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van Dijl TL, Videler AC, Aben HP, Kop WJ. Anger regulation in patients with functional neurological disorder: A systematic review. Gen Hosp Psychiatry 2024; 88:30-47. [PMID: 38458028 DOI: 10.1016/j.genhosppsych.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND. METHODS MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340). RESULTS A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality. CONCLUSIONS This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.
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Affiliation(s)
- T L van Dijl
- Department of Medical and Clinical Psychology, Center for Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Psychiatry, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Child and Adolescent Psychiatry, De Hoop ggz, Dordrecht, the Netherlands.
| | - A C Videler
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands
| | - H P Aben
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - W J Kop
- Department of Medical and Clinical Psychology, Center for Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands
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Watson M, Cook K, Sillau S, Greenwell E, Libbon R, Strom L. Death of a loved one: A potential risk factor for onset of functional seizures. Epilepsy Behav 2024; 155:109769. [PMID: 38636145 DOI: 10.1016/j.yebeh.2024.109769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
Functional seizures (FS) are a symptom of Functional Neurological Disorder (FND), the second most common neurological diagnosis made worldwide. Childhood trauma is associated with the development of FS, but more research is needed to truly understand the effects of trauma on FS onset. A sample of 256 responses by adults with FS to the Childhood Traumatic Events Scale were analyzed using a Cox proportional hazard model. When investigating each unique childhood traumatic exposure and its associated self-reported severity together, experiencing death of a loved one and experiencing violence were significantly associated with FS onset, suggesting reduced time from trauma exposure to first FS. Death of a loved one in childhood is often overlooked as an influential risk factor for future development of serious mental illnesses such as FS. In this study we show death of a loved one in childhood should be considered as an influential traumatic experience and recommend FND researchers examine its prevalence in patient histories and the potential effects on attachment-related processes and clinical treatment formulations. We recommend future studies incorporate loss of a loved one during childhood (before age 18) in both quantitative and qualitative assessments of persons with FND.
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Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, CO, USA.
| | - Kimberlyn Cook
- Department of Environmental Health and Safety, University of Colorado, Aurora, CO, USA
| | - Stefan Sillau
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Elizabeth Greenwell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Randi Libbon
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado, Aurora, CO, USA
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3
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Kofler M, Haibach M, Kofler M, Thurner M, Pucks-Faes E, Versace V. Abnormal modulation of the blink reflex in functional sensory loss. Clin Neurophysiol 2024; 162:162-164. [PMID: 38640821 DOI: 10.1016/j.clinph.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Österreich.
| | - Moritz Haibach
- Department of Neurology, Hochzirl Hospital, Zirl, Österreich
| | - Manuela Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Österreich
| | - Michael Thurner
- Department of Neurology, Hochzirl Hospital, Zirl, Österreich
| | - Elke Pucks-Faes
- Department of Neurology, Hochzirl Hospital, Zirl, Österreich
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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Guy L, Caceres GA, Jackson T, Gorman S, Wilson J, Hsieh Y, Petty D, Harrison S, Pick S. Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder. J Neurol 2024; 271:1873-1884. [PMID: 38091087 DOI: 10.1007/s00415-023-12111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 03/28/2024]
Abstract
OBJECTIVES We report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND). METHODS The program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman's ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up). RESULTS Analyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up. DISCUSSION This outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.
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Affiliation(s)
- Lisette Guy
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gabriella A Caceres
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Temeika Jackson
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sean Gorman
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jennifer Wilson
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Yvonne Hsieh
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Demelza Petty
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Simon Harrison
- FiND Programme, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Duncan R, Berlowitz DJ, Mullen S, Bondarenko J, Winton-Brown TT, O'Brien TJ, Zaloumis S, Braat S, Oliver G, Kanaan RA. Breathing control training for functional seizures: A multi-site, open-label pilot study. Epilepsy Behav 2024; 154:109745. [PMID: 38521027 DOI: 10.1016/j.yebeh.2024.109745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
There are no well-validated treatments for functional seizures. While specialist psychotherapy is usually recommended, the evidence for its benefit is qualified, and it can be difficult to obtain. Given the association between hyperventilation and functional seizures we explored an alternative modality, breathing control training, in a multi-site open label pilot trial. Participants with functional seizures over the age of 16 received an hour of breathing training from a respiratory physiotherapist, with a half-hour booster session a month later. Seizure frequency and Nijmegen scores (a measure of hyperventilation) were reported at baseline and follow-up, 3-4 months later. Eighteen subjects were recruited, and 10 completed follow-up. Seven of these 10 had improved seizure frequency, and 3 did not (Wilcoxon signed rank test, p = 0.09), with seizure frequency correlating with Nijmegen score (Spearman's rank correlation = 0.75, p = 0.034). The intervention was well tolerated, with no adverse events reported. These preliminary results support a potentially new approach to treating functional seizures that should prove cost-effective and acceptable, though require confirmation by a randomised controlled trial.
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Affiliation(s)
- Roderick Duncan
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - David J Berlowitz
- Department of Physiotherapy, The University of Melbourne, Melbourne Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Saul Mullen
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Janet Bondarenko
- Physiotherapy, Alfred Health, Melbourne, Australia; Respiratory Research@Alfred, Monash University, Melbourne, Australia
| | - Toby T Winton-Brown
- Department of Neuroscience, Central Clinical School, Monash University, Prahran 3004, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Prahran 3004, Australia
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne Australia
| | - Georgina Oliver
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Richard A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia.
