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Májovská J, Nestrašil I, Ahmed A, Bondy MT, Klempíř J, Jahnová H, Schneider SA, Horáková D, Krásenský J, Ješina P, Vaneckova M, Nascene DR, Whitley CB, Jarnes JR, Magner M, Dušek P. Quantitative brain morphometry identifies cerebellar, cortical, and subcortical gray and white matter atrophy in late-onset Tay-Sachs disease. J Inherit Metab Dis 2024; 47:327-339. [PMID: 38112342 PMCID: PMC10947897 DOI: 10.1002/jimd.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Cerebellar atrophy is a characteristic sign of late-onset Tay-Sachs disease (LOTS). Other structural neuroimaging abnormalities are inconsistently reported. Our study aimed to perform a detailed whole-brain analysis and quantitatively characterize morphometric changes in LOTS patients. Fourteen patients (8 M/6F) with LOTS from three centers were included in this retrospective study. For morphometric brain analyses, we used deformation-based morphometry, voxel-based morphometry, surface-based morphometry, and spatially unbiased cerebellar atlas template. The quantitative whole-brain morphometric analysis confirmed the finding of profound pontocerebellar atrophy with most affected cerebellar lobules V and VI in LOTS patients. Additionally, the atrophy of structures mainly involved in motor control, including bilateral ventral and lateral thalamic nuclei, primary motor and sensory cortex, supplementary motor area, and white matter regions containing corticospinal tract, was present. The atrophy of the right amygdala, hippocampus, and regions of occipital, parietal and temporal white matter was also observed in LOTS patients in contrast with controls (p < 0.05, FWE corrected). Patients with dysarthria and those initially presenting with ataxia had more severe cerebellar atrophy. Our results show predominant impairment of cerebellar regions responsible for speech and hand motor function in LOTS patients. Widespread morphological changes of motor cortical and subcortical regions and tracts in white matter indicate abnormalities in central motor circuits likely coresponsible for impaired speech and motor function.
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Affiliation(s)
- Jitka Májovská
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Igor Nestrašil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Monica T Bondy
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Helena Jahnová
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | | | - Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Jan Krásenský
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Pavel Ješina
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David R Nascene
- Department of Neuroradiology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Chester B Whitley
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Gene Therapy and Diagnostic Laboratory, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - Jeanine R Jarnes
- Advanced Therapies Program, Division of Genetics and Metabolism, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Chastan N, Etard O, Parain D, Gerardin P, Fouldrin G, Derambure P, Tard C, Gillibert A, Nathou C, Delval A, Welter ML, Guillin O. Repetitive transcranial magnetic stimulation for patients with functional paralysis: a randomized controlled study. Eur J Neurol 2022; 29:1293-1302. [PMID: 35098613 DOI: 10.1111/ene.15264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been proposed to treat functional neurological disorders. Here, we aim to assess the efficacy of rTMS to treat functional paralysis in a controlled randomized trial. METHODS Patients received 2 sessions of active or sham 0.25 Hz rTMS (60 stimuli each), with a one-day interval, applied over the motor cortex contralateral to the paralysis. The primary outcome was the number of patients with an increase in motor score between baseline and after the second rTMS session, rated by two investigators blinded to the treatment allocation. Secondary outcomes were changes in global and fine motor scores between groups after rTMS, and occurrence of adverse events. RESULTS Sixty-two patients (46 female; mean [SD] age, 35.2 [13.9] years) were enrolled and randomized. Thirteen out of 32 (41%) and 11/30 (37%) patients had increased motor strength after active or sham rTMS, respectively (p=0.80). Changes in both global and fine motor scores after rTMS relative to baseline were also not significantly different between treatment groups (median difference in the global motor score 0.62 [0.83] and 0.37 [0.61], and fine motor scores 0.12 [0.18] and 0.08 [0.11], in active and sham rTMS groups, respectively, p=0.14). We observed six serious adverse events, consisting of 3 cephalalgia in the active group and 2 cephalalgia and 1 asthenia in the sham group. CONCLUSIONS Two sessions of sham or active low frequency rTMS were effective to improve functional paralysis, suggesting a placebo effect of this non-invasive brain stimulation technique.
