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Steinruecke M, Mason I, Keen M, McWhirter L, Carson AJ, Stone J, Hoeritzauer I. Pain and functional neurological disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2024; 95:874-885. [PMID: 38383157 PMCID: PMC11347250 DOI: 10.1136/jnnp-2023-332810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Functional neurological disorder (FND) is characterised by neurological symptoms, such as seizures and abnormal movements. Despite its significance to patients, the clinical features of chronic pain in people with FND, and of FND in people with chronic pain, have not been comprehensively studied. METHODS We systematically reviewed PubMed, Embase and PsycINFO for studies of chronic pain in adults with FND and FND in patients with chronic pain. We described the proportions of patients reporting pain, pain rating and timing, pain-related diagnoses and responsiveness to treatment. We performed random effects meta-analyses of the proportions of patients with FND who reported pain or were diagnosed with pain-related disorders. RESULTS Seven hundred and fifteen articles were screened and 64 were included in the analysis. Eight case-control studies of 3476 patients described pain symptoms in a higher proportion of patients with FND than controls with other neurological disorders. A random effects model of 30 cohorts found that an estimated 55% (95% CI 46% to 64%) of 4272 patients with FND reported pain. Random effects models estimated diagnoses of complex regional pain syndrome in 22% (95% CI 6% to 39%) of patients, irritable bowel syndrome in 16% (95% CI 9% to 24%) and fibromyalgia in 10% (95% CI 8% to 13%). Five studies of FND diagnoses among 361 patients with chronic pain were identified. Most interventions for FND did not ameliorate pain, even when other symptoms improved. CONCLUSIONS Pain symptoms and pain-related diagnoses are common in FND. Classification systems and treatments should routinely consider pain as a comorbidity in patients with FND.
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Affiliation(s)
| | - Isabel Mason
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Mairi Keen
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
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2
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Zhu H, Wen B, Xu J, Zhang Y, Xu L, Huang Y. Efficacy and Safety of Pharmacological Treatment in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2024; 17:811. [PMID: 38931478 PMCID: PMC11206895 DOI: 10.3390/ph17060811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Complex regional pain syndrome (CRPS) is a disabling condition that usually affects the extremities after trauma or surgery. At present, there is no FDA-approved pharmacological treatment for patients with CRPS. We performed this systematic review and meta-analysis to evaluate the efficacy and safety of pharmacological therapies and determine the best strategy for CRPS. We searched the databases, including PubMed, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov, for published eligible randomized controlled trials (RCTs) comparing pharmacological treatment with placebo in CRPS patients. Target patients were diagnosed with CRPS according to Budapest Criteria in 2012 or the 1994 consensus-based IASP CRPS criteria. Finally, 23 RCTs comprising 1029 patients were included. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty (confidence in evidence and quality of evidence). Direct meta-analysis showed that using bisphosphonates (BPs) (mean difference [MD] -2.21, 95% CI -4.36--0.06, p = 0.04, moderate certainty) or ketamine (mean difference [MD] -0.78, 95% CI -1.51--0.05, p = 0.04, low certainty) could provide long-term (beyond one month) pain relief. However, there was no statistically significant difference in the efficacy of short-term pain relief. Ketamine (rank p = 0.55) and BPs (rank p = 0.61) appeared to be the best strategies for CRPS pain relief. Additionally, BPs (risk ratio [RR] = 1.86, 95% CI 1.34-2.57, p < 0.01, moderate certainty) and ketamine (risk ratio [RR] = 3.45, 95% CI 1.79-6.65, p < 0.01, moderate certainty) caused more adverse events, which were mild, and no special intervention was required. In summary, among pharmacological interventions, ketamine and bisphosphonate injection seemed to be the best treatment for CRPS without severe adverse events.
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Affiliation(s)
- He Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Bei Wen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jijun Xu
- Department of Pain Management, Anesthesiology Institute, Cleveland, OH 44195, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH 44195, USA
- Cleveland Clinic, Case Western Reserve University, Cleveland, OH 44195, USA
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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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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4
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Scheurich JA, Klaas KM, Sim LA, Weiss KE, Case HF, Harbeck-Weber C. Characteristics and outcomes of youth with functional seizures attending intensive interdisciplinary pain treatment. Epilepsy Behav 2024; 153:109689. [PMID: 38447301 DOI: 10.1016/j.yebeh.2024.109689] [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: 09/26/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
Functional seizures (FS) can be debilitating and negatively impact quality of life. Yet intervention research for FS is limited, especially for youth. This study examined clinical characteristics and outcomes of youth with FS (13-23 years) presenting to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States. Sixty youth (mean age = 16.5 years; 83.3 % female) met inclusion criteria. At intake, comorbid chronic pain, somatic symptoms, autonomic dysfunction, eating and weight disturbances, and mental health concerns were common. Despite this high symptom burden, youth with FS reported significant improvements in functioning measured with the Functional Disability Inventory, t(53) = 9.80, p <.001, d = 1.32; depression measured with the Center for Epidemiological Studies - Depression Scale for Children, t(53) = 6.76, p <.001, d = 0.91; anxiety measured with the Spence Children's Anxiety Scale, t(53) = 3.97, p < .001, d = 0.53; and catastrophizing measured with the Pain Catastrophizing Scale for Children, t(53) = 6.44, p <.001, d = 0.86, following completion of the program, suggesting that IIPT may be an effective treatment option for highly disabled and emotionally distressed youth with FS. Future research is needed to continue to refine best practices for youth with FS to reduce suffering and improve outcomes.
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Affiliation(s)
- Jennifer A Scheurich
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; University of Missouri-Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Kelsey M Klaas
- Department of Pediatric & Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Leslie A Sim
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Karen E Weiss
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Hannah F Case
- Department of Otolaryngology, Texas Tech University Health Sciences Center, 3601 4th Street STOP 8315, Lubbock, TX 79430, USA.
| | - Cynthia Harbeck-Weber
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Edwards M, Koens L, Liepert J, Nonnekes J, Schwingenschuh P, van de Stouwe A, Morgante F. Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter. Clin Neurophysiol Pract 2024; 9:69-77. [PMID: 38352251 PMCID: PMC10862411 DOI: 10.1016/j.cnp.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Abstract
Functional Motor Disorders are common and disabling. Clinical diagnosis has moved from one of exclusion of other causes for symptoms to one where positive clinical features on history and examination are used to make a "rule in" diagnosis wherever possible. Clinical neurophysiological assessments have developed increasing importance in assisting with this positive diagnosis, not being used simply to demonstrate normal sensory-motor pathways, but instead to demonstrate specific abnormalities that help to positively diagnose these disorders. Here we provide a practical review of these techniques, their application, interpretation and pitfalls. We also highlight particular areas where such tests are currently lacking in sensitivity and specificity, for example in people with functional dystonia and functional tic-like movements.
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Affiliation(s)
- M.J. Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Department of Neuropsychiatry, Maudsley Hospital, London, UK
| | - L.H. Koens
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Martini Ziekenhuis, Groningen, the Netherlands
| | - J. Liepert
- Kliniken Schmieder Allensbach, Allensbach, Germany
| | - J. Nonnekes
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
- Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, the Netherlands
| | | | - A.M.M. van de Stouwe
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology, Ommelander Ziekenhuis, Scheemda, the Netherlands
| | - F. Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Serranová T, Di Vico I, Tinazzi M. Functional Movement Disorder: Assessment and Treatment. Neurol Clin 2023; 41:583-603. [PMID: 37775192 DOI: 10.1016/j.ncl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Functional movement disorder (FMD) is a common, potentially reversible source of disability in neurology. Over the last two decades, there have been major advances in our understanding of the clinical picture, diagnosis, and management of this condition. Motor presentation is heterogeneous and several non-motor symptoms (e.g., pain, fatigue) are part of the clinical spectrum. The diagnosis should be made by neurologists or neuropsychiatrists based on the presence of positive signs of inconsistency and incongruence with neurological diseases. Promising evidence has accumulated for the efficacy of physiotherapy, psychotherapy, or both in the management of FMD, for a majority of patients.