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7
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Gilmour GS, Salmon A, Josephson CB. Functional Seizures in the Elderly: Accurate Diagnosis Can Reduce Iatrogenic Harm. Can J Neurol Sci 2024; 51:330-332. [PMID: 36600669 DOI: 10.1017/cjn.2022.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Gabriela S Gilmour
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Salmon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
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Fox J, Bollig MK, Mishra M, Jacobs M. Neuropsychological characteristics of drug resistant epilepsy patients with and without comorbid functional seizures. Epilepsy Res 2024; 201:107340. [PMID: 38442550 DOI: 10.1016/j.eplepsyres.2024.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Neuropsychological testing is a mandatory component in the evaluation of drug resistant epilepsy. The results of testing may assist with both the localization of an epilepsy as well as assessment of surgical risk. Previous studies have demonstrated differences in the neuropsychological performance of patients with epilepsy and functional seizures. We hypothesized that comorbid functional seizures could potentially influence neuropsychological test performance. Therefore, we evaluated whether there is a difference in the neuropsychological test results between drug resistant epilepsy patients with and without comorbid functional seizures. METHOD Neuropsychological test results were compared between 25 patients with drug resistant focal epilepsy and 25 patients that also had documented functional seizures. Univariate analyses and multiple logistic regression models were used to both assess performance differences between the groups and to assess whether test results could be used to accurately identify which patients had comorbid functional seizures. RESULTS Epilepsy patients with comorbid functional seizures performed significantly worse on the FAS Verbal Fluency Test compared to ES patients (p = 0.047). Digit Span Backwards (p = 0.10), Digit Span Forwards (p = 0.14) and Working Memory Index (p = 0.10) tended to be lower in the epilepsy and functional seizures group but was not statistically significant. A multiple logistic regression model using the results of four neuropsychological tests was able to identify patients with comorbid functional seizures with 83.33% accuracy. CONCLUSIONS There are appeared to be some differences in the neuropsychological performance among drug resistant epilepsy patients based on whether they have comorbid functional seizures. These findings may have relevant implications for the interpretation of neuropsychological test results.
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Affiliation(s)
- Jonah Fox
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Madelyn K Bollig
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Murli Mishra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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Yaraki PT, Yu YJ, AlKhateeb M, Mirsattari SM. Longitudinal Comparison of PNES spell and ASM reduction in PNES Patients with and without Epilepsy Discharged from an Epilepsy Monitoring Unit. Epilepsy Res 2024; 201:107319. [PMID: 38422801 DOI: 10.1016/j.eplepsyres.2024.107319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To examine trends of Antiseizure Medication (ASM) reduction and discontinuation, as well as Psychogenic Non-Epileptic Seizure (PNES) spell reduction and resolution in patients with PNES, with and without comorbid epileptic seizures (ES). METHODS A retrospective analysis was conducted on data from 145 patients with PNES, including 109 with PNES alone and 36 with PNES plus comorbid epilepsy. Patients were admitted to the Epilepsy Monitoring Unit (EMU) between May 2000 and April 2008, with follow-up clinical data collected until September 2015. Clinical records were thoroughly examined, encompassing the period preceding the PNES diagnosis until either loss to follow-up or September 2015. A subsequent chart review was conducted by two neurologists, covering the period following the diagnosis of PNES until either loss to follow-up or September 2015, which ever came first. RESULTS Patients with PNES alone had higher rates of ASM reduction for all variables of ASM reduction measured compared to those with comorbid epilepsy (all at p < 001). Among patients with PNES alone, reductions in ASMs were observed after EMU discharge, but an uptick and plateau were seen in later follow-up years (100% of patients free of ASMs at years 2-3, 20% on at least one ASM by year 7). This pattern differs greatly in PNES + ES patients, in which the only time point at which any patient was able to discontinue all ASMs was at EMU discharge (4.5% of patients), with all patients taking at least one ASM for every other follow-up time point. Reductions in PNES spell frequency did not differ significantly between the two groups (for example PNES spells reduced at final FU 47.2% vs 42.9%, p = 0.65). In both groups, despite an initial drop in variables of PNES spell reduction and resolution in the early years post discharge, there is an eventual rebound and plateau (for example in PNES only patients, 33.9% of patients having no resolution in 1st year FU, which rises to 78% at years 4-5, and plateus around 52.8% at more than 7 years follow-up.) SIGNIFICANCE: This study contributes to the growing body of research focused on improving the current approach to management and prognostic outlook of PNES. Although PNES only patients had higher rates of ASM reduction, the uptick and plateau observed in later years highlights the challenges in managing PNES. Similarly, the continued persistence and rebound of PNES spells underline the continued poor prognostic outcomes associated with this condition.
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Affiliation(s)
- Pouyan Tavakoli Yaraki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yeyao Joe Yu
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mashael AlKhateeb
- Neurology Section, Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Diagnostic Imaging, Biomedical Imaging and Psychology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Popkirov S, Jungilligens J, Michaelis R. [Understanding and explaining functional movement disorders]. Nervenarzt 2024:10.1007/s00115-024-01619-3. [PMID: 38363298 DOI: 10.1007/s00115-024-01619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Functional movement disorders are not uncommon in neurological consultations, hospitals and emergency departments. Although the disorder can usually be recognized clinically, the communication of the diagnosis is often unsatisfactory. Those affected are indirectly accused of a lack of insight or openness but it is often the doctors who fail to formulate a coherent and comprehensible explanation of the underlying disorder. In this review an integrative model for the development of functional movement disorders is presented, which places the motor (and nonmotor) symptoms in a neuroscientific light. In addition, explanations and metaphors are presented that have proven helpful in conveying an understanding of the disorder.