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Affiliation(s)
- Nathalie Chastan
- Department of Neurophysiology and Clinical Investigation Center 1404, Rouen University Hospital, Rouen, France.,Normandy University, UNICAEN, INSERM U1075, Caen, France
| | - Olivier Etard
- Université de Normandie, ISTS, EA 7466, GIP Cyceron, Caen, France and CHU de Caen, Service des Explorations Fonctionnelles du Système Nerveux, Caen, France
| | - Dominique Parain
- Department of Neurophysiology and Clinical Investigation Center 1404, Rouen University Hospital, Rouen, France
| | | | - Gaël Fouldrin
- Department of Psychiatry, Rouen University Hospital, Rouen, France
| | - Philippe Derambure
- U1171, Department of Neurophysiology, Lille University Hospital, Lille, France
| | - Céline Tard
- U1171, Department of Neurophysiology, Lille University Hospital, Lille, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Clément Nathou
- CHU de Caen, Service de Psychiatrie adulte, Centre Esquirol, 14000, Caen, France
| | - Arnaud Delval
- U1171, Department of Neurophysiology, Lille University Hospital, Lille, France
| | - Marie-Laure Welter
- Department of Neurophysiology and Clinical Investigation Center 1404, Rouen University Hospital, Rouen, France.,Brain Institute, INSERM U1127, Paris, France
| | - Olivier Guillin
- Department of Psychiatry, Rouen University Hospital, Rouen, France
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Bonnan M. Transcranial and muscular single-pulse magnetic stimulation is efficient on motor functional neurological disorders by the feedback of induced muscle contractions - A retrospective case series. Clin Park Relat Disord 2021; 5:100112. [PMID: 34746742 PMCID: PMC8554265 DOI: 10.1016/j.prdoa.2021.100112] [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: 05/13/2021] [Revised: 09/23/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Motor functional neurological disorders (mFNDs) are improved by repetitive transcranial magnetic stimulation (rTMS), which is thought to involve cortical modulation. We examined the outcome of a rapid TMS procedure. Methods Single-center retrospective case series including 41 consecutive patients suffering from mFNDs and receiving a combination of motor-evoked potentials (MEP), TMS and/or muscle stimulation. Results MEP and additional TMS were administered in 35 patients, sometimes with rescue by muscle stimulation. Magnetic muscle stimulation was given in 6 patients, sometimes with rescue by TMS. Complete immediate recovery was obtained in 65.9 % of the 41 patients, but the outcome of mFNDs after one year was poor. Treatment by TMS (n = 19) or by muscle stimulation (n = 4) given alone were associated with 78.9 % and 75 % of complete immediate recovery, respectively. Conclusions A rapid easy-to-perform TMS procedure obtained a high rate of immediate complete recovery in mFND. Clinical recovery was improved but was also obtained by direct magnetic stimulation of the paralyzed muscles. Significance TMS-induced recovery of mFND may not involve cortical modulation but could rather occur through reinforcement of the suggestion. Magnetic-induced muscle twitches may facilitate the self-expectation of motor recovery and could unlock the motor symptoms of mFND.
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Gonsalvez I, Spagnolo P, Dworetzky B, Baslet G. Neurostimulation for the treatment of functional neurological disorder: A systematic review. Epilepsy Behav Rep 2021; 16:100501. [PMID: 34950864 PMCID: PMC8671519 DOI: 10.1016/j.ebr.2021.100501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 01/02/2023] Open
Abstract
Functional Neurological Disorder (FND), also known as conversion disorder, is characterized by neurological symptoms that are incompatible with any known structural disorder and best explained by a biopsychosocial model. Evidence-based treatments for FND are limited, with cognitive behavioral therapy (CBT) and physiotherapy being the most effective interventions [1]. In recent years, functional neuroimaging studies have provided robust evidence of alterations in activity and connectivity in multiple brain networks in FND. This body of evidence suggests that neurocircuitry-based interventions, such as non-invasive brain stimulation techniques (NIBS), may also represent an effective therapeutic option for patients with FND. In this systematic review, we outline the current state of knowledge of NIBS in FND, and discuss limitations and future directions that may help establish the efficacy of NIBS as a therapeutic option for FND.