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Affiliation(s)
- Tereza Serranová
- Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Kateřinská 30, 12 800, Prague, Czech Republic.
| | - Ilaria Di Vico
- Movement Disorders Division, Department of Neurosciences, Neurology Unit, Biomedicine and Movement Sciences, University of Verona, Piazzale L. A. Scuro 10, 37124, Verona, VR, Italy
| | - Michele Tinazzi
- Movement Disorders Division, Department of Neurosciences, Neurology Unit, Biomedicine and Movement Sciences, University of Verona, Piazzale L. A. Scuro 10, 37124, Verona, VR, Italy
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7
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Mason I, Renée J, Marples I, McWhirter L, Carson A, Stone J, Hoeritzauer I. Functional neurological disorder is common in patients attending chronic pain clinics. Eur J Neurol 2023; 30:2669-2674. [PMID: 37227931 DOI: 10.1111/ene.15892] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND PURPOSE Chronic pain is a common comorbidity in those with functional neurological disorder (FND); however, the prevalence and characteristics of FND in those with chronic pain is unknown. METHODS A retrospective electronic records review was made of consecutive new patients attending a chronic pain clinic of a regional service. Clinical features, medication for and outcome of chronic pain, any lifetime diagnoses of functional disorders, FND, and psychiatric disorders, and undiagnosed neurological symptoms were recorded. RESULTS Of 190 patients attending the chronic pain clinic, 32 (17%) had a lifetime diagnosis of FND and an additional 11 (6%) had undiagnosed neurological symptoms. Pain patients with comorbid FND were more likely to have chronic primary pain (88% with FND, 44% without FND, p < 0.0001), widespread chronic primary pain (53%, 15%, p < 0.00001), and depression (84%, 52%, p < 0.005) and less likely to have a pain-precipitating event (19% vs. 56%, p < 0.001). However, there was no significant difference between these patients in opiate prescription, benzodiazepine prescription, or pain outcome. CONCLUSIONS This first study of FND in a chronic pain patient population found a remarkably high prevalence of FND (17%) and is possibly an underestimation. The size of the overlap indicates that FND and chronic pain research fields are likely to have a lot to learn from each other.
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Affiliation(s)
- Isabel Mason
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Joanna Renée
- Department of Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Ivan Marples
- Department of Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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8
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Carle-Toulemonde G, Goutte J, Do-Quang-Cantagrel N, Mouchabac S, Joly C, Garcin B. Overall comorbidities in functional neurological disorder: A narrative review. L'ENCEPHALE 2023:S0013-7006(23)00086-6. [PMID: 37414721 DOI: 10.1016/j.encep.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The importance to assess and include the frequent comorbidities in the personalised care management plan of patients with functional neurological disorders (FND) has arisen through the years. FND patients are not only complaining from motor and/or sensory symptoms. They also report some non-specific symptoms that participate to the burden of FND. In this narrative review, we aim to better describe these comorbidities in terms of prevalence, clinical characteristics and their variability depending on the subtype of FND. METHODS The literature was searched for on Medline and PubMed. The search was narrowed to articles between 2000 and 2022. RESULTS Fatigue is the most common symptom reported in relation to FND (from 47 to 93%), followed by cognitive symptoms (from 80 to 85%). Psychiatric disorders are reported in 40 to 100% FND patients, depending on the FND subtype (functional motor disorder [FMD], functional dissociative seizures [FDS]…) but also on the type of psychiatric disorder (anxiety disorders being the most frequent, followed by mood disorders and neurodevelopmental disorders). Stress factors such as childhood trauma exposure (emotional neglect and physical abuse predominantly) have also been identified in up to 75% of FND patients, along with maladaptive coping strategies. Organic disorders are commonly reported in FND, such as neurological disorders (including epilepsy in FDS [20%] and FMD in Parkinson's Disease [7%]). Somatic symptom disorders including chronic pain syndromes are frequently associated to FND (about 50%). To be noted, recent data also suggest a high comorbidity between FND and hypermobile Ehlers Danlos Syndrome (about 55%). CONCLUSION Put together, this narrative review highlights the high burden of FND patients, not only due to somatosensory alterations but also by considering the frequent comorbidities reported. Thus, such comorbidities must be taken into consideration when defining the FND personalised care management strategy for the patients.
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Affiliation(s)
| | - Julie Goutte
- Internal Medicine Department, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France
| | | | - Stéphane Mouchabac
- Sorbonne University, Department of Psychiatry, AP-HP, Saint-Antoine University Hospital, Paris, France
| | - Charlotte Joly
- Neurology Department, Assistance Publique-Hôpitaux de Paris, AP-HP Avicenne University Hospital, Bobigny, France
| | - Béatrice Garcin
- Neurology Department, Assistance Publique-Hôpitaux de Paris, AP-HP Avicenne University Hospital, Bobigny, France
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Issak S, Kanaan R, Nielsen G, Fini NA, Williams G. Functional Gait Disorders: Clinical presentations, Phenotypes and Implications for treatment. Brain Inj 2023; 37:437-445. [PMID: 36617694 DOI: 10.1080/02699052.2023.2165158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Functional Gait Disorders (FGD) are a common presentation of motor-Functional Neurological Disorders (motor-FND) that affect walking ability. AIM To provide a narrative review of the current literature on FGD. METHODS A narrative overview of published literature was undertaken, based on a systematic search of relevant databases, authoritative texts and citation tracking. RESULTS FGD is multidimensional and disabling, with numerous phenotypes described in the literature, including 'knee buckling,' 'astasia-abasia' and 'excessive slowness.' Motor symptoms such as weakness or tremor, and non-motor symptoms, such as pain and fatigue may contribute to the disability and distress in FGD. Phenotypic features and clinical signs are seen in FGD that demonstrate inconsistency and incongruity with structural disease. A limited number of treatment studies have specifically focussed on FGD, however, reporting of outcomes from motor-FND cohorts has demonstrated short and long-term improvements in walking ability through multidisciplinary rehabilitation. CONCLUSIONS The relative contribution of motor and non-motor symptoms in FGD remains unknown, but it is likely that non-motor symptoms increase the illness burden and should be considered during assessment and treatment. Recommended treatment for FGD involves multidisciplinary rehabilitation, but optimum treatment elements are yet to be determined.
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Affiliation(s)
- Sara Issak
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Epworth Healthcare, Melbourne, Australia
| | - Richard Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia
| | - Glenn Nielsen
- Neurosciences Research Centre, Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Natalie A Fini
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Gavin Williams
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Epworth Healthcare, Melbourne, Australia
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10
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Ducroizet A, Zimianti I, Golder D, Hearne K, Edwards M, Nielsen G, Coebergh J. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci 2023; 110:116-125. [PMID: 36871491 DOI: 10.1016/j.jocn.2023.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
Functional Neurological Disorder (FND) is common and is often accompanied by multiple comorbid symptoms and conditions. There have been no large-scale studies exploring the change of its clinical manifestations and comorbidities. We used an online survey to assess FND patient characteristics, changes to fatigue, sleep and pain and comorbid symptoms and diagnoses, as well as treatment strategies. The survey was shared via the charities FND Action and FND Hope. 527 participants were included in the analysis. Most (97.3%) reported experiencing more than one core FND symptom. Many respondents reported associated pain (78.1%), fatigue (78.0%) and sleep disturbances (46.7%) before FND diagnosis which often increased thereafter. Rates of obesity were higher (36.9%) than in the general population. Obesity was associated with increased pain, fatigue and sleep difficulties. There was frequent weight gain after diagnosis. 50.0% of participants reported having other diagnoses prior to FND, while in 43.3% new comorbidities arise after FND diagnosis. Many respondents reported being dissatisfied with their care, expressing a wish for further follow-up from mental health (32.7%) and/or neurological services (44.3%). This large online survey further supports the phenotypic complexity of FND. High rates of pain, fatigue and sleep disturbance exist before diagnosis but monitoring for change is worthwhile. Our study identified major gaps in service provision; we highlight the importance of an open mind regarding change in symptoms; this could aid the early identification and management of co-morbidities, including obesity and migraine, which possibly have a negative impact on FND.
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Affiliation(s)
- Alexandra Ducroizet
- Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | | | - Mark Edwards
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
| | - Glenn Nielsen
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK; Department of Neurology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Jan Coebergh
- Department of Neurology, Ashford St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK; Department of Neurology, St. George's Hospital NHS Foundation Trust, London, UK.
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11
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Varley D, Sweetman J, Brabyn S, Lagos D, van der Feltz-Cornelis C. The clinical management of functional neurological disorder: A scoping review of the literature. J Psychosom Res 2023; 165:111121. [PMID: 36549074 DOI: 10.1016/j.jpsychores.2022.111121] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To date, there have been no reviews bringing together evidence on the clinical management of functional neurological disorder (FND) and patients', caregivers', and healthcare workers' experiences. This review provides an overview of the literature focused on the clinical management of FND. METHODS Four databases were searched, and a consultation exercise was conducted to retrieve relevant records dated from September 2010 to September 2020. Articles documenting diagnostic methods, treatments or interventions, or the experiences and perspectives of patients and healthcare workers in the clinical management of FND were included. RESULTS In total, 2756 records were retrieved, with 162 included in this review. The diagnostic methods reported predominantly included positive clinical signs, v-EEG and EEG. Psychological treatments and medication were the most reported treatments. Mixed findings of the effectiveness of CBT were found. Haloperidol, physiotherapy and scripted diagnosis were found to be effective in reducing FND symptoms. Several facilitators and barriers for patients accessing treatment for FND were reported. CONCLUSION The literature describing the clinical management for FND has increased considerably in recent times. A wide variety of diagnostic tools and treatments and interventions were found, with more focus being placed on tests that confirm a diagnosis than 'rule-out' tests. The main treatment type found in this review was medication. This review revealed that there is a lack of high-quality evidence and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.
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Affiliation(s)
- Danielle Varley
- Department of Health Sciences, University of York, York YO10 5DD, UK.
