To study characteristics of social gaze in patients with bvFTD compared to age and education matched-patients with early-onset Alzheimer's disease (eAD) and healthy controls (HC). METHOD Fifty picture stimuli were presented to each participant (bvFTD = 12, eAD = 18, HC = 13). Each stimuli contained two properties: face (facial versus non-facial) and valence (positive, negative, and neutral). The "facial" stimuli contained human faces. The participants Visual Fixation Time (VFT) was measured for each picture stimuli of interest (per facial expressions on the Facial Action Coding System). A linear mixed-effects regression model with participant-level of random effects was used to compare VFTs between groups. RESULTS The patients with bvFTD showed significantly prolonged VFTs to faces than the patients with eAD and the HC, regardless of valence (all p < 0.01). There were no differences in VFTs for non-facial stimuli between patients with bvFTD and eAD. However, patients with bvFTD and eAD had significantly prolonged VFTs to negative non-facial stimuli than the HC (p = 0.006 and 0.019, respectively). CONCLUSION Patients with bvFTD exhibited a prolonged stare toward human faces. This prolonged visual facial grasp may contribute to the disturbed social interactions of patients with bvFTD and can help distinguish them from those with Alzheimer's disease and other conditions. Additionally, both dementia groups tended to stare at negative stimuli whether faces or non-faces.
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Affiliation(s)
- Pongsatorn Paholpak
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.,Department of Psychiatry, Khon Kaen University, Khon Kaen, Thailand
| | - Liang Li-Jung
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Drew R Carr
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Elvira Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.,Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Robin J Barrows
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.,Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA
| | - Valeiry Sabodash
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.,Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.,Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
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Coubard OA. What do we know about eye movements in Alzheimer's disease? The past 37 years and future directions. Biomark Med 2016; 10:677-80. [DOI: 10.2217/bmm-2016-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Olivier A Coubard
- The Neuropsychological Laboratory, CNS-Fed, 14 rue du Regard, 75006 Paris, France
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Snir M, Hasanreisoglue M, Goldenberg-Cohen N, Friling R, Katz K, Nachum Y, Benjamini Y, Herscovici Z, Axer-Siegel R. Suppression of the Oculocephalic Reflex (Doll’s Eyes Phenomenon) in Normal Full-Term Babies. Curr Eye Res 2010; 35:370-4. [DOI: 10.3109/02713680903576708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fitzgerald DB, Drago V, Jeong Y, Chang YL, White KD, Heilman KM. Asymmetrical alien hands in corticobasal degeneration. Mov Disord 2007; 22:581-4. [PMID: 17230447 DOI: 10.1002/mds.21337] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There are several forms of alien limb, but alien limb in corticobasal degeneration (CBD) is not well understood. We studied a patient with CBD who demonstrated two different types of alien limb. With his right hand he demonstrated a tactile avoidance response with levitation. With his left hand, he demonstrated continuous tactile pursuit of the examiner's hand ("tactile mitgehen"). Mitgehen is often associated with frontal dysfunction, but avoidance response and levitation are often associated with parietal dysfunction.
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Affiliation(s)
- David B Fitzgerald
- Department of Neurology, University of Florida, Gainesville, Florida, USA.
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Drago V, Jeong Y, Crucian GP, Fitzgerald DB, Finney GR, Mizuno T, Pisani F, Heilman KM. Ipsilesional attentional-approach neglect or crossover effect. Neurocase 2006; 12:207-11. [PMID: 17000588 DOI: 10.1080/13554790600598758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients with ipsilateral neglect (IN) bisect lines toward contralesional space. It has been posited that IN might be induced by an attempt at compensation, as part of the crossover effect, where patients with an ipsilesional bias when bisecting long lines, cross over and develop a contralesional bias on short lines or as a release of an approach (grasp) behavior that might be attentional or intentional. To test these alternative hypotheses we had a patient with IN from a right medial frontal lesion bisect lines that contained no cue, a left-sided cue, a right-sided cue, and bilateral cues. If this patient had ipsilateral neglect (IN) because of a crossover effect or compensation, right-sided cues should have influenced bisection more than left-sided cues. We, however, found that only left-sided cues induced a significant change (left-sided deviation) providing support for the attentional-approach (grasp) hypothesis. Further support of this contralesional attentional grasp hypothesis comes from the observation that this patient also had ipsilesional extinction to simultaneous stimuli.
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Affiliation(s)
- Valeria Drago
- Department of Neurology and Center for Neuropsychological Studies, University of Florida College of Medicine, and Neurology Service, Department of Veteran Affairs Medical Center, Gainesville, Florida 32610-0236, USA.
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