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Affiliation(s)
- Irene Gonsalvez
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Primavera Spagnolo
- Mary Horrigan Connors Center for Women's Health & Gender Biology, Department of Psychiatry, Brigham and Women Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barbara Dworetzky
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Stephen CD, Balkwill D, James P, Haxton E, Sassower K, Schmahmann JD, Eichler F, Lewis R. Quantitative oculomotor and nonmotor assessments in late-onset GM2 gangliosidosis. Neurology 2020; 94:e705-e717. [PMID: 31964693 DOI: 10.1212/wnl.0000000000008959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/23/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE A cross-sectional study was performed to evaluate whether quantitative oculomotor measures correlate with disease severity in late-onset GM2 gangliosidosis (LOGG) and assess cognition and sleep as potential early nonmotor features. METHODS Ten patients with LOGG underwent quantitative oculomotor recordings, including measurements of the angular vestibulo-ocular reflex (VOR), with results compared to age- and sex-matched controls. Disease severity was assessed by ataxia rating scales. Cognitive/neuropsychiatric features were assessed by the cerebellar cognitive affective syndrome (CCAS) scale, Cerebellar Neuropsychiatric Rating Scale, and sleep quality evaluated using subjective sleep scales. RESULTS Oculomotor abnormalities were found in all participants, including 3/10 with clinically normal eye movements. Abnormalities involved impaired saccadic accuracy (5/10), abnormal vertical (8/10) and horizontal (4/10) pursuit, reduced optokinetic nystagmus (OKN) responses (7/10), low VOR gain (10/10), and impaired VOR cancellation (2/10). Compared to controls, the LOGG group showed significant differences in saccade, VOR, OKN, and visually enhanced VOR gains. Severity of saccadic dysmetria, OKN, and VOR fixation-suppression impairments correlated with ataxia scales (p < 0.05). Nine out of ten patients with LOGG had evidence of the CCAS (5/10 definite, 2/10 probable, 2/10 possible). Excessive daytime sleepiness was present in 4/10 and 8/10 had poor subjective sleep quality. CONCLUSIONS Cerebellar oculomotor abnormalities were present in all patients with LOGG, including those with normal clinical oculomotor examinations. Saccade accuracy (dorsal cerebellar vermis localization), fixation suppression, and OKN gain (cerebellar flocculus/paraflocculus localization) correlated with disease severity, suggesting that quantitative oculomotor measurements could be used to track disease progression. We found evidence of the CCAS, suggesting that cerebellar dysfunction may explain the cognitive disorder in LOGG. Sleep impairments were prevalent and require further study.
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Affiliation(s)
- Christopher D Stephen
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
| | - David Balkwill
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Peter James
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Elizabeth Haxton
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Kenneth Sassower
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jeremy D Schmahmann
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Florian Eichler
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Richard Lewis
- From the Ataxia Unit (C.D.S., J.D.S.), Center for Rare Neurological Diseases (C.D.S., P.J., E.H., F.E.), Cognitive Behavioral Neurology Unit (J.D.S.), Laboratory for Neuroanatomy and Cerebellar Neurobiology (C.D.S., J.D.S.), and Sleep Division, Department of Neurology (K.S.), Massachusetts General Hospital, and Jenks Vestibular Physiology Laboratory (D.B., R.L.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Abstract
PURPOSE OF REVIEW This article provides a broad overview of conversion disorder, encompassing diagnostic criteria, epidemiology, etiologic theories, functional neuroimaging findings, outcome data, prognostic indicators, and treatment. RECENT FINDINGS Two important changes have been made to the recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria: the criteria that conversion symptoms must be shown to be involuntary and occurring as the consequence of a recent stressor have been dropped. Outcome studies show that the rate of misdiagnosis has declined precipitously since the 1970s and is now around 4%. Functional neuroimaging has revealed a fairly consistent pattern of hypoactivation in brain regions linked to the specific conversion symptom, accompanied by ancillary activations in limbic, paralimbic, and basal ganglia structures. Cognitive-behavioral therapy looks promising as the psychological treatment of choice, although more definitive data are still awaited, while preliminary evidence indicates that repetitive transcranial magnetic stimulation could prove beneficial as well. SUMMARY Symptoms of conversion are common in neurologic and psychiatric settings, affecting up to 20% of patients. The full syndrome of conversion disorder, while less prevalent, is associated with a guarded prognosis and a troubled psychosocial outcome. Much remains uncertain with respect to etiology, although advances in neuroscience and technology are providing reproducible findings and new insights. Given the confidence with which the diagnosis can be made, treatment should not be delayed, as symptom longevity can influence outcome.
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Schönfeldt-Lecuona C, Lefaucheur JP, Lepping P, Liepert J, Connemann BJ, Sartorius A, Nowak DA, Gahr M. Non-Invasive Brain Stimulation in Conversion (Functional) Weakness and Paralysis: A Systematic Review and Future Perspectives. Front Neurosci 2016; 10:140. [PMID: 27065796 PMCID: PMC4815435 DOI: 10.3389/fnins.2016.00140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022] Open
Abstract
Conversion (functional) limb weakness or paralysis (FW) can be a debilitating condition, and often causes significant distress or impairment in social, occupational, or other important areas of functioning. Most treatment concepts are multi-disciplinary, containing a behavioral approach combined with a motor learning program. Non-invasive brain stimulation (NIBS) methods, such as electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS) have been used in the past few decades to treat FW. In order to identify all published studies that used NIBS methods such as ECT, TMS and transcranial direct current stimulation (tDCS) for treating FW patients a systematic review of the literature was conducted in PubMed and Web of Science. In a second step, narratives were used to retrospectively determine nominal CGI-I (Clinical Global Impression scale–Improvement) scores to describe approximate changes of FW symptoms. We identified two articles (case reports) with ECT used for treatment of FW, five with TMS with a total of 86 patients, and none with tDCS. In 75 out of 86 patients treated with repetitive (r)TMS a nominal CGI-I score could be estimated, showing a satisfactory short-term improvement. Fifty-four out of seventy-five identified patients (72%) had a CGI-I score of 1 (very much improved), 13 (17%) a score of 2 (much improved), 5 (7%) a score of 3 (minimally improved), and 3 (5%) remained unchanged (CGI-I = 4). In no case did patients worsen after rTMS treatment, and no severe adverse effects were reported. At follow-up, symptom improvement was not quantifiable in terms of CGI-I for the majority of the cases. Patients treated with ECT showed a satisfactory short-term response (CGI-I = 2), but deterioration of FW symptoms at follow-up. Despite the predominantly positive results presented in the identified studies and satisfactory levels of efficacy measured with retrospectively calculated nominal CGI-I scores, any assumption of a beneficial effect of NIBS in FW has to be seen with caution, as only few articles could be retrieved and their quality was mostly poor. This article elucidates how NIBS might help in FW and gives recommendations for future study designs using NIBS in this condition.