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Affiliation(s)
- Stoyan Popkirov
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - Johannes Jungilligens
- Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - Rosa Michaelis
- Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
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11
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Silverberg ND, Rush BK. Neuropsychological evaluation of functional cognitive disorder: A narrative review. Clin Neuropsychol 2024; 38:302-325. [PMID: 37369579 DOI: 10.1080/13854046.2023.2228527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Objective: To critically review contemporary theoretical models, diagnostic approaches, clinical features, and assessment findings in Functional Cognitive Disorder (FCD), and make recommendations for neuropsychological evaluation of this condition. Method: Narrative review. Results: FCD is common in neuropsychological practice. It is characterized by cognitive symptoms that are not better explained by another medical or psychiatric disorder. The cognitive symptoms are associated with distress and/or limitations in daily functioning, but are potentially reversible with appropriate identification and treatment. Historically, a variety of diagnostic frameworks have attempted to capture this condition. A contemporary conceptualization of FCD positions it as a subtype of Functional Neurological Disorder, with shared and unique etiological factors. Patients with FCD tend to perform normally on neuropsychological testing or demonstrate relatively weak memory acquisition (e.g. list learning trials) in comparison to strong attention and delayed recall performance. Careful history-taking and behavioral observations are essential to support the diagnosis of FCD. Areas of ongoing controversy include operationalizing "internal inconsistencies" and the role of performance validity testing. Evidence for targeted interventions remains scarce. Conclusions: Neuropsychologists familiar with FCD can uniquely contribute to the care of patients with this condition by improving diagnostic clarity, richening case formulation, communicating effectively with referrers, and leading clinical management. Further research is needed to refine diagnosis, prognosis, and treatment.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Beth K Rush
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida, USA
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van Dijl TL, Aben HP, Synhaeve NE, de Waardt DA, Videler AC, Kop WJ. Alexithymia and facial emotion recognition in patients with functional neurological disorder. Clin Neurol Neurosurg 2024; 237:108128. [PMID: 38325039 DOI: 10.1016/j.clineuro.2024.108128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Patients with functional neurological disorder (FND) are known to have difficulties recognizing and processing emotions. Problems recognizing internal emotional states (alexithymia) are common in FND, but little is known about recognizing emotions expressed by other people. This study investigates whether patients with FND have higher levels of alexithymia and reduced facial emotion recognition compared to healthy controls. METHODS Patients with FND (n = 31, mean age=42.7 [SD=14.8] years, 54.8% women) were compared to healthy controls (n = 33, mean age=45.1 [SD=16.2] years, 63.6% women). The Bermond-Vorst Alexithymia Questionnaire (BVAQ) was used for the assessment of alexithymia and the Ekman 60 Faces Test (EFT) for facial emotion recognition. RESULTS Patients with FND had higher levels of alexithymia than healthy controls (BVAQ=71.8 [SD=19.8] versus 59.3 [SD=20.3], p = .02, Cohen's d=0.62). Facial emotion recognition did not significantly differ between FND patients and controls (EFT total score FND: 46.1 [SD=5.9], Controls: 47.5 [SD=5.5], p = .34, Cohen's d=0.24). Only recognition of surprise differed between patients and controls (FND: 8.4 [SD=1.8], Controls: 9.2 [SD=1.0), p = .03, Cohen's d= 0.56). Higher levels of alexithymia were associated with poorer facial emotion recognition, but this relationship was not statistically significant (FND: β= -0.20, p = .28; Controls: β=-0.03; p = .87). CONCLUSIONS The current data confirm prior observations that patients with FND have higher alexithymia levels than controls without FND. Difficulties recognizing emotions among patients with FND primarily involves recognition of internal emotional states rather than recognition of facially expressed emotions by others. These findings require replication in a larger and more divers sample.
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Affiliation(s)
- T L van Dijl
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Center for Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands; Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Child and Adolescent Psychiatry, De Hoop ggz, Dordrecht, the Netherlands.
| | - H P Aben
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - N E Synhaeve
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - D A de Waardt
- Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - A C Videler
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands; Department Tranzo, Tilburg University, Tilburg, the Netherlands
| | - W J Kop
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Center for Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
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13
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Foley C, Kirkby A, Eccles FJR. A meta-ethnographic synthesis of the experiences of stigma amongst people with functional neurological disorder. Disabil Rehabil 2024; 46:1-12. [PMID: 36519449 DOI: 10.1080/09638288.2022.2155714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Functional neurological disorder (FND) causes many neurological symptoms and significant disability. It is often misunderstood by medical professionals and the public meaning stigma is regularly reported. The aim of this review was to synthesise the qualitative findings in the literature to develop a more in-depth understanding of how people with FND experience stigma to inform future interventions. METHOD This review used a meta-ethnography approach. Five databases were searched (PsycINFO, Web of Science, CINAHL, MEDLINE, and EMBASE) in February 2021 and updated in July 2022 for qualitative papers in FND. Included papers were critically assessed using the critical appraisal skills programme (CASP) checklist. Data were analysed and synthesised utilising meta-ethnography. RESULTS AND CONCLUSION Sixteen papers were included in the final synthesis. Four major themes emerged: stigmatized by delegitimization; stigmatized by social exclusion and rejection; coping with stigma; and stigma and identity. The results identified negative, stigmatizing attitudes towards people experiencing FND symptoms in a variety of contexts including healthcare and other social institutions. The effects of stigma led to further exclusion for participants and appeared to trigger coping styles that led to additional difficulty. Stigma is a key part of the illness experience of FND and needs to be addressed.
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Affiliation(s)
- Ciarán Foley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Antonia Kirkby
- Department of Clinical Neuropsychology, Salford Royal Hospital, Salford, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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14
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Chen T, Papaioannou V, Liberman G, Gordon KA, Papsin BC, Cushing SL. Importance of early objective auditory testing in the presentation of sudden sensorineural hearing loss in children. Am J Otolaryngol 2024; 45:104087. [PMID: 37839178 DOI: 10.1016/j.amjoto.2023.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Functional hearing loss can be due to an auditory manifestation of functional neurological disorder, previously known as conversion disorder. METHODS This is a case series of 3 pediatric patients with a diagnosis of idiopathic SSNHL who ultimately were found to have functional neurological disorder. RESULTS Average age was 12.7 years at presentation (range 10-14 years). All three patients underwent invasive interventions prior to their initial clinic visit. All patients demonstrated profound SNHL on behavioural audiogram, but normal otoacoustic emissions (OAE) and auditory brainstem response testing. With counselling, both patients demonstrated significant hearing improvement. CONCLUSIONS Early use of OAE's in the workup of SSNHL can avoid unnecessary and potentially harmful therapies and expedite access to counselling services which may help lead to symptom resolution.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vicky Papaioannou
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada
| | - Gillian Liberman
- Social Work Department, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Blake C Papsin
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
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15
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Connors MH, Quinto L, Deeley Q, Halligan PW, Oakley DA, Kanaan RA. Hypnosis and suggestion as interventions for functional neurological disorder: A systematic review. Gen Hosp Psychiatry 2024; 86:92-102. [PMID: 38154334 DOI: 10.1016/j.genhosppsych.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/10/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Functional neurological disorder (FND) involves the presence of neurological symptoms that cannot be explained by neurological disease. FND has long been linked to hypnosis and suggestion, both of which have been used as treatments. Given ongoing interest, this review examined evidence for the efficacy of hypnosis and suggestion as treatment interventions for FND. METHOD A systematic search of bibliographic databases was conducted to identify group studies published over the last hundred years. No restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, extracted data, and rated study quality. RESULTS The search identified 35 studies, including 5 randomised controlled trials, 2 non-randomised trials, and 28 pre-post studies. Of 1584 patients receiving either intervention, 1379 (87%) showed significant improvements, including many who demonstrated resolution of their symptoms in the short-term. Given the heterogeneity of interventions and limitations in study quality overall, more formal quantitative synthesis was not possible. CONCLUSIONS The findings highlight longstanding and ongoing interest in using hypnosis and suggestion as interventions for FND. While the findings appear promising, limitations in the evidence base, reflecting limitations in FND research more broadly, prevent definitive recommendations. Further research seems warranted given these supportive findings.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia; Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia.