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Dimitris Lagos
- Hull York Medical School, University of York, York YO10 5DD, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York YO10 5DD, UK; Hull York Medical School, University of York, York YO10 5DD, UK; York Biomedical Research Institute, University of York, York YO10 5DD, UK; Institute of Health Informatics, University College London, London NW1 2DA, UK
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12
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Melf-Marzi A, Böhringer B, Wiehle M, Hausteiner-Wiehle C. Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:879-886. [PMID: 36482756 PMCID: PMC10011717 DOI: 10.3238/arztebl.m2022.0358] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/21/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Background: Complex regional pain syndrome (CRPS) is a relatively common complication, occurring in 5% of cases after injury or surgery, particularly in the limbs. The incidence of CPRS is around 5-26/100 000. The latest revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) now categorizes CRPS as a primary pain condition of multifactorial origin, rather than a disease of the skeletal system or the autonomic nervous system. METHODS Method: Based on a selective search of the literature, we summarize current principles for the diagnosis and treatment of CRPS. RESULTS Results: Regional findings in CRPS are accompanied by systemic symptoms, especially by neurocognitive disorders of body perception and of symptom processing. The therapeutic focus is shifting from predominantly passive peripheral measures to early active treatments acting both centrally and peripherally. The treatment is centered on physiotherapy and occupational therapy to improve sensory perception, strength, (fine) motor skills, and sensorimotor integration/ body perception. This is supported by stepped psychological interventions to reduce anxiety and avoidance behavior, medication to decrease inflammation and pain, passive physical measures for reduction of edema and of pain, and medical aids to improve functioning in daily life. Interventional procedures should be limited to exceptional cases and only be performed in specialized centers. Spinal cord and dorsal root ganglion stimulation, respectively, are the interventions with the best evidence. CONCLUSION Conclusion: The modern principles for the diagnosis and treatment of CRPS consider both, physiological and psychological mechanisms, with the primary goal of restoring function and participation. More research is needed to strengthen the evidence base in this field.
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Affiliation(s)
- Alexandra Melf-Marzi
- Department for BG Rehabilitation; Outpatient CRPS Clinic; BG Trauma Center Murnau; Department for Anesthesiology, Intensive Care Medicine and Pain Therapy; Multimodal Pain Therapy; BG Trauma Center Murnau; Department for Neurology, Clinical Neurophysiology and Stroke Unit; BG Trauma Center Murnau; Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich
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13
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Jungilligens J, Paredes-Echeverri S, Popkirov S, Barrett LF, Perez DL. A new science of emotion: implications for functional neurological disorder. Brain 2022; 145:2648-2663. [PMID: 35653495 PMCID: PMC9905015 DOI: 10.1093/brain/awac204] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 01/11/2023] Open
Abstract
Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic symptoms. In doing so, we address several themes for the functional neurological disorder field including: (i) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, 'panic attack without panic', dissociation, insecure attachment and the influential role of life experiences; (ii) re-interpret select neurobiological research findings in functional neurological disorder cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and (iii) discuss therapeutic implications. While we continue to support that functional neurological disorder is mechanistically and aetiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology and cognitive-affective neuroscience.
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Affiliation(s)
- Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, USA
- Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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14
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Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations. PLoS One 2022; 17:e0266118. [PMID: 36006991 PMCID: PMC9409494 DOI: 10.1371/journal.pone.0266118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. Methods We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. Results Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28–42) years in patients receiving CoronaVac and 46 (33.5–60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16–960) min and 30 (8.8–750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). Conclusions Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.
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15
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Terkelsen AJ, Birklein F. Complex Regional Pain Syndrome or Limb Pain: A Plea for a Critical Approach. J Pain Res 2022; 15:1915-1923. [PMID: 35837543 PMCID: PMC9275500 DOI: 10.2147/jpr.s351099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Most frequently, complex regional pain syndrome (CRPS) develops after a trauma and affects distal parts of the limbs. Early recognition and initiation of adequate treatment is crucial for a favorable outcome. On the other hand, misdiagnosing other disorders as CRPS is detrimental because more appropriate treatment may be withheld from the patients. Despite intensive research, a specific biomarker or paraclinical measure for CRPS diagnosis is still lacking. Instead, clinical criteria approved by the International Association for the Study of Pain (IASP) and latest adapted in 2019 are central for diagnosing CPRS. Thus, the CRPS diagnosis remains challenging with the risk of a “deliberate diagnosis” for unexplained pain, while at the same time a delayed CRPS diagnosis prevents early treatment and full recovery. CRPS is a diagnosis of exclusion. To clinically diagnose CRPS, a vigorous exclusion of “other diseases that would better explain the signs and symptoms” are needed before the patients should be referred to tertiary centers for specific pain treatment. We highlight red flags that suggest “non-CRPS” limb pain despite clinical similarity to CRPS. Clinical and neurological examination and paraclinical evaluation of a probably CRPS patient are summarized. Finally, we pinpoint common differential diagnoses for CRPS. This perspective might help CRPS researchers and caregivers to reach a correct diagnosis and choose the right treatment, regardless whether for CRPS mimics or CRPS itself.
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Affiliation(s)
- Astrid Juhl Terkelsen
- Department of Neurology, Aarhus University Hospital and Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Birklein
- University Medical Centre Mainz, Department of Neurology, Mainz, Germany
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16
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Lagrand TJ, Almuwais A, Lehn AC. ‘Tricked’ sensory trick: a geste antagoniste in functional dystonia. BMJ Case Rep 2022; 15:15/7/e248779. [PMID: 35793856 PMCID: PMC9260767 DOI: 10.1136/bcr-2022-248779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A sensory trick, or geste antagoniste, is a manoeuvre used by patients with dystonia to ameliorate their dystonic movements or posturing. Typically, a sensory trick is a confirmatory clue indicating an organic nature of the dystonia. In this report, we present an extremely rare case of a sensory trick in a patient with functional dystonia.
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Affiliation(s)
- Tjerk J Lagrand
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ahmed Almuwais
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Alexander C Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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17
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Moutran-Barroso H, Kreinter-Rosembaun H, Zafra-Sierra MP, Ramírez-Arquez E, Martínez-Rubio C. Multiple Cranial Neuropathy: Clinical Findings in a Case Series of 142 Patients. Mult Scler Relat Disord 2022; 65:103997. [DOI: 10.1016/j.msard.2022.103997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/05/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
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18
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Butler M, Seynaeve M, Bradley-Westguard A, Bao J, Crawshaw A, Pick S, Edwards M, Nicholson T, Rucker J. Views on Using Psychoactive Substances to Self-Manage Functional Neurological Disorder: Online Patient Survey Results. J Neuropsychiatry Clin Neurosci 2022; 35:77-85. [PMID: 35578800 DOI: 10.1176/appi.neuropsych.21080213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: Functional neurological disorder (FND) causes a high burden of disability and distress. Although it is a common disorder, there is a pressing need for improved access to evidence-based treatments. With difficulties in finding effective treatment, some people with FND may seek alternative means of symptom relief, such as legal and illicit psychoactive substances, although the prevalence and nature of such self-management strategies are currently unclear. Additionally, psychoactive substances may represent novel treatment research opportunities, particularly for those with suboptimal improvement. The investigators examined the use of self-management techniques, as well as perspectives on novel therapies, in this patient population. Methods: An online survey was created to assess self-management strategies and views on novel treatments for FND, including psychedelic therapy. The survey was accessible for 1 month, and respondents were recruited internationally through social media and patient groups. A total of 1,048 respondents from 16 countries completed the survey. Results: Almost half (46%) of 980 respondents reported having tried legal psychoactive substances for the management of their FND symptoms and, on average, nicotine, alcohol, and cannabidiol were reported as modestly effective. Additionally, 15% of respondents reported having used illicit substances, mostly cannabis, to manage FND, with the majority reporting moderate effectiveness and experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents (46%) reported that they would be willing to try medically supervised psychedelic therapy (with 19% of respondents ambivalent) if it were found to be safe and effective. Conclusions: Many people with FND seek alternative means of symptom management outside usual medical care, including legal and illicit psychoactive substances. Further research exploring novel treatment options, such as psychedelics, in FND may be warranted.