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Affiliation(s)
| | - Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de ParisCréteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil UniversityCréteil, France
| | - Peter Lepping
- Department of Psychiatry, Betsi Cadwaladr University Health BoardWrexham, UK; Centre for Mental Health and Society, Bangor UniversityWrexham, UK; Department of Psychiatry, Mysore Medical College and Research InstituteMysore, India
| | - Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder Allensbach, Germany
| | | | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg Mannheim, Germany
| | - Dennis A Nowak
- Department of Neurology, Helios-Klinik KipfenbergKipfenberg, Germany; Department of Neurology, University Hospital MarburgMarburg, Germany
| | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University of Ulm Ulm, Germany
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Nicholson TRJ, Voon V. Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:619-629. [PMID: 27719877 DOI: 10.1016/b978-0-12-801772-2.00050-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Functional neurologic disorder (FND), also known as conversion disorder, is common and often associated with a poor prognosis. It has been relatively neglected by research and as such there is a conspicuous lack of evidence-based treatments. Physical and psychologic therapies are the main treatment modalities, over and above reassurance and sensitive explanation of the diagnosis. However there are two other historic treatments that have seen a recent resurgence of interest and use. The first is electric stimulation, which was initially pioneered with direct stimulation of nerves but now used indirectly (and therefore noninvasively) in the form of transcranial magnetic stimulation (TMS). The second is (therapeutic) sedation, previously known as "abreaction," where it was mostly used in the context of psychologic investigation and treatment, but now increasingly advocated during rehabilitation as a way to therapeutically demonstrate reversibility of symptoms. This chapter introduces the background of these treatment modalities, their evolution into their current applications before critically evaluating their current evidence base and exploring possible mechanisms of action. It also tentatively suggests when they should be considered in current practice and briefly considers their future potential. In summary there is encouraging preliminary evidence to suggest that both TMS and sedation may be effective treatments for FNDs.
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Affiliation(s)
- T R J Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - V Voon
- Department of Psychiatry, Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge, UK
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Santos NDO, Benute GRG, Santiago A, Marchiori PE, Lucia MCSD. Psychogenic non-epileptic seizures and psychoanalytical treatment: results. Rev Assoc Med Bras (1992) 2014; 60:577-84. [DOI: 10.1590/1806-9282.60.06.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/17/2014] [Indexed: 11/22/2022] Open
Abstract
Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes.
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Noll-Hussong M, Holzapfel S, Pokorny D, Herberger S. Caloric vestibular stimulation as a treatment for conversion disorder: a case report and medical hypothesis. Front Psychiatry 2014; 5:63. [PMID: 24917828 PMCID: PMC4040883 DOI: 10.3389/fpsyt.2014.00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/19/2014] [Indexed: 12/12/2022] Open
Abstract
Conversion disorder is a medical condition in which a person has paralysis, blindness, or other neurological symptoms that cannot be clearly explained physiologically. To date, there is neither specific nor conclusive treatment. In this paper, we draw together a number of disparate pieces of knowledge to propose a novel intervention to provide transient alleviation for this condition. As caloric vestibular stimulation has been demonstrated to modulate a variety of cognitive functions associated with brain activations, especially in the temporal-parietal cortex, anterior cingulate cortex, and insular cortex, there is evidence to assume an effect in specific mental disorders. Therefore, we go on to hypothesize that lateralized cold vestibular caloric stimulation will be effective in treating conversion disorder and we present provisional evidence from one patient that supports this conclusion. If our hypothesis is correct, this will be the first time in psychiatry and neurology that a clinically well-known mental disorder, long considered difficult to understand and to treat, is relieved by a simple or common, non-invasive medical procedure.