| | - Lena Quinto
- Forensic & Analytical Science Services, NSW Health, Sydney, Australia
| | - Quinton Deeley
- Cultural and Social Neuroscience Research Group, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - David A Oakley
- School of Psychology, Cardiff University, Cardiff, UK; Division of Psychology & Language Sciences, University College London, London, UK
| | - Richard A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia
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16
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Charney M, Foster S, Shukla V, Zhao W, Jiang SH, Kozlowska K, Lin A. Neurometabolic alterations in children and adolescents with functional neurological disorder. Neuroimage Clin 2023; 41:103557. [PMID: 38219534 PMCID: PMC10825645 DOI: 10.1016/j.nicl.2023.103557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/22/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES In vivo magnetic resonance spectroscopy (MRS) was used to investigate neurometabolic homeostasis in children with functional neurological disorder (FND) in three regions of interest: supplementary motor area (SMA), anterior default mode network (aDMN), and posterior default mode network (dDMN). Metabolites assessed included N-acetyl aspartate (NAA), a marker of neuron function; myo-inositol (mI), a glial-cell marker; choline (Cho), a membrane marker; glutamate plus glutamine (Glx), a marker of excitatory neurotransmission; γ-aminobutyric acid (GABA), a marker of inhibitor neurotransmission; and creatine (Cr), an energy marker. The relationship between excitatory (glutamate and glutamine) and inhibitory (GABA) neurotransmitter (E/I) balance was also examined. METHODS MRS data were acquired for 32 children with mixed FND (25 girls, 7 boys, aged 10.00 to 16.08 years) and 41 healthy controls of similar age using both short echo point-resolved spectroscopy (PRESS) and Mescher-Garwood point-resolved spectroscopy (MEGAPRESS) sequences in the three regions of interest. RESULTS In the SMA, children with FND had lower NAA/Cr, mI/Cr (trend level), and GABA/Cr ratios. In the aDMN, no group differences in metabolite ratios were found. In the pDMN, children with FND had lower NAA/Cr and mI/Cr (trend level) ratios. While no group differences in E/I balance were found (FND vs. controls), E/I balance in the aDMN was lower in children with functional seizures-a subgroup within the FND group. Pearson correlations found that increased arousal (indexed by higher heart rate) was associated with lower mI/Cr in the SMA and pDMN. CONCLUSIONS Our findings of multiple differences in neurometabolites in children with FND suggest dysfunction on multiple levels of the biological system: the neuron (lower NAA), the glial cell (lower mI), and inhibitory neurotransmission (lower GABA), as well as dysfunction in energy regulation in the subgroup with functional seizures.
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Affiliation(s)
- Molly Charney
- Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sheryl Foster
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Radiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Vishwa Shukla
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wufan Zhao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam H Jiang
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia; Brain Dynamics Centre, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Calma AD, Heffernan J, Farrell N, Gelauff J, O'Connell N, Perez DL, Perriman D, Smyth L, Stone J, Lueck CJ. The Impact of Depression, Anxiety and Personality Disorders on the Outcome of Patients with Functional Limb Weakness - Individual Patient Data Meta-Analysis. J Psychosom Res 2023; 175:111513. [PMID: 37832273 DOI: 10.1016/j.jpsychores.2023.111513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Psychiatric comorbidities such as depression, anxiety, and personality disorders are common in patients with functional limb weakness/paresis (FND-par). The impact of these conditions on the prognosis of FND-par has not been systematically reviewed. The aim of this study was to identify a potential prognostic effect of comorbid depression, anxiety, and/or personality disorder on prognosis in patients with FND-par. METHODS A systematic review was performed to identify studies that reported measures of baseline depression, anxiety, and/or personality disorder, and physical disability. An individual patient data meta-analysis was subsequently performed. RESULTS Eight studies comprising 348 individuals were included (7 prospective cohorts; 1 case-control study). There was heterogeneity in sample size, follow-up duration, and treatment modality. Depression and anxiety were present in 51.4% and 53.0% of FND-par patients, respectively. In individuals whose FND-par improved, there was no significant difference between those with versus without depression (52.6% vs 47.4%, p = 0.69) or those with versus without anxiety (50.3% vs 49.7%, p = 0.38). Meta-analysis showed no clear impact of baseline depression or anxiety per se [pooled OR for depression 0.85 (95%CI 0.50-1.45; p = 0.40) and anxiety 0.84 (95%CI 0.51-1.38; p = 0.91)]; and of depression or anxiety severity [pooled OR for depression 1.23 (95%CI 0.63-2.39; p = 0.91) and anxiety 1.40 (95%CI 0.70-2.78; p = 0.58)] on FND-par outcome. Insufficient data were available to assess the impact of personality disorders. CONCLUSION We found no evidence that depression or anxiety influenced outcome in FND-par. Large-scale, prospective studies in FND-par, and other FND subtypes, are needed to fully contextualize the impact of concurrent mental health concerns on outcomes.