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Affiliation(s)
- Matthew Butler
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Mathieu Seynaeve
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Abigail Bradley-Westguard
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Jianan Bao
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Ania Crawshaw
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Susannah Pick
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Mark Edwards
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - Timothy Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
| | - James Rucker
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pick, Nicholson); Institute of Psychiatry, Psychology and Neuroscience, King's College London (Seynaeve, Bao, Rucker); independent patient researcher (Bradley-Westguard); National Health Service Foundation Trust (Crawshaw) and Department of Neurology (Edwards), St. George's University Hospitals, London; Institute of Molecular and Clinical Sciences, St. George's University of London (Crawshaw, Edwards); and Sobell Department of Motor Neurosciences and Movement Disorders, Queen Square Institute of Neurology, University College London (Edwards)
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Fox S. Behavioral Ethics Ecologies of Human-Artificial Intelligence Systems. Behav Sci (Basel) 2022; 12:bs12040103. [PMID: 35447675 PMCID: PMC9029794 DOI: 10.3390/bs12040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Historically, evolution of behaviors often took place in environments that changed little over millennia. By contrast, today, rapid changes to behaviors and environments come from the introduction of artificial intelligence (AI) and the infrastructures that facilitate its application. Behavioral ethics is concerned with how interactions between individuals and their environments can lead people to questionable decisions and dubious actions. For example, interactions between an individual’s self-regulatory resource depletion and organizational pressure to take non-ethical actions. In this paper, four fundamental questions of behavioral ecology are applied to analyze human behavioral ethics in human–AI systems. These four questions are concerned with assessing the function of behavioral traits, how behavioral traits evolve in populations, what are the mechanisms of behavioral traits, and how they can differ among different individuals. These four fundamental behavioral ecology questions are applied in analysis of human behavioral ethics in human–AI systems. This is achieved through reference to vehicle navigation systems and healthcare diagnostic systems, which are enabled by AI. Overall, the paper provides two main contributions. First, behavioral ecology analysis of behavioral ethics. Second, application of behavioral ecology questions to identify opportunities and challenges for ethical human–AI systems.
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Affiliation(s)
- Stephen Fox
- VTT Technical Research Centre of Finland, FI-02150 Espoo, Finland
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20
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Kanaan RA. Functional neurological disorder and other unexplained syndromes. Lancet Neurol 2022; 21:499-500. [DOI: 10.1016/s1474-4422(22)00095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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21
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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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22
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Santiago V. Painful Truth: The Need to Re-Center Chronic Pain on the Functional Role of Pain. J Pain Res 2022; 15:497-512. [PMID: 35210849 PMCID: PMC8859280 DOI: 10.2147/jpr.s347780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
Pain is undesirable, whether it is a symptom of mild or severe illness or instead indicates disorder in the nervous system’s ability to perceive and process sensory information. Nonetheless, pain is part of the body’s ability to defend itself and promote its own survival—this is its fundamental evolutionary function. This normal expression of pain is not limited to what is considered useful because it alerts us to the initiation of illness. It also applies to pain that continues when illness or noxious stimuli persist. However, the parameters of what is here termed functional pain are not fully understood and are seldom explicitly the focus of research. This paper posits that failure to appreciate the functional role of pain in research has had significant unintended consequences and may be contributing to inconsistent research findings. To that end, the paper describes the misclassification issue at the core of chronic pain research—whether a given pain reflects functional or pathological processes—and discusses research areas where reconsidering the functional role of pain may lead to advancements.
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Affiliation(s)
- Vivian Santiago
- Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
- Correspondence: Vivian Santiago, Email
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23
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Barak S, Silberg T, Gerner M, Eisenstein E, Bardach CA, Yissar T, Landa J. Functional neurological symptom disorder: Preliminary findings of factors associated with walking ability post integrative pediatric rehabilitation. J Pediatr Rehabil Med 2022; 15:433-446. [PMID: 36031917 DOI: 10.3233/prm-210107] [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] Open
Abstract
PURPOSE The current study's aims were to (1) examine long-distance walking ability (6-minute walking test [6MWT]) and walking hemodynamic responses (i.e., heart rate) among youth with functional neurological symptom disorder (FNSD) before and after an integrative pediatric rehabilitation (IPR) program; and (2) explore factors predicting improvement in walking ability. METHODS Thirty-one youth with FNSD participating in an IPR program were recruited. The IPR program was activated biweekly in an ambulatory format. Study measures included the 6MWT, hemodynamic characteristics, rate of perceived exertion (RPE), pain-intensity perception, and Child's Somatization Inventory-24 (CSI-24). All measures were conducted upon admission to the IPR and discharge. RESULTS Findings indicated a significant increase in 6MWT distance, as well as decreases in heart rate, RPE, and pain-intensity perception from admission to discharge. At admission, CSI-24 and pain intensity predicted 6MWT distance (adjusted R2 = 0.68). Pain intensity predicted discharge 6MWT distance (adjusted R2 = 0.18). Initial 6MWT predicted changes in 6MWT distance from admission to discharge (adjusted R2 = 0.33). CONCLUSION Using an integrative rehabilitation approach increases walking distance and decreases pain-related symptoms in youth with FNSD, emphasizing the need for collaboration between physical therapists and pediatric psychologists. Moreover, changes in walking ability may increase participation and thus should be the focus of IPR.
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Affiliation(s)
- Sharon Barak
- Department of Nursing, College of Health Sciences, Ariel University, Ariel, Israel.,Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Tamar Silberg
- Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel.,Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Maya Gerner
- Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Etzyona Eisenstein
- Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Chen Arzoni Bardach
- Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Tamar Yissar
- Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Jana Landa
- Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhan J, Ai Y, Zhan L, Pan R, Wang Y, Dong C, Wang Q, Chen H, Lu L, Li M. Effect of abdominal acupuncture combined with routine rehabilitation training on shoulder-hand syndrome after stroke: A randomized controlled trial. Integr Med Res 2021; 11:100805. [PMID: 34877254 PMCID: PMC8627967 DOI: 10.1016/j.imr.2021.100805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Post-stroke shoulder-hand syndrome (SHS) is a common complication after stroke. To date, there is still a lack of consistently effective and good patient compliance methods for SHS. Methods Fifty patients with SHS were included in this study. Patients in the control group received rehabilitation training (RT) for 2 weeks; each session was 30 min, 1 time per day, and 5 times per week. Patients in the observation group were additionally given Bo's abdominal acupuncture (BAA) with the same frequency and duration. The primary outcome was the change value in the VAS score from baseline to 2 weeks. The secondary outcomes measured were motor function of the upper limb, shoulder range of motion, ADL, and swelling volume. Results Compared with baseline values, the mean VAS score at 2 weeks was reduced by 3.68 in the observation group and by 1.92 in the control group, with a difference between the two groups of 1.84 (P < 0.001); the mean MBI score at 2 weeks increased by 10.44 in the observation group and by 4.79 in the control group, with a difference between the two groups of 5.84 (P = 0.032); the mean swelling volume at 2 weeks decreased by 9.64 in the observation group and by 3.29 in the control group, with a difference between the two groups of 6.48 (P < 0.001). BAA-related adverse events were not found during the study. Conclusions BAA combined with RT is superior to RT alone in improving shoulder pain, swelling, and ADL in post-stroke SHS patients. Trial Registration ChiCTR2100045464 (www.chictr.org.cn).
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Affiliation(s)
- Jie Zhan
- Postdoctoral Research Station, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yirang Ai
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lechang Zhan
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Ruihuan Pan
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yiqiao Wang
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cong Dong
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Qiuchun Wang
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hongxia Chen
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Liming Lu
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mei Li
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Perez DL, Aybek S, Popkirov S, Kozlowska K, Stephen CD, Anderson J, Shura R, Ducharme S, Carson A, Hallett M, Nicholson TR, Stone J, LaFrance WC, Voon V. A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. J Neuropsychiatry Clin Neurosci 2021; 33:14-26. [PMID: 32778007 DOI: 10.1176/appi.neuropsych.19120357] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Selma Aybek
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Stoyan Popkirov
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Kasia Kozlowska
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Christopher D Stephen
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jordan Anderson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Robert Shura
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Simon Ducharme
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Alan Carson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Mark Hallett
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Timothy R Nicholson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jon Stone
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Valerie Voon
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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Groenveld TD, Boersma EZ, Blokhuis TJ, Bloemers FW, Frölke JPM. Decreasing incidence of complex regional pain syndrome in the Netherlands: a retrospective multicenter study. Br J Pain 2021; 16:214-222. [PMID: 35419200 PMCID: PMC8998521 DOI: 10.1177/20494637211041935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Complex regional pain syndrome type I (CRPS) is a symptom-based diagnosis of which the reported incidence varies widely. In daily practice, there appears to be a decrease in incidence of CRPS after a distal radius fracture and in general. Questions/purposes: The aim of this study was to assess the trend in the incidence of CRPS after a distal radius fracture and in general in the Netherlands from 2014 to 2018. Methods: The incidence of CRPS after a distal radius fracture was calculated by dividing the number of confirmed cases of CRPS after distal radius fracture by the total number of patients diagnosed with a distal radius fracture. Medical records of these patients were reviewed. Hospital-based data were used to establish a trend in incidence of CRPS in general. A Dutch national database was used to measure the trend in the incidence of CRPS in the Netherlands by calculating annual incidence rates: the number of new CRPS cases, collected from the national database, divided by the Dutch mid-year population. Results: The incidence of CRPS after distal radius fracture over the whole study period was 0.36%. Hospital data showed an absolute decrease in CRPS cases from 520 in 2014 to 223 in 2018. National data confirmed this with a decrease in annual incidence from 23.2 (95% CI: 22.5–23.9) per 100,000 person years in 2014 to 16.1 (95% CI: 15.5–16.7) per 100,000 person years in 2018. Conclusion: A decreasing trend of CRPS is shown in this study. We hypothesize this to be the result of the changing approach towards CRPS and fracture management, with more focus on prevention and the psychological aspects of disproportionate posttraumatic pain. Level of Evidence: level 3 (retrospective cohort study).