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Affiliation(s)
- Michael Noll-Hussong
- Klinik und Poliklinik fuer Psychosomatische Medizin und Psychotherapie des Universitaetsklinikums Ulm, Ulm, Germany
| | - Sabrina Holzapfel
- Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Dan Pokorny
- Klinik und Poliklinik fuer Psychosomatische Medizin und Psychotherapie des Universitaetsklinikums Ulm, Ulm, Germany
| | - Simone Herberger
- Klinik fuer Psychosomatische Medizin und Psychotherapie des Klinikums Muenchen-Harlaching, Muenchen, Germany
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Parain D, Chastan N. Large-field repetitive transcranial magnetic stimulation with circular coil in the treatment of functional neurological symptoms. Neurophysiol Clin 2014; 44:425-31. [PMID: 25306083 DOI: 10.1016/j.neucli.2014.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 01/04/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Patients with functional neurological symptoms (FNS) are frequently encountered by neurologists and are difficult to treat. Symptoms are multiple and may appear concurrently or successively in the same patient. To date, few studies have been published on focal repetitive transcranial magnetic stimulation (rTMS) in FNS. This type of stimulation induces a focal current, vertically in the cortex. Results are contradictory, probably because it is difficult to identify a limited cortical area that triggers these symptoms. We assessed the efficacy of another type of rTMS: large-field stimulation by means of a circular coil covering a surface area approximately 20 times greater and inducing a circular current tangentially to the cortex. PUBLISHED STUDIES We analysed two studies on the efficacy of large-field rTMS in functional paralysis and in functional movement disorders. The efficacy of large-field rTMS was very marked in these two studies. PERSONAL NON-PUBLISHED STUDIES We reported several open series, including patients with functional sensory loss, functional visual loss, and non-epileptic seizures. METHOD For all patients, one or several sessions of 60 stimuli with circular coil were carried out with a protocol depending on the symptoms. RESULTS The efficacy of large-field rTMS was dramatic in all patient series. Additionally, we discuss the possible involved mechanism: placebo effect, cognitive behavioural effect or neuromodulatory effect. CONCLUSION According to the data from these different studies, large-field rTMS could be a new therapy for patients with FNS. However, controlled studies are mandatory.
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Affiliation(s)
- D Parain
- Physiology Department, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
| | - N Chastan
- Physiology Department, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
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Suntrup S, Teismann I, Wollbrink A, Warnecke T, Winkels M, Pantev C, Dziewas R. Altered cortical swallowing processing in patients with functional dysphagia: a preliminary study. PLoS One 2014; 9:e89665. [PMID: 24586948 PMCID: PMC3929717 DOI: 10.1371/journal.pone.0089665] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/24/2014] [Indexed: 12/12/2022] Open
Abstract
Objective Current neuroimaging research on functional disturbances provides growing evidence for objective neuronal correlates of allegedly psychogenic symptoms, thereby shifting the disease concept from a psychological towards a neurobiological model. Functional dysphagia is such a rare condition, whose pathogenetic mechanism is largely unknown. In the absence of any organic reason for a patient's persistent swallowing complaints, sensorimotor processing abnormalities involving central neural pathways constitute a potential etiology. Methods In this pilot study we measured cortical swallow-related activation in 5 patients diagnosed with functional dysphagia and a matched group of healthy subjects applying magnetoencephalography. Source localization of cortical activation was done with synthetic aperture magnetometry. To test for significant differences in cortical swallowing processing between groups, a non-parametric permutation test was afterwards performed on individual source localization maps. Results Swallowing task performance was comparable between groups. In relation to control subjects, in whom activation was symmetrically distributed in rostro-medial parts of the sensorimotor cortices of both hemispheres, patients showed prominent activation of the right insula, dorsolateral prefrontal cortex and lateral premotor, motor as well as inferolateral parietal cortex. Furthermore, activation was markedly reduced in the left medial primary sensory cortex as well as right medial sensorimotor cortex and adjacent supplementary motor area (p<0.01). Conclusions Functional dysphagia - a condition with assumed normal brain function - seems to be associated with distinctive changes of the swallow-related cortical activation pattern. Alterations may reflect exaggerated activation of a widely distributed vigilance, self-monitoring and salience rating network that interferes with down-stream deglutition sensorimotor control.