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Affiliation(s)
- Aicee Dawn Calma
- Department of Neurosciences Concord Repatriation General Hospital, Sydney, Australia; School of Medicine and Psychology, Australian National University, Canberra, Australia; Department of Neurology, Canberra Hospital Health Services, Canberra, Australia.
| | - James Heffernan
- School of Medicine and Psychology, Australian National University, Canberra, Australia; Department of Neurology, Canberra Hospital Health Services, Canberra, Australia
| | - Neil Farrell
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Jeanette Gelauff
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nicola O'Connell
- Sexual Health and Crisis Pregnancy Programme, Health Service Executive, Dublin 1, Ireland
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Perriman
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Lilian Smyth
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Christian J Lueck
- School of Medicine and Psychology, Australian National University, Canberra, Australia; Department of Neurology, Canberra Hospital Health Services, Canberra, Australia
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18
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Ohira M, Osada T, Kimura H, Sano T, Takao M. Clinical characteristics of motor functional neurological disorder manifesting as limb weakness after vaccination against coronavirus disease 2019: A case series. eNeurologicalSci 2023; 33:100487. [PMID: 38046447 PMCID: PMC10692754 DOI: 10.1016/j.ensci.2023.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/04/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023] Open
Abstract
Background The characteristics of functional limb weakness (FLW) as one of the manifestations of functional neurological disorder after vaccination against coronavirus disease 2019 (COVID-19) remain controversial. Methods In this descriptive case series, we aimed to elucidate the characteristics of Japanese patients with FLW who claimed muscle weakness after COVID-19 vaccination among patients who visited our outpatient clinic between 1 June 2021 and 31 December 2022. Results Nine patients were diagnosed with FLW (mean age: 30.8 years), including two men and seven women. Seven patients were vaccinated with the BioNTech/Pfizer vaccine and two with the mRNA-1273 Moderna vaccine. All patients demonstrated various positive signs for FLW. Magnetic resonance imaging or computed tomography indicated no abnormality that could explain their symptoms. At the time of the clinic visit, five patients were treated for psychiatric disorders, including depression, insomnia, attention-deficit hyperactivity disorder, and Asperger's syndrome. Muscle weakness spread to the limbs beyond the vaccinated arm in seven patients. Conclusions We describe the basic characteristics of FLW in Japanese patients after COVID-19 vaccination. Further recognition of these characteristics could aid the diagnosis of FLW by physicians allowing them to support these patients effectively.
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Affiliation(s)
- Masayuki Ohira
- Department of General Internal Medicine and Clinical Laboratory, National Center of Neurology and Psychiatry National Center Hospital, Kodaira, Tokyo, Japan
| | - Takashi Osada
- Department of General Internal Medicine, National Center of Neurology and Psychiatry National Center Hospital, Kodaira, Tokyo, Japan
| | - Hiroaki Kimura
- Department of General Internal Medicine, National Center of Neurology and Psychiatry National Center Hospital, Kodaira, Tokyo, Japan
| | - Terunori Sano
- Department of General Internal Medicine and Clinical Laboratory, National Center of Neurology and Psychiatry National Center Hospital, Kodaira, Tokyo, Japan
| | - Masaki Takao
- Department of General Internal Medicine, National Center of Neurology and Psychiatry National Center Hospital, Kodaira, Tokyo, Japan
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19
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Drane DL, Hewitt KC, Price ME, Rush BK, Blackmon K, Okada N, Shade T, Valentin E, Vinson J, Rosen P, Loring DW. Case study of invalid to valid shift in cognitive performance following successful treatment of psychogenic nonepileptic seizure events. J Clin Exp Neuropsychol 2023; 45:1024-1038. [PMID: 38533868 DOI: 10.1080/13803395.2024.2335600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
Patients with psychogenic nonepileptic seizure (PNES) who fail performance validity testing (PVT) may appear to produce non-valid cognitive profiles. Consequently, they may not get referred to treatment and events persist, with worsening disability and high resource utilization. As a result, we report pre- and post-treatment neuropsychological evaluation findings in a 59-year-old woman with a confirmed diagnosis of PNES established using video-EEG monitoring. At pre-treatment baseline neuropsychological evaluation, PNES events occurred weekly to daily. Performance was impaired across PVTs and across multiple cognitive domains. After behavioral intervention specific to PNES, these events substantially reduced in frequency to rare stress-induced flares. Post-treatment neuropsychological evaluation revealed marked improvement of most cognitive and behavioral scores from baseline, and valid PVT scores. We review predisposing, precipitating, and perpetuating factors for PNES and cognitive impairment in this case and discuss the patient's outcome from treatment. Effectively managing PNES events and dissociative tendencies while reducing unnecessary pharmacological interventions appears to have allowed this patient to function closer to her optimal state. This case illustrates the complexity of Functional Neurologic Disorder (FND) clinical presentation and challenges the assumption that suboptimal neuropsychological performance predicts poor treatment engagement and outcome. We showcase the reversibility of PNES and cognitive manifestations of FND using targeted psychotherapeutic interventions, which resulted in reduced disability and associated healthcare costs, as well as re-engagement in life.
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Affiliation(s)
- Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Kelsey C Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Michele E Price
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Beth K Rush
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Karen Blackmon
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Noah Okada
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taylor Shade
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edward Valentin
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Vinson
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Phyllis Rosen
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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20
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de Vroege L, van Dijl TL, Woudstra-de Jong JE, Videler AC, Kop WJ. Personality traits related to cognitive functioning in patients with functional neurological disorder. J Clin Exp Neuropsychol 2023; 45:1014-1023. [PMID: 38623749 DOI: 10.1080/13803395.2024.2335599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 04/17/2024]
Abstract
Cognitive symptoms are prevalent in patients with functional neurological disorder (FND). Several studies have suggested that personality traits such as neuroticism may play a pivotal role in the development of FND. FND has also been associated with alexithymia: patients with FND report difficulties in identifying, analyzing, and verbalizing emotions. Whether or not alexithymia and other personality traits are associated with cognitive symptomatology in patients with FND is unknown. In the current study, we explored whether the Big Five personality model factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and alexithymia were associated with cognitive functioning in FND. Twenty-three patients with FND were assessed using a neuropsychological assessment and questionnaire assessment to explore personality traits (Neuroticism-Extraversion-Openness Five-Factor Inventory) and alexithymia (Bermond-Vorst Alexithymia Questionnaire). The results indicated that high conscientiousness was associated with lower planning scores (ρ = -0.52, p = .012) and high scores on alexithymia were associated with lower scores on verbal memory scores (ρ = -0.46, p = .032) and lower sustained attention scores (ρ = -0.45, p = .046). The results did not remain significant after controlling for multiple testing. The preliminary results of our study suggest that personality and cognitive symptomatology in patients with FND are topics that should be further explored in future studies, as cognitive symptomology can affect treatment results.