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Affiliation(s)
- Tjitske D Groenveld
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emily Z Boersma
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Taco J Blokhuis
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank W Bloemers
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Paul M Frölke
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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27
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Defina S, Niedernhuber M, Shenker N, Brown CA, Bekinschtein TA. Attentional modulation of neural dynamics in tactile perception of complex regional pain syndrome patients. Eur J Neurosci 2021; 54:5601-5619. [PMID: 34250660 DOI: 10.1111/ejn.15387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 01/10/2023]
Abstract
Body perceptual disturbances are an increasingly acknowledged set of symptoms and possible clinical markers of complex regional pain syndrome (CRPS), but the neurophysiological and neurocognitive changes that underlie them are still far from being clear. We adopted a multivariate and neurodynamical approach to the analysis of EEG modulations evoked by touch to highlight differences between patients and healthy controls, between affected and unaffected side of the body, and between "passive" (i.e., no task demands and equiprobable digit stimulation) and "active" tactile processing (i.e., where a digit discrimination task was administered and spatial probability manipulated). When correct identifications are considered, an early reduction in cortical decodability (28-56 ms) distinguishes CRPS patients from healthy volunteers. However, when error trials are included in the classifier's training, there is an unexpected increased decodability in the CRPS group compared with healthy volunteers (280-320 ms). These group differences in neural processing seemed to be driven by the affected rather than the unaffected side. We corroborated these findings with several exploratory analyses of neural representation dynamics and behavioural modelling, highlighting the need for single participant analyses. Although several limitations impacted the robustness and generalizability of these comparisons, the proposed analytical approach yielded promising insights (as well as possible biomarkers based on neural dynamics) into the relatively unexplored alterations of tactile decision-making and attentional control mechanisms in chronic CRPS.
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Affiliation(s)
- Serena Defina
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Maria Niedernhuber
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Nicholas Shenker
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher A Brown
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Tristan A Bekinschtein
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge, UK
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28
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Butler M, Shipston-Sharman O, Seynaeve M, Bao J, Pick S, Bradley-Westguard A, Ilola E, Mildon B, Golder D, Rucker J, Stone J, Nicholson T. International online survey of 1048 individuals with functional neurological disorder. Eur J Neurol 2021; 28:3591-3602. [PMID: 34245646 DOI: 10.1111/ene.15018] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Functional neurological disorder (FND) is common, and symptoms can be severe. There have been no international large-scale studies of patient experiences of FND. METHODS A patient questionnaire was created to assess FND patient characteristics, symptom comorbidities and illness perceptions. Respondents were recruited internationally through an open access questionnaire via social media and patient groups over a month-long period. RESULTS In total, 1048 respondents from 16 countries participated. Mean age was 42 years (86% female). Median FND symptom duration was 5 years, and median time from first symptom to diagnosis was 2 years. Mean number of current symptoms (core FND and associated) was 9.9. Many respondents had associated symptoms, for example fatigue (93%), memory difficulties (80%) and headache (70%). Self-reported psychiatric comorbidities were relatively common (depression, 43%; anxiety, 51%; panic, 20%; and post-traumatic stress disorder, 22%). Most respondents reported that FND had multiple causes, including physical and psychological. CONCLUSIONS This large survey adds further evidence that people with FND typically have high levels of multiple symptom comorbidity with resultant distress. It also supports the notion that associated physical symptoms are of particular clinical significance in FND patients. Dualistic ideas of FND were not supported by respondents, who generally preferred to conceptualize the disorder as one at the interface of mind and brain. The need for a broad approach to this poorly served patient group is highlighted. Potential selection and response biases due to distribution of the survey online, mostly via FND patient groups, are a key limitation.
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Affiliation(s)
- Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Mathieu Seynaeve
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jianan Bao
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susannah Pick
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eveliina Ilola
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - James Rucker
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Timothy Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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29
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Phillips W. Functional neurological disorders in personal injury. BMJ Neurol Open 2021; 3:e000100. [PMID: 34189462 PMCID: PMC8204167 DOI: 10.1136/bmjno-2020-000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Wendy Phillips
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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30
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Lee D, Choi SH, Noh E, Lee WJ, Jang JH, Moon JY, Kang DH. Impaired Performance in Mental Rotation of Hands and Feet and Its Association with Social Cognition in Patients with Complex Regional Pain Syndrome. PAIN MEDICINE 2021; 22:1411-1419. [PMID: 33749758 PMCID: PMC8185560 DOI: 10.1093/pm/pnaa482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives. So far, dysfunction in mental rotation has been assessed in relation to the left- or right-sided CRPS. Here we examined mental rotation in patients with upper or lower limb CRPS. Considering the potential role of socio-emotional functioning on the perception of body image, we further investigated the association between performance on mental rotation and socio-emotional characteristics. Methods. We examined the performance of 36 patients with upper or lower limb CRPS on the limb laterality recognition. Accuracy and response times for pictures of hands and feet at 4 rotation angles were evaluated. Socio-emotional functioning was measured by the Interpersonal Reactivity Scale and the Toronto Alexithymia Scale. Results. Patients with upper limb pain showed longer RTs to recognize the laterality of hands than feet (P = 0.002), whereas patients with lower limb pain showed longer RTs for feet than hands (P = 0.039). Exploratory correlation analyses revealed that RTs for feet were negatively correlated with the levels of empathic ability to take another’s perspective (P = 0.006) and positively correlated with the level of emotional difficulty in identifying feelings (P = 0.006). Conclusions. This study is the first to report selectively impaired mental rotation of hands vs feet in patients with upper or lower limb CRPS. The findings suggest that impaired mental rotation derives from relative deficits in the representation of the affected limb. Correlations between impaired mental rotation and socio-emotional inability indicate that an altered body schema may be closely associated with impaired social cognitive aspects in CRPS patients.
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Affiliation(s)
- Dasom Lee
- Emotional Information and Communication Technology Industrial Association, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry and Institute of Human Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunchung Noh
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Republic of Korea
| | - Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Emotional Information and Communication Technology Industrial Association, Seoul, Republic of Korea
- Correspondence to: Do-Hyung Kang, MD, PhD, Emotional Information and Communication Technology Industrial Association, 06168, Samseong-ro 508, Gangnam-gu, Seoul, Republic of Korea. Tel: +82-42-860-1648; Fax: +82-50-7083-6323; E-mail:
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31
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Navaratnam D, Harm K, Fenton A, Bullock-Saxton J, Griffin A, Lehn A. Implicit motor imagery using laterality recognition in functional movement disorders. J Clin Neurosci 2021; 89:139-143. [PMID: 34119257 DOI: 10.1016/j.jocn.2021.04.022] [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: 09/09/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Functional movement disorder (FMD) presents as disabling motor symptoms that cannot be explained by organic processes. Despite the lack of lesion or known central nervous system dysfunction, distortion in sensorimotor processing in movement generation and execution is often observed. A person's capacity to judge laterality of a body part requires processing of sensorimotor information. This prospective observational study compared reaction time (RT) and accuracy (ACC) of hand laterality recognition between 30 people diagnosed with FMD and 30 age-matched healthy control participants. The association of RT and ACC with severity of FMD as measured by the Simplified Functional Movement Disorders Rating Scale (SFMDRS) was also explored. RT was on average 0.6 s slower (95% CI 0.4 - 0.8 s, p < 0.001) in patients with FMD (mean 2.2 s, standard deviation (SD) 0.5) than controls (mean 1.7 s, SD 0.3). ACC was on average 8.9% lower (95% CI -15.7 - -2.2, p = 0.01) in patients with FMD (mean 79.6%, SD 16.6) than controls (mean 88.5%, SD 8.1). When adjusted for SFMDRS using robust regression, RT was 0.3 s slower (95% CI 0.01 - 0.5, p = 0.04) in cases than in controls, but ACC was no longer different between groups. There was a moderate negative correlation between RT and ACC in FMD patients (ρ -0.58, p < 0.001 but not in controls (ρ -0.26, p = 0.17). People with FMD had significantly slower RT and lower ACC compared to the control group. These results provide new insights into underlying sensorimotor processing deficits in those with FMD.