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Affiliation(s)
- Sonja Suntrup
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
- Department of Neurology, University of Muenster, Muenster, Germany
- * E-mail:
| | - Inga Teismann
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Martin Winkels
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University of Muenster, Muenster, Germany
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Pollak TA, Nicholson TR, Edwards MJ, David AS. A systematic review of transcranial magnetic stimulation in the treatment of functional (conversion) neurological symptoms. J Neurol Neurosurg Psychiatry 2014; 85:191-7. [PMID: 23303960 DOI: 10.1136/jnnp-2012-304181] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Functional (conversion) neurological symptoms (FNS) are commonly encountered in neurological and psychiatric clinical settings and represent a considerable burden on healthcare systems. There is a conspicuous paucity of evidence-based treatments for FNS. Transcranial magnetic stimulation (TMS) offers a safe, non-invasive method of probing changes in cortical excitability and/or connectivity. It has already had some success in demonstrating abnormalities of cortical excitability in patients with FNS, particularly when the functional symptom in question relates to movement. We reviewed the literature for studies in which TMS has been used in the treatment of FNS. All patients in the identified studies had motor symptoms (either weakness or movement disorder). There was considerable heterogeneity in terms of study quality, population sampled, study design, TMS parameters and outcome measures. No studies were placebo controlled. Despite the majority of studies claiming success for the technique, there is insufficient good quality evidence to establish TMS as an effective treatment modality for FNS. We outline the methodological considerations that should be taken into account in future studies of the efficacy of TMS in treating FNS and discuss mechanisms by which TMS, if efficacious, may exert a therapeutic effect, including: (a) via genuine neuromodulation, (b) via non-specific placebo effects and (c) by demonstrating, through its immediate effects on the motor system (eg, movement in a 'paretic' limb), that symptom improvement is possible, thus directly changing higher level beliefs that may be responsible for the maintenance of the disorder.
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Affiliation(s)
- Thomas A Pollak
- Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, King's College London, , London, UK
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Dubas F, Thomas-Antérion C. [Somatoform disorders in neurology visits: history and circumstances: retrospective study of 124 cases]. Rev Neurol (Paris) 2012; 168:887-900. [PMID: 23153685 DOI: 10.1016/j.neurol.2012.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 11/26/2022]
Abstract
We report 124 cases of somatoform disorders, considering psychogenic disorders at the same level as neurological disorders. We noted any psychic, somatic or social condition (history taking) and facilitating circumstances. The patients were aged 16 to 84 years old; 71.7% were women. We observed pain (35.4%), psychogenic headache (25%), sensorimotor loss (27.4%), gait and psychogenic tremor (17.7%), cognitive disorders (11.8%), ocular symptoms (7.2%), and urogenital symptoms (2.4%). Delay to consultation ranged from a few days to 20 years. Psychiatric comorbidity was noted in 30.6% of the cases. In 55.6% of 124 cases, we observed a psychological background. It was a childhood trauma in 15.3% of these cases. In one-third of the 124 situations, we noted an underlying somatic or social condition. Facilitation conditions were frequently mixed. Somatic and/or psychological conditions were noted in one-third of the 124 cases and social conditions in half of them. The neurologist is faced with the challenge of naming the symptom (most often labelled a functional disorder) and of making the decision to stop or limit investigations. Visits by patients with psychogenic disorders make up a significant percentage of neurology speciality appointments. The neurologist should not limit the consultation to differentiating "real" symptoms from psychogenic somatoform disorders, but should also propose a straightforward compassionate approach for effective therapeutic care. By carefully listening to the patient's dialogue, the neurologist can help the patient give meaning to the symptoms, and progress towards improved well-being.
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Affiliation(s)
- F Dubas
- Service de neurologie, CHU d'Angers, 4 rue Larrey, Angers, France
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Bensghir M, Alaoui H, Ahtil R, Azendour H, Mouhadi K, Drissi Kamili N. [Impaired consciousness associated with a hysterical conversion after obstetrical epidural analgesia: a case report with literature review]. ACTA ACUST UNITED AC 2012; 31:919-21. [PMID: 23069138 DOI: 10.1016/j.annfar.2012.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/24/2012] [Indexed: 11/26/2022]
Abstract
The occurrence of impaired consciousness after epidural analgesia is an alarming situation that requires urgent diagnostic and therapeutic approach. Various causes may be responsible for such a state. Hysterical conversion remains an outstanding issue. Through a clinical case of a hysterical conversion and a literature review the authors draw attention to the difficulty of diagnosing this entity after epidural analgesia.
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Affiliation(s)
- M Bensghir
- Pole anesthésie réanimation, hôpital militaire Med V Rabat, université Mohamed V, Souissi, Rabat, Maroc.