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Affiliation(s)
- Lars de Vroege
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Timothy L van Dijl
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | | | - Arjan C Videler
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Personacura, Clinical Centre of Excellence for Personality and Developmental Disorders in Older Adults, GGz Breburg, Tilburg, The Netherlands
| | - Willem J Kop
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
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21
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Lerario MP, Fusunyan M, Stave CD, Roldán V, Keuroghlian AS, Turban J, Perez DL, Maschi T, Rosendale N. Functional neurological disorder and functional somatic syndromes among sexual and gender minority people: A scoping review. J Psychosom Res 2023; 174:111491. [PMID: 37802674 DOI: 10.1016/j.jpsychores.2023.111491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To describe the current literature on functional neurological disorder and functional somatic syndromes among sexual and gender minority people (SGM). METHODS A search string with descriptors of SGM identity and functional disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles published before May 24, 2022, yielding 3121 items entered into Covidence, where 835 duplicates were removed. A neurologist and neuropsychiatrist screened titles and abstracts based on predefined criteria, followed by full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent systematic data extraction and statistical description. RESULTS Our search identified 26 articles on functional disorders among SGM people. Most articles were case (13/26, 46%) or cross-sectional (4/26, 15%) studies. Gender minority people were represented in 50% of studies. Reported diagnoses included fibromyalgia (n = 8), functional neurological disorder (n = 8), somatic symptom disorder (n = 5), chronic fatigue syndrome (n = 3), irritable bowel syndrome (n = 2), and other functional conditions (n = 3). Three cohort studies of fibromyalgia or somatic symptom disorder reported an overrepresentation of gender minority people compared to cisgender cohorts or general population measures. Approximately half of case studies reported pediatric or adolescent onset (7/13, 54%), functional neurological disorder diagnosis (7/13, 54%), and symptom improvement coinciding with identity-affirming therapeutic interventions (7/13, 58%). CONCLUSION Despite a methodologically rigorous literature search, there are limited data on functional neurological disorder and functional somatic syndromes among SGM people. Several studies reported increased prevalence of select conditions among transgender people. More observational studies are needed regarding the epidemiology and clinical course of functional disorders among SGM people.
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Affiliation(s)
- Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, United States of America; Greenburgh Pride, Westchester, NY, United States of America.
| | - Mark Fusunyan
- Department of Psychiatry, Santa Clara Valley Medical Center, San Jose, CA, United States of America
| | - Christopher D Stave
- Lane Medical Library, Stanford University, Stanford, CA, United States of America.
| | - Valeria Roldán
- Facultad de Medicina Alberto Hurtado, La Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Boston, MA, United States of America.
| | - Jack Turban
- Division of Child & Adolescent Psychiatry, University of California San Francisco, United States of America.
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Tina Maschi
- Fordham Graduate School of Social Service, New York, NY, United States of America; Greenburgh Pride, Westchester, NY, United States of America.
| | - Nicole Rosendale
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America; Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States of America.
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22
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Perez DL, Finkelstein S, Adams C, Saxena A. Toward a Precision Medicine Approach to the Outpatient Assessment and Treatment of Functional Neurological Disorder. Neurol Clin 2023; 41:681-693. [PMID: 37775198 DOI: 10.1016/j.ncl.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional neurological disorder (FND) is a neuropsychiatric condition. In this field, prospective psychotherapy trials and consensus recommendations for physiotherapy, occupational therapy, and speech language therapy have been published. However, significant clinical complexities remain. "Rule in" signs - while critical for making a positive diagnosis - do not equate to a personalized treatment plan in many instances. Here, we propose that the neuropsychiatric assessment and real-time development of a work-in-progress biopsychosocial clinical formulation aids the development of a patient-centered outpatient treatment plan. This precision medicine approach is based on the literature, expert opinions and our clinical experience working in an interdisciplinary FND service.
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Affiliation(s)
- David L Perez
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
| | - Sara Finkelstein
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Adams
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Aneeta Saxena
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Finkelstein SA, Popkirov S. Functional Neurological Disorder: Diagnostic Pitfalls and Differential Diagnostic Considerations. Neurol Clin 2023; 41:665-679. [PMID: 37775197 DOI: 10.1016/j.ncl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Functional neurologic disorder (FND) is a "rule-in" diagnosis, characterized by positive examination signs or semiological features. Similar to other clinical diagnoses, providers should ideally see robustly present features, including if possible the identification of multiple features consistent with FND for the diagnosis to be made with a high degree of certainty. Diagnostic pitfalls need to be guarded against and vary depending on FND symptom subtype and the specific patient presentation. This perspective article aims to review pitfalls based on an FND symptom subtype, as well as discuss differential diagnostic considerations with respect to both neurologic and psychiatric entities.
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Affiliation(s)
- Sara A Finkelstein
- Department of Neurology, Functional Neurological Disorder Unit, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 20114, USA.
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, Bochum 44892, Germany.