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Affiliation(s)
- Dharsha Navaratnam
- Active Rehabilitation Physiotherapy, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia.
| | - Karl Harm
- Active Rehabilitation Physiotherapy, Brisbane, Australia
| | - Alison Fenton
- Active Rehabilitation Physiotherapy, Brisbane, Australia
| | | | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alexander Lehn
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Mater Research, Brisbane, Australia
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32
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Popkirov S, Enax-Krumova EK, Mainka T, Hoheisel M, Hausteiner-Wiehle C. Functional pain disorders - more than nociplastic pain. NeuroRehabilitation 2021; 47:343-353. [PMID: 32986624 DOI: 10.3233/nre-208007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nociplastic pain has been recently introduced as a third mechanistic descriptor of pain arising primarily from alterations of neural processing, in contrast to pain due to tissue damage leading to nociceptor activation (nociceptive) or due to lesion or disease of the somatosensory nervous system (neuropathic). It is characterized by hyperalgesia and allodynia, inconsistency and reversibility, as well as dynamic cross-system interactions with biological and psychobehavioral factors. Along with this renewed understanding, functional pain disorders, also classified as chronic primary pain, are being reframed as biopsychosocial conditions that benefit from multimodal treatment. OBJECTIVE To summarize the current understanding of nociplastic pain and functional pain disorders, with a focus on conditions that are common in neurology practice. METHODS This was a narrative literature review. RESULTS Chronic back pain, fibromyalgia syndrome and complex regional pain syndrome are best understood within a biopsychosocial framework of pain perception that considers structural factors (predispositions and sequelae) and psychobehavioral mechanisms. Although pain is often the primary complaint, it should not be the only focus of treatment, as accompanying symptoms such as sleep or mood problems can significantly impact quality of life and offer useful leverage points for multimodal treatment. Analgesic pharmacotherapy is rarely helpful on its own, and should always be imbedded in a multidisciplinary setting.
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | | | - Constanze Hausteiner-Wiehle
- Neurocenter, BG Trauma Center Murnau, Murnau, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
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33
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Frucht L, Perez DL, Callahan J, MacLean J, Song PC, Sharma N, Stephen CD. Functional Dystonia: Differentiation From Primary Dystonia and Multidisciplinary Treatments. Front Neurol 2021; 11:605262. [PMID: 33613415 PMCID: PMC7894256 DOI: 10.3389/fneur.2020.605262] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
Dystonia is a common movement disorder, involving sustained muscle contractions, often resulting in twisting and repetitive movements and abnormal postures. Dystonia may be primary, as the sole feature (isolated) or in combination with other movement disorders (combined dystonia), or as one feature of another neurological process (secondary dystonia). The current hypothesis is that dystonia is a disorder of distributed brain networks, including the basal ganglia, cerebellum, thalamus and the cortex resulting in abnormal neural motor programs. In comparison, functional dystonia (FD) may resemble other forms of dystonia (OD) but has a different pathophysiology, as a subtype of functional movement disorders (FMD). FD is the second most common FMD and amongst the most diagnostically challenging FMD subtypes. Therefore, distinguishing between FD and OD is important, as the management of these disorders is distinct. There are also different pathophysiological underpinnings in FD, with for example evidence of involvement of the right temporoparietal junction in functional movement disorders that is believed to serve as a general comparator of internal predictions/motor intentions with actual motor events resulting in disturbances in self-agency. In this article, we present a comprehensive review across the spectrum of FD, including oromandibular and vocal forms and discuss the history, clinical clues, evidence for adjunctive "laboratory-based" testing, pathophysiological research and prognosis data. We also provide the approach used at the Massachusetts General Hospital Dystonia Center toward the diagnosis, management and treatment of FD. A multidisciplinary approach, including neurology, psychiatry, physical, occupational therapy and speech therapy, and cognitive behavioral psychotherapy approaches are frequently required; pharmacological approaches, including possible targeted use of botulinum toxin injections and inpatient programs are considerations in some patients. Early diagnosis and treatment may help prevent unnecessary investigations and procedures, while facilitating the appropriate management of these highly complex patients, which may help to mitigate frequently poor clinical outcomes.
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Affiliation(s)
- Lucy Frucht
- Faculty of Arts and Sciences, Harvard University, Boston, MA, United States
| | - David L. Perez
- Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Functional Neurological Disorder Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Neuropsychiatry Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Janet Callahan
- MGH Institute of Healthcare Professionals, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Julie MacLean
- Occupational Therapy Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Phillip C. Song
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
| | - Nutan Sharma
- Functional Neurological Disorder Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Dystonia Center and Movement Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Christopher D. Stephen
- Functional Neurological Disorder Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Dystonia Center and Movement Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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34
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Bennett K, Diamond C, Hoeritzauer I, Gardiner P, McWhirter L, Carson A, Stone J. A practical review of functional neurological disorder (FND) for the general physician. Clin Med (Lond) 2021; 21:28-36. [PMID: 33479065 PMCID: PMC7850207 DOI: 10.7861/clinmed.2020-0987] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.
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Affiliation(s)
| | | | | | | | | | - Alan Carson
- Centre for Clinical Brain Services, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Services, Edinburgh, UK
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35
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Kempert H. Clinical overlap of functional neurologic symptom disorder and complex regional pain syndrome in pediatrics: A case report. J Pediatr Rehabil Med 2021; 14:113-120. [PMID: 33720859 DOI: 10.3233/prm-200700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This case study documents a 13-year-old female who presented to our intensive inpatient chronic pain rehabilitation program with complex regional pain syndrome (CRPS) of her left leg, which was significantly interfering with her normal daily functioning. She participated in a full day of traditional interdisciplinary therapies, including physical and occupational therapy for 3 hours daily. As assistive equipment was altered or weaned her physical mobility, balance, and tremors worsened and/or increased. As she began advancing her legs more independently (versus requiring physical assist), she demonstrated more variable functional strength and stability, inconsistent balance reactions, and a more unsteady gait pattern. The team was treating her according to her incoming CRPS diagnosis; however, as treatment progressed, her physical and psychological presentation seemed more aligned with diagnostic criteria of functional neurologic symptom disorder (FND). Staff then treated according to the FND diagnosis resulting in successful long-term outcomes. The clinical impact from this case study includes highlighting the commonalities between CPRS and FND clinically, discussing treatment suggestions depending on the diagnosis, and emphasizing key components of family/patient education.
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36
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Duong HP, Konzelmann M, Vuistiner P, Burrus C, Léger B, Stiefel F, Luthi F. Psychiatric Comorbidity and Complex Regional Pain Syndrome Through the Lens of the Biopsychosocial Model: A Comparative Study. J Pain Res 2020; 13:3235-3245. [PMID: 33311997 PMCID: PMC7725070 DOI: 10.2147/jpr.s278614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/31/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To compare the prevalence of psychiatric comorbidity between patients with complex regional pain syndrome (CRPS) of the hand and non-CRPS patients and to assess the association between biopsychosocial (BPS) complexity profiles and psychiatric comorbidity in a comparative study. PATIENTS AND METHODS We included a total of 103 patients with CRPS of the hand and 290 patients with chronic hand impairments but without CRPS. Psychiatric comorbidities were diagnosed by a psychiatrist, and BPS complexity was measured by means of the INTERMED. The odds ratios (OR) of having psychiatric comorbidities according to BPS complexity were calculated with multiple logistic regression (adjusted for age, sex, and pain). RESULTS Prevalence of psychiatric comorbidity was 29% in CRPS patients, which was not significantly higher than in non-CRPS patients (21%, relative risk=1.38, 95% CI: 0.95 to 2.01 p=0.10). The median total scores of the INTERMED were the same in both groups (23 points). INTERMED total scores (0-60 points) were related to an increased risk of having psychiatric comorbidity in CRPS patients (OR=1.46; 95% CI: 1.23-1.73) and in non-CRPS patients (OR=1.21; 95% CI: 1.13-1.30). The four INTERMED subscales (biological, psychological, social, and health care) were correlated with a higher risk of having psychiatric comorbidity in both groups. The differences in the OR of having psychiatric comorbidity in relation to INTERMED total and subscale scores were not statistically different between the two groups. CONCLUSION The total scores, as well as all four dimensions of BPS complexity measured by the INTERMED, were associated with psychiatric comorbidity, with comparable magnitudes of association between the CRPS and non-CRPS groups. The INTERMED was useful in screening for psychological vulnerability in the two groups.
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Affiliation(s)
- Hong Phuoc Duong
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Michel Konzelmann
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Philippe Vuistiner
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Cyrille Burrus
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Bertrand Léger
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland
| | - François Luthi
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Rheumatology and Rehabilitation, Hôpital Orthopédique, University and University Hospital of Lausanne, Lausanne, Switzerland
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37
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Pun P, Frater J, Broughton M, Dob R, Lehn A. Psychological Profiles and Clinical Clusters of Patients Diagnosed With Functional Neurological Disorder. Front Neurol 2020; 11:580267. [PMID: 33178122 PMCID: PMC7593396 DOI: 10.3389/fneur.2020.580267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Our understanding about underlying mechanisms leading to Functional Neurological Disorders (FND) has changed in recent years. While in the past these disorders were presumed to be solely due to psychological issues we know now that their development is dependent on complex interactions between biological, psychological and social factors. We present an analysis of clinical presentations and psychological profiles of patients who were seen in our FND outpatient clinic over 3 years. We aim to review the prevalence of common symptoms in the patients seen within our clinic, and to identify any common psychological or psychiatric profiles that differentiated these symptom groups. This may help to elucidate underlying mechanisms leading to the development of functional symptoms and identify the predisposing, triggering and perpetuation factors.