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Dietrich M, Andreatta RD, Jiang Y, Joshi A, Stemple JC. Preliminary findings on the relation between the personality trait of stress reaction and the central neural control of human vocalization. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:377-389. [PMID: 22698155 DOI: 10.3109/17549507.2012.688865] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objectives of this study were to examine whether the personality trait of stress reaction (SR), as assessed with the Multidimensional Personality Questionnaire-Brief Form (MPQ-BF), (1) influences prefrontal and limbic area activity during overt sentence reading and if (2) SR and associated individual differences in prefrontal and limbic activations correlate with sensorimotor cortical activity during overt sentence reading. Ten vocally healthy adults (22-57 years) participated in a functional MRI study using an event-related sparse sampling design to acquire brain activation data during sentence production tasks (covert, whispered, overt). The outcome measure was the blood oxygenation level-dependent signal change in prefrontal, limbic, and primary somatosensory (S1) and motor cortices (M1). Significant positive correlations were found between SR scores and S1, dorsolateral prefrontal cortex (both r =.73, p <.05), and periaqueductal gray (r =.88, p <.01) activity. M1 activity was positively correlated with SR (r =.64, p <.05) and negatively with social potency (r = -.70, p <.05). Our findings suggest that motor cortical control subserving voice and speech production varies with expression of selected personality traits. Future studies should investigate the functional significance of personality differences in the central neural control of vocalization.
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Gaillard A, Gaillard R, Mouaffak F, Radtchenko A, Lôo H. Traitement par électroconvulsivothérapie d’une tétraplégie par conversion hystérique : à propos d’un cas. Encephale 2012; 38:104-9. [PMID: 22381730 DOI: 10.1016/j.encep.2011.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 03/23/2011] [Indexed: 11/17/2022]
Affiliation(s)
- A Gaillard
- Service hospitalo-universitaire de santé mentale et de thérapeutique, faculté de médecine Paris-Descartes, université Paris-Descartes, hôpital Sainte-Anne, 7, rue Cabanis, 75674 Paris cedex 14, France.
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Schuster JP, Mouchabac S, Le Strat Y, Limosin F. [Hysterical mutism]. Encephale 2011; 37:339-44. [PMID: 22032276 DOI: 10.1016/j.encep.2010.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose, and whose treatment is poorly codified. Hysterical mutism is a disorder of the vocal function without changing the integrity of the body, resulting in loss of voice. Identified at all times, hysterical mutism entered the medical field in the late nineteenth century, under the direction of Jean-Martin Charcot (Salpêtrière School). Since then, although the disorder has emerged as a clinical entity, it remains little known. METHOD A systematic review of the literature. We performed electronic literatures search of relevant studies using Medline, SUDOC, and BIUM. Search terms used were mutism, functional aphonia, conversion disorder, hysteria. RESULTS The epidemiology of hysterical mutism is difficult to assess. The first limitation is the lack of consensensual diagnostic criteria. An estimate of its frequency may be advanced through registries consultation of otolaryngology-head and neck surgery. Through a literature review, emerges a rare disorder, about 5% of functional dysphonia. The sex-ratio is in favour of women. Regarding age of onset of disorder, functional aphonia mainly concerns adults with an average around the age of 30-40 years. The onset of the disorder typically involves a sudden onset and a recent stressful event. The duration of the disorder is difficult to specify. It appears that this dysfunction is rapidly reversible and that the majority of patients are in remission of this disorder within three months. The recurrence of dysfunction seems to be frequent. The existence of psychiatric comorbidity did not appear to be the rule. The natural history of this disorder is not known making it tricky to evaluate the efficiency of therapeutic approaches. CONCLUSION Today the term hysterical mutism does not appear as an entity in either international classification. It belongs to the category of conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Identified as a medical entity described by the school of the Salpêtrière, this disorder has raised little interest. The medicalization of the condition remains difficult because of the importance of stigma associated with it, which contributes to the rejection rather than support of patients with mutism. To better understand this disorder and improve the care of patients who suffer, renewed interest is warranted.
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Affiliation(s)
- J-P Schuster
- Service universitaire de psychiatrie, hôpital Corentin-Celton, assistance publique-hôpitaux de Paris, université Paris Descartes, France.
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Lang AE, Voon V. Psychogenic movement disorders: past developments, current status, and future directions. Mov Disord 2011; 26:1175-86. [PMID: 21626561 DOI: 10.1002/mds.23571] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
As the field of movement disorders has developed and matured over the past 25 years, psychogenic movement disorders have become increasingly recognized in subspecialty clinics. The diagnosis can be challenging and should be based on positive features rather than a purely exclusionary approach. The clinical phenotype can be quite varied, although certain categories of abnormal movement are more common than others. Electrophysiological studies may be particularly useful in establishing the diagnosis, especially with respect to tremor and myoclonus, and an argument can be made for adding a "laboratory-supported definite" category to earlier classification schemes. The diagnosis of psychogenic dystonia remains a major challenge, although there are some recent promising developments with respect to the evaluation of cortical plasticity that require further study. The pathogenesis of psychogenic movement disorders is poorly understood; insights may be provided from the study of other neurological conversion disorders such as psychogenic hemiparesis. Psychogenic movement disorders typically result in considerable disability and negatively impact quality of life to the same or greater extent than do many organic movement disorders. Treatment is extremely challenging, and many patients experience chronic disability despite various therapeutic interventions. Given the personal and societal impact of these problems, further advances in our understanding of their pathogenesis and the subsequent development of effective therapies are sorely needed.