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24
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Finkelstein SA, Carson A, Edwards MJ, Kozlowska K, Lidstone SC, Perez DL, Polich G, Stone J, Aybek S. Setting up Functional Neurological Disorder Treatment Services: Questions and Answers. Neurol Clin 2023; 41:729-743. [PMID: 37775201 DOI: 10.1016/j.ncl.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Functional neurologic disorder (FND) is commonly encountered across outpatient and inpatient medical settings. Given the potential for a high burden of disability in some patients and mounting evidence for the efficacy of FND-specific multidisciplinary treatment services, expanding clinical services for this population is a necessity. In this perspective article, we discuss considerations for creating FND services, including the types of services that exist, how to start, how to identify appropriate referrals, and how to develop and monitor individualized treatment plans. In addition, we discuss how this effort can be done sustainably - balancing patient needs with limited healthcare resources.
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Affiliation(s)
- Sara A Finkelstein
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
| | - Alan Carson
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kasia Kozlowska
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead Institute for Medical Research, Psychological Medicine, The Children's Hospital at Westmead, Cn Hawkesbury Road, Hainsworth Street, Westmead, NSW 2145, Australia
| | - Sarah C Lidstone
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Centre, Room 3-131, 550 University Avenue, Toronto ON M5G 2A2, Canada
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ginger Polich
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, MA 02129, USA
| | - Jon Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Bureau 2.106d, Chemin du Musée 5, 1700 Fribourg, Suisse
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25
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Cabreira V, McWhirter L, Carson A. Functional Cognitive Disorder: Diagnosis, Treatment, and Differentiation from Secondary Causes of Cognitive Difficulties. Neurol Clin 2023; 41:619-633. [PMID: 37775194 DOI: 10.1016/j.ncl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional cognitive disorder is an increasingly common cause of referral to the memory clinic. As a substantial source of disability, clinicians involved in the management of patients with cognitive complaints need to familiarize themselves with this important differential diagnosis. Our approach focuses on the identification of positive features of internal inconsistency (historical and clinical clues alongside patterns of performance) instead of an exclusionary approach. Although effective treatments are desperately needed, promising therapies include metacognitive retraining and cognitive-behavioral therapy modalities. Future research should focus on a better understanding of disease trajectories and outcomes as well as the development of evidence-based interventions.
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Affiliation(s)
- Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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26
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Vilyte G, Butler J, Pretorius C. Prevalence and comparison of psychological trauma and stressors in functional seizure patients from a public and private hospital. Seizure 2023; 112:112-120. [PMID: 37797429 DOI: 10.1016/j.seizure.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To date not much is known about the differences, if any, between patients with functional seizures (FS) from different socioeconomic backgrounds. We sought to compare the psychological stress and trauma profiles of patients with FS from a private and public hospital in Cape Town, South Africa. METHODS Only video-electroencephalography-confirmed patients with FS were eligible for the study. In this retrospective case-control study we collected data on self-reported demographic and psychological stressor/trauma variables using digital patient records starting with the earliest available digital patient record for each hospital. RESULTS A total of 321 patients from a private hospital and 68 patients from a public hospital were included in the study. Most factors showed no significant differences. However, public hospital patients had higher odds of being older (p = 0.002), almost nine times the odds of reporting physical violence by an intimate partner (aOR = 8.65, 95% CI [1.70, 44.08]), more than eight times the odds of reporting psychological stress in the form of death and/or sickness in the family (aOR = 8.56, 95% CI [1.81, 40.41]) and almost three times the odds for other general psychosocial stressors (aOR = 2.82, 95% CI [1.08, 7.42]) compared to those attending the private hospital. They also had half the odds of being female compared to the private hospital patients (aOR = 0.47, 95% CI [0.23, 0.95]) and 93% fewer odds of reporting coming from an abusive home (aOR = 0.07, 95% CI [0.01, 0.52]). CONCLUSION History and psychological trauma and stressor profiles showed many similarities between the public and private hospital groups; however, some differences were noted and could benefit further exploration and consideration in therapeutic and diagnostic contexts.
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Affiliation(s)
- Gabriele Vilyte
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa.
| | - James Butler
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chrisma Pretorius
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa
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27
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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28
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Freeburn JL, Baker J. Functional Speech and Voice Disorders: Approaches to Diagnosis and Treatment. Neurol Clin 2023; 41:635-646. [PMID: 37775195 DOI: 10.1016/j.ncl.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Historically, formal training for speech-language therapists (SLTs) in the area of functional speech and voice disorders (FSVD) has been limited, as has the body of empirical research in this content area. Recent efforts in the field have codified expert opinions on best practices for diagnosing and treating FSVD and have begun to demonstrate positive treatment outcomes. To provide comprehensive interventions for these complex conditions at the intersection of neurology, psychiatry, and other medical specialties, the SLT must not only build knowledge of diagnostic strategies and components of symptomatic treatment in FSVD but also embrace behavior change techniques and counseling strategies.
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Affiliation(s)
- Jennifer L Freeburn
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, MA, USA.
| | - Janet Baker
- Flinders University, Adelaide, Unit 111/3 Young Street, Randwick, NSW 2031, Australia
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29
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Abstract
The idea that a neurologist would do an 'FND clinic' or that functional neurological disorder (FND) could be a subspecialty of neurology would have been outlandish even 20 years ago but has become a reality in many places around the world. In this personal review, I reflect on 25 years of being a neurologist with an interest in FND, initially as a research fellow and later as a consultant/attending. I review lessons from diagnosis and management in the hope that they may assist other neurologists embarking on a similar career as well as other health professionals whose roles overlap.
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Affiliation(s)
- Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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30
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Abstract
Persistent postural-perceptual dizziness (PPPD) is a functional neuro-otologic (vestibular) disorder manifesting dizziness, unsteadiness, or nonspinning vertigo lasting 3 months or more and exacerbated by upright posture, active or passive motion, and complex visual stimuli. PPPD is the most common cause of chronic vestibular symptoms. Early pathophysiologic models of PPPD emphasized the adverse effects of anxiety on postural control and spatial orientation. More recent concepts added predictive processing of sensory inputs and alterations in motion perception. Herein, a third-generation model incorporates prioritization of postural stability over fluid locomotion to explain symptoms, physiologic and neuroimaging data, and effects of current treatments.