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Affiliation(s)
- Paul Pun
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, QLD, Australia
| | - Julanne Frater
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, QLD, Australia
| | - Megan Broughton
- Brisbane Clinical Neuroscience Centre, Brisbane, QLD, Australia
| | - Rian Dob
- Map and Mind Psychology, Brisbane, QLD, Australia
| | - Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,The University of Queensland Princess Alexandra Hospital Clinical School, Woolloongabba, QLD, Australia
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38
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Stone J, Warlow C, Deary I, Sharpe M. Predisposing Risk Factors for Functional Limb Weakness: A Case-Control Study. J Neuropsychiatry Clin Neurosci 2020; 32:50-57. [PMID: 31466514 DOI: 10.1176/appi.neuropsych.19050109] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Functional limb weakness is a common symptom of functional neurological disorder. Few controlled studies have examined possible predisposing factors to determine their specificity for this symptom. METHODS In this prospective case-control study, patients with functional limb weakness (<2 years duration, N=107) were compared with a control group (comprising patients with weakness attributable to neurological disease, N=46, and healthy individuals, N=39). A structured clinical interview and questionnaires assessed potential predisposing factors, including family structure and childhood abuse and neglect (Childhood Trauma Questionnaire [CTQ]), personality traits (NEO Five-Factor Inventory), medical and surgical comorbidity, and exposure to a symptom model. RESULTS The patients with functional limb weakness and the control subjects were similar in gender and age. Self-reported childhood sexual abuse (15% versus 5%, p<0.01), and physical abuse (18% versus 7%, p<0.01; CTQ "moderate or above") were more common in the functional limb weakness group, although the absolute frequency was lower than anticipated. In the functional limb weakness group, there were modest differences in two personality traits, compared with the control group: higher neuroticism (p=0.02) and lower openness (p=0.01). Medical comorbidity, including appendectomy (33% versus 5%), irritable bowel syndrome (36% versus 18%), and chronic back pain (40% versus 16%), was more frequent in the functional limb weakness group. There were no differences in birth order or exposure to a symptom model. CONCLUSIONS Medical and surgical comorbidity and adverse childhood experience are risk factors, but not essential, for the development of functional limb weakness. However, evidence for personality traits or exposure to a symptom model is less robust.
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Affiliation(s)
- Jon Stone
- The Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom (Stone, Warlow); the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (Deary); the Department of Psychological Medicine Research, University of Oxford, United Kingdom (Sharpe)
| | - Charles Warlow
- The Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom (Stone, Warlow); the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (Deary); the Department of Psychological Medicine Research, University of Oxford, United Kingdom (Sharpe)
| | - Ian Deary
- The Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom (Stone, Warlow); the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (Deary); the Department of Psychological Medicine Research, University of Oxford, United Kingdom (Sharpe)
| | - Michael Sharpe
- The Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom (Stone, Warlow); the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom (Deary); the Department of Psychological Medicine Research, University of Oxford, United Kingdom (Sharpe)
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Bullock K, Won AS, Bailenson J, Friedman R. Virtual Reality-Delivered Mirror Visual Feedback and Exposure Therapy for FND: A Midpoint Report of a Randomized Controlled Feasibility Study. J Neuropsychiatry Clin Neurosci 2020; 32:90-94. [PMID: 31687867 DOI: 10.1176/appi.neuropsych.19030071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim was to provide preliminary feasibility, safety, and efficacy data for a personalized virtual reality-delivered mirror visual feedback (VR-MVF) and exposure therapy (VR-ET) intervention for functional neurological disorder (FND). METHODS Midpoint results of a single-blind, randomized controlled pilot are presented. Fourteen adults were randomly assigned to eight weekly 30-minute VR sessions-seven in the treatment arm and seven in the control arm. The treatment arm consisted of an immersive avatar-embodied VR-MVF treatment, plus optional weekly VR-ET starting at session 4 if participants had identifiable FND triggers. The control arm received equally immersive nonembodied sessions involving exploration of a virtual interactive space. Feasibility was measured by acceptability of randomization, completion rates, side effects, adverse events, and integrity of blinding procedures. Exploratory primary and secondary outcome measures were weekly symptom frequency and the Oxford Handicap Scale, respectively. RESULTS Two early dropouts occurred in the treatment arm, resulting in an 86% completion rate (N=12/14). No side effects or adverse events were reported. Blind assessment at study end indicated that two of the seven treatment arm and three of the seven control arm participants incorrectly guessed their assignment. Changes in mean symptom frequency and disability were reported, but data will not be statistically analyzed until study end. CONCLUSIONS This study is the first to report on MVF and VR for treatment of FND. Results generated thus far support feasibility and justify continuation of the study and further investigation into the efficacy of VR interventions for FND.
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Affiliation(s)
- Kim Bullock
- The Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif. (Bullock); the Department of Communication, Cornell University, Ithaca, N.Y. (Won); the Department of Communication, Stanford University, Stanford, Calif. (Bailenson); and Palo Alto University, Palo Alto, Calif. (Friedman)
| | - Andrea Stevenson Won
- The Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif. (Bullock); the Department of Communication, Cornell University, Ithaca, N.Y. (Won); the Department of Communication, Stanford University, Stanford, Calif. (Bailenson); and Palo Alto University, Palo Alto, Calif. (Friedman)
| | - Jeremy Bailenson
- The Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif. (Bullock); the Department of Communication, Cornell University, Ithaca, N.Y. (Won); the Department of Communication, Stanford University, Stanford, Calif. (Bailenson); and Palo Alto University, Palo Alto, Calif. (Friedman)
| | - Raquel Friedman
- The Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif. (Bullock); the Department of Communication, Cornell University, Ithaca, N.Y. (Won); the Department of Communication, Stanford University, Stanford, Calif. (Bailenson); and Palo Alto University, Palo Alto, Calif. (Friedman)
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Nicholson C, Edwards MJ, Carson AJ, Gardiner P, Golder D, Hayward K, Humblestone S, Jinadu H, Lumsden C, MacLean J, Main L, Macgregor L, Nielsen G, Oakley L, Price J, Ranford J, Ranu J, Sum E, Stone J. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry 2020; 91:1037-1045. [PMID: 32732388 DOI: 10.1136/jnnp-2019-322281] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND People with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention. METHODS The recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved. RESULTS We recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document. CONCLUSIONS Occupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.
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Affiliation(s)
- Clare Nicholson
- Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Mark J Edwards
- Neurosciences Research Centre, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Paula Gardiner
- Centre for Clinical Brain Services, University of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - Kate Hayward
- Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Susan Humblestone
- Department of Neuropsychiatry, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - Helen Jinadu
- The Lishman Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Carrie Lumsden
- Community Rehabilitation and Brain Injury Service, West Lothian Community Health and Care Partnership, Livingston, West Lothian, United Kingdom
| | - Julie MacLean
- Occupational Therapy Department, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Lynne Main
- Neurological rehabilitation out-patient services, Astley Ainslie Hospital, NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - Lindsey Macgregor
- Falkirk Community Mental Health Service for Adults, NHS Forth Valley, Falkirk, Scotland, United Kingdom
| | - Glenn Nielsen
- Neurosciences Research Centre, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Louise Oakley
- National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Jason Price
- Department of Neuropsychology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Jessica Ranford
- Occupational Therapy Department, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Jasbir Ranu
- Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Ed Sum
- Integrated Community Neurology Team, East Coast Community Healthcare CIC, Lowestoft, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
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Maggio J, Alluri PR, Paredes-Echeverri S, Larson AG, Sojka P, Price BH, Aybek S, Perez DL. Briquet syndrome revisited: implications for functional neurological disorder. Brain Commun 2020; 2:fcaa156. [PMID: 33426523 PMCID: PMC7784044 DOI: 10.1093/braincomms/fcaa156] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013, the functional neurological (symptom) disorder diagnostic criteria underwent transformative changes. These included an emphasis on ‘rule-in’ physical examination signs/semiological features guiding diagnosis and the removal of a required proximal psychological stressor to be linked to symptoms. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder, somatoform pain disorder and undifferentiated somatoform disorder conditions were eliminated and collapsed into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition somatic symptom disorder diagnosis. With somatic symptom disorder, emphasis was placed on a cognitive-behavioural (psychological) formulation as the basis for diagnosis in individuals reporting distressing bodily symptoms such as pain and/or fatigue; the need for bodily symptoms to be ‘medically unexplained’ was removed, and the overall utility of this diagnostic criteria remains debated. A consequence of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition restructuring is that the diagnosis of somatization disorder that encompassed individuals with functional neurological (sensorimotor) symptoms and prominent other bodily symptoms, including pain, was eliminated. This change negatively impacts clinical and research efforts because many patients with functional neurological disorder experience pain, supporting that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition would benefit from an integrated diagnosis at this intersection. We seek to revisit this with modifications, particularly since pain (and a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder comorbidity, more specifically) is associated with poor clinical prognosis in functional neurological disorder. As a first step, we systematically reviewed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder literature to detail epidemiologic, healthcare utilization, demographic, diagnostic, medical and psychiatric comorbidity, psychosocial, neurobiological and treatment data. Thereafter, we propose a preliminary revision to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition allowing for the specifier functional neurological disorder ‘with prominent pain’. To meet this criterion, core functional neurological symptoms (e.g. limb weakness, gait difficulties, seizures, non-dermatomal sensory loss and/or blindness) would have ‘rule-in’ signs and pain (>6 months) impairing social and/or occupational functioning would also be present. Two optional secondary specifiers assist in characterizing individuals with cognitive-behavioural (psychological) features recognized to amplify or perpetuate pain and documenting if there is a pain-related comorbidity. The specifier of ‘with prominent pain’ is etiologically neutral, while secondary specifiers provide additional clarification. We advocate for a similar approach to contextualize fatigue and mixed somatic symptoms in functional neurological disorder. While this preliminary proposal requires prospective data and additional discussion, these revisions offer the potential benefit to readily identify important functional neurological disorder subgroups—resulting in diagnostic, treatment and pathophysiology implications.