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Affiliation(s)
- Anthony E Lang
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
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Fecteau S, Agosta S, Oberman L, Pascual-Leone A. Brain stimulation over Broca's area differentially modulates naming skills in neurotypical adults and individuals with Asperger's syndrome. Eur J Neurosci 2011; 34:158-64. [PMID: 21676037 DOI: 10.1111/j.1460-9568.2011.07726.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In the present study we tested the hypothesis that, in subjects with Asperger's syndrome (ASP), the dynamics of language-related regions might be abnormal, so that repetitive transcranial magnetic stimulation (rTMS) over Broca's area leads to differential behavioral effects as seen in neurotypical controls. We conducted a five-stimulation-site, double-blind, multiple crossover, pseudo-randomized, sham-controlled study in 10 individuals with ASP and 10 age- and gender-matched healthy subjects. Object naming was assessed before and after low-frequency rTMS of the left pars opercularis, left pars triangularis, right pars opercularis and right pars triangularis, and sham stimulation, as guided stereotaxically by each individual's brain magnetic resonance imaging. In ASP participants, naming improved after rTMS of the left pars triangularis as compared with sham stimulation, whereas rTMS of the adjacent left opercularis lengthened naming latency. In healthy subjects, stimulation of parts of Broca's area did not lead to significant changes in naming skills, consistent with published data. Overall, these findings support our hypothesis of abnormal language neural network dynamics in individuals with ASP. From a methodological point of view, this work illustrates the use of rTMS to study the dynamics of brain-behavior relations by revealing the differential behavioral impact of non-invasive brain stimulation in a neuropsychiatric disorder.
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Affiliation(s)
- Shirley Fecteau
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Ouss-Ryngaert L. Expressions neurologiques des conversions de l’enfant et de l’adolescent. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kranick SM, Gorrindo T, Hallett M. Psychogenic movement disorders and motor conversion: a roadmap for collaboration between neurology and psychiatry. PSYCHOSOMATICS 2011; 52:109-16. [PMID: 21397102 PMCID: PMC3073765 DOI: 10.1016/j.psym.2010.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 10/14/2022]
Abstract
BACKGROUND There are a host of vague terms to describe psychologically-mediated symptoms that mimic neurological disease, such as "functional," "non-organic," "psychogenic," or "medically unexplained." None of these terms has a direct translation in psychiatric classification, and psychiatrists are often faced with patients who do not believe in a psychological origin for their symptoms. OBJECTIVE Within the framework of psychogenic movement disorders, we discuss the roadblocks to effective collaboration and treatment in these patients and the current state of the literature regarding diagnosis and treatment. RESULTS We describe the approach to these patients from the perspective of neurology and psychiatry, illustrating the differences in terminology and categorization. CONCLUSION Psychogenic movement disorders represent a unique opportunity for these fields to collaborate in the care of a potentially curable but significantly disabling disorder.
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Affiliation(s)
- Sarah M Kranick
- Human Motor Control Section, Medical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1428, USA.
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Nemr K, Simões-Zenari M, Marques SF, Cortez JP, Silva ALD. Disfonia psicogênica associada a outras doenças: desafio para o tratamento fonoaudiológico. ACTA ACUST UNITED AC 2010; 22:359-61. [DOI: 10.1590/s0104-56872010000300033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/01/2010] [Indexed: 11/22/2022]
Abstract
TEMA: sucessos e dificuldades no tratamento de disfonia psicogênica. OBJETIVO: discutir as limitações da terapia fonoaudiológica para disfonia psicogênica associada a outras doenças. MÉTODO: foram utilizados protocolos de avaliação e registros de terapia para discussão do caso. RESULTADOS: a paciente chegou com importante alteração vocal e, após avaliação, diagnosticou-se disfonia psicogênica. O tratamento envolveu ativação vocal e modificação do ajuste fixado. Observaram-se mudanças positivas como estabilidade no padrão vocal, redução da rouquidão, aspereza, soprosidade e desconforto laríngeo e na qualidade de vida relacionada à voz, mas que não se sustentaram na medida em que houve piora dos outros problemas de saúde. CONCLUSÃO: o tratamento fonoaudiológico pode ser limitado, contudo desafiador, quando a disfonia psicogênica ocorre de maneira concomitante com outras doenças.
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Chastan N, Parain D. Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation. Mov Disord 2010; 25:1501-4. [DOI: 10.1002/mds.23187] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Psychogenic movement disorders (PMDs) represent a challenging dilemma for the treating neurologist. The terminology to classify this disorder is confusing and making the diagnosis is difficult. Once the diagnosis has been established, treatment options are limited, and the patient generally does not accept the diagnosis.
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