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Affiliation(s)
- Julie Maggio
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Priyanka R Alluri
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna G Larson
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Petr Sojka
- Department of Psychiatry, University Hospital Brno, Czech Republic
| | - Bruce H Price
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Selma Aybek
- Department of Neurology, Inselspital University Hospital Bern and Clinical Neurosciences Bern, Bern University, Switzerland
| | - David L Perez
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hsieh Y, Deshpande S. A therapy-led, multidisciplinary programme for treatment-resistant functional fixed dystonia. BMJ Case Rep 2020; 13:e235213. [PMID: 32690570 PMCID: PMC7373327 DOI: 10.1136/bcr-2020-235213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/03/2022] Open
Abstract
Functional neurological disorder (FND) describes various neurological symptoms that are not explained by an organic aetiology. The condition has a poor prognosis. Despite this, there is sparse research that informs clinical interventions for FND, particularly when treating functional fixed dystonia. Our article has outlined an intervention for a patient with a treatment-resistant functional fixed dystonia that was informed by a biopsychosocial model, which aimed to rehabilitate the patient's functional motor symptoms. This led to favourable outcomes including restoring full range of movement in the patient's right foot and improvements in routine outcome measurement scores. The patient also described the programme as life-changing and was able to re-engage in meaningful and purposeful activities.
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Affiliation(s)
- Yvonne Hsieh
- Neuropsychiatry Outpatient, South London and Maudsley NHS Foundation Trust, Kent, UK
| | - Shaunak Deshpande
- Neuropsychiatry Outpatient, South London and Maudsley NHS Foundation Trust, Kent, UK
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Abstract
This scientific commentary refers to ‘Briquet syndrome revisited: implications for functional neurological disorder’, by Maggio et al. (https://doi.org/10.1093/braincomms/fcaa156)
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Affiliation(s)
- Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, EH16 4SB, UK
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Van der Feltz-Cornelis CM, Allen SF, Van Eck van der Sluijs JF. Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study. Brain Behav 2020; 10:e01558. [PMID: 32031757 PMCID: PMC7066336 DOI: 10.1002/brb3.1558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/19/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND). METHODS Prospective observational design. Clinical cohort study among consecutive outpatients with DSM-IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient-related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome. RESULTS A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, β = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, β = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, β = 0.435, p = .008) outcome. CONCLUSION Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.
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Affiliation(s)
- Christina M Van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands.,Department of Health Sciences, HYMS, University of York, York, UK
| | - Sarah F Allen
- Department of Health Sciences, HYMS, University of York, York, UK
| | - Jonna F Van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
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Park HY, Jang YE, Oh S, Lee PB. Psychological Characteristics in Patients with Chronic Complex Regional Pain Syndrome: Comparisons with Patients with Major Depressive Disorder and Other Types of Chronic Pain. J Pain Res 2020; 13:389-398. [PMID: 32104060 PMCID: PMC7026116 DOI: 10.2147/jpr.s230394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objective This study investigated psychological characteristics of patients with chronic complex regional pain syndrome (CRPS) and examined relationships between psychosocial factors and pain severity. Methods In total, 76 patients with CRPS, 95 patients with other types of chronic pain, 171 healthy controls, and 66 patients with major depressive disorder (MDD) were included. Minnesota Multiphasic Personality Inventory (MMPI-2) profiles and scores on the Beck Depression Inventory and State-Trait Anxiety Inventory were calculated. Pain intensity was measured using a visual analog scale (VAS). Results Patients with CRPS scored higher on the Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Paranoia (Pa), and Psychasthenia (Pt) scales of the MMPI-2 compared to healthy controls. The CRPS group scored lower on the D, Psychopathic deviate (Pd), Pa, Pt, Schizophrenia (Sc), and Social introversion (Si) scales compared to the MDD group. Although CRPS patients reported higher levels of pain than patients with other types of pain, the MMPI profiles of the two pain groups did not differ significantly. Linear regression analyses revealed that pain severity was significantly associated with depression and scores on the Masculinity-Femininity (Mf) scale. Conclusion This is the first comparative study of the psychological characteristics of chronic CRPS patients, healthy controls, and patients with MDD. The neurotic profiles of CRPS patients were more psychologically adaptable than were those of patients with MDD; however, this profile was shared by both pain groups. The present findings further showed that, although pain severity was not a major contributor to depression, patients with CRPS should be evaluated for depressive symptoms.
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Affiliation(s)
- Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ye Eun Jang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghee Oh
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyung Bok Lee
- Pain Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury. Diagnostics (Basel) 2020; 10:diagnostics10020095. [PMID: 32050691 PMCID: PMC7168287 DOI: 10.3390/diagnostics10020095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 11/19/2022] Open
Abstract
A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.
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Li Z, Hao Y, Han Y, Wu S, Zhu D, Liu M, Dong Q, Wang X, Guan Y. Prevalence and associated physical symptoms of depressive and anxiety symptoms in neurology outpatient clinic. J Neurol Neurosurg Psychiatry 2019; 90:1286-1287. [PMID: 30760642 DOI: 10.1136/jnnp-2018-320130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Zezhi Li
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Hao
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Han
- Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China
| | - Shuai Wu
- Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China
| | - Desheng Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingyuan Liu
- Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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48
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Suboptimal learning of tactile-spatial predictions in patients with complex regional pain syndrome. Pain 2019; 161:369-378. [DOI: 10.1097/j.pain.0000000000001730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Functional Neurological Disorder Responds Favorably to Interdisciplinary Rehabilitation Models. PSYCHOSOMATICS 2019; 60:556-562. [PMID: 31399207 DOI: 10.1016/j.psym.2019.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Functional neurological disorder (FND) is difficult to treat and costly. Interdisciplinary chronic pain rehabilitation programs (iCPRPs) are multidimensional functional restoration interventions for pain; their impact on FND specifically has not been assessed. OBJECTIVE The purpose of this study was to assess iCPRP's impact on functioning in FND. METHODS Data were examined retrospectively from an Institutional Review Board-approved registry capturing admission and discharge data from patients participating in an outpatient iCPRP. Subjective measures included pain-related disability, depression, anxiety, and stress scores, whereas objective measures included physical functioning measures (timed up and go, stair climbing test, and 6-min walk test). Pre-iCPRP and post-iCPRP measures were compared using a paired t-test approach. RESULTS Forty-nine FND patients completed care and showed pre-measures and postmeasures. Statistically significant reductions in subjective measures of pain-related disability (46.40-20.91; P < 0.001, d = 1.92), depression (20.38-4.81; P < 0.001, d = 1.53), anxiety (15.09-6.29; P < 0.001, d = 1.18), and stress (21.96-9.70; P < 0.001, d = 1.21) scores were observed. Statistically significant changes in objective measures of mean timed up and go scores (decreased from 15.96 to 8.87 s), stair climbing test scores (increased from 40.98 to 71.93 steps), and mean 6-minute walk test scores (increased from 0.21 to 0.30 miles) were also observed across the group. CONCLUSIONS While preliminary and based on a small patient sample, these findings support the use of interdisciplinary care models for FND treatment. Clinical and investigational implications are explored.
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Hanzlíková Z, Kofler M, Slovák M, Věchetová G, Fečíková A, Kemlink D, Sieger T, Růžička E, Valls‐Solé J, Edwards MJ, Serranová T. Prepulse inhibition of the blink reflex is abnormal in functional movement disorders. Mov Disord 2019; 34:1022-1030. [DOI: 10.1002/mds.27706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Zuzana Hanzlíková
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Markus Kofler
- Department of NeurologyHochzirl Hospital Hochzirl Austria
| | - Matěj Slovák
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Gabriela Věchetová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Anna Fečíková
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Tomáš Sieger
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
- Department of Cybernetics, Faculty of Electrical EngineeringCzech Technical University in Prague Prague Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
| | - Josep Valls‐Solé
- Neurology Service, Hospital Clíınic, Facultad de MedicinaUniversitat de Barcelona Barcelona Spain
| | - Mark J. Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical SciencesSt George's University of London London United Kingdom
| | - Tereza Serranová
- Department of Neurology and Center of Clinical NeuroscienceCharles University in Prague, 1st Faculty of Medicine and General University Hospital Prague Czech Republic
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