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Affiliation(s)
- Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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31
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Finkelstein SA, O'Neal MA, Gaston Baslet, Dworetzky BA, Godena E, Maggio J, Millstein D, Milligan T, Perez DL. Developing a Curriculum for Functional Neurological Disorder in Neurology Training: Questions and Answers. Neurol Clin 2023; 41:711-728. [PMID: 37775200 DOI: 10.1016/j.ncl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional neurologic disorder (FND) is a common condition for which neurology residents often receive little to no formal teaching. Using a question-and-answer format, this article puts forward a case for why an FND curriculum is needed and aims to provide guidance on possible curricular content including medical knowledge, clinical skills, communication, and team-based collaboration. The authors also discuss methods for teaching and evaluating this knowledge and associated clinical skills, linking this to current Accreditation Council for Graduate Medical Education neurology milestones. Finally, the authors consider how to better engage and energize neurology trainees around this underserved yet challenging patient population.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - M Angela O'Neal
- Division of General Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Gaston Baslet
- Division of Neuropsychiatry, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Barbara A Dworetzky
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Ellen Godena
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Julie Maggio
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Physical Therapy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tracey Milligan
- Department of Neurology, Westchester Medical Center Health Network, New York Medical College, Valhalla, NY, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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32
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Lerario MP, Rosendale N, Waugh JL, Turban J, Maschi T. Functional Neurological Disorder Among Sexual and Gender Minority People. Neurol Clin 2023; 41:759-781. [PMID: 37775203 DOI: 10.1016/j.ncl.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Sexual and gender minority (SGM) people can face unique stressors and structural discrimination that result in higher rates of neuropsychiatric symptoms, such as depression, anxiety, and suicidality. Although more rigorous studies are needed, emerging data suggest a possible higher prevalence of functional neurological disorder and other brain-mind-body conditions in SGM people. Representation and iterative feedback from affected community members is critical to the process of developing affirming environments. More research is needed to explore the relevance of functional neurologic disorder in SGM people within a biopsychosocial framework.
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Affiliation(s)
- Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, USA; Greenburgh Pride, Greenburgh, NY, USA.
| | - Nicole Rosendale
- Department of Neurology, University of California San Francisco; Weill Institute for Neurosciences, University of California San Francisco
| | - Jeff L Waugh
- Department of Pediatrics, UT Southwestern Medical School, Dallas, TX, USA
| | - Jack Turban
- Division of Child & Adolescent Psychiatry, University of California San Francisco
| | - Tina Maschi
- Fordham Graduate School of Social Service, New York, NY, USA; Greenburgh Pride, Greenburgh, NY, USA
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33
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Ranford J, MacLean J. Outpatient Approach to Occupational Therapy for Paroxysmal Functional Neurologic Symptoms: Sensory Modulation Training as an Emerging Treatment. Neurol Clin 2023; 41:695-709. [PMID: 37775199 DOI: 10.1016/j.ncl.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Occupational therapy (OT) is an important treatment modality for patients with paroxysmal functional neurologic disorder (FND) symptoms. In our clinical experience, an outpatient, OT-based sensory modulation treatment can address sensory processing difficulties often endorsed by patients with paroxysmal motor FND and functional seizures. This article aims to describe in detail the goals and treatment strategies for occupational therapists to replicate this approach. This article is also an important first step in aiding the development and execution of clinical trials to further evaluate the effectiveness of sensory-based treatment in patients with FND.
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Affiliation(s)
- Jessica Ranford
- Functional Neurological Disorder Unit and Research Group, Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center 8th Floor, Suite 835, 15 Parkman Street, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Wang Ambulatory Care Center 1st Floor, Suite 127, 15 Parkman Street, Boston, MA 02114, USA.
| | - Julie MacLean
- Functional Neurological Disorder Unit and Research Group, Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center 8th Floor, Suite 835, 15 Parkman Street, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Wang Ambulatory Care Center 1st Floor, Suite 127, 15 Parkman Street, Boston, MA 02114, USA
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34
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Zeun D, Hunter H. Physiotherapy management of functional movement disorders: the patient perspective. Disabil Rehabil 2023:1-9. [PMID: 37876224 DOI: 10.1080/09638288.2023.2272709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment. METHOD Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data. RESULTS Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn't, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery. CONCLUSION Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities.IMPLICATIONS FOR REHABILITATIONPatients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given.An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments.Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment.
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Affiliation(s)
- Debbie Zeun
- Department of Physiotherapy, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Heather Hunter
- Department of Physiotherapy, School of Health Professions, University of Plymouth, Plymouth, UK
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35
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Watson M, Woodward J, Strom LA. The Financial Burden of Functional Neurological Disorders. Curr Neurol Neurosci Rep 2023; 23:637-643. [PMID: 37695443 DOI: 10.1007/s11910-023-01298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Functional neurological disorder (FND) is a common and severely debilitating condition lacking clinical ownership, existing between neurology and psychiatry. This article reports the findings of recent research investigating the economic costs of FND diagnosis and management. We define what the costs are, why they exist, and suggest actionable steps to reduce them. RECENT FINDINGS The financial burden of FND exists across the globe characterized by high healthcare utilization resulting in exorbitant direct and indirect costs for the patient, healthcare system, and society. Inadequate medical education and stigmatization of the disorder prolong the time to diagnosis, during which cyclical utilization of inpatient and emergency department services drive up costs. Despite being cost-effective, lack of accessible treatment compounds the issue, leaving patients without a reliable exit. Recent findings support an increased awareness and the need for a cultural shift to overcome the financial burden associated with this underserved population.
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Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, CO, USA.
| | - Jared Woodward
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Laura A Strom
- Department of Neurology, University of Colorado, Aurora, CO, USA
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36
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Millman LSM, Short E, Stanton B, Winston JS, Nicholson TR, Mehta MA, Reinders AATS, Edwards MJ, Goldstein LH, David AS, Hotopf M, Chalder T, Pick S. Interoception in functional motor symptoms and functional seizures: Preliminary evidence of intact accuracy alongside reduced insight and altered sensibility. Behav Res Ther 2023; 168:104379. [PMID: 37516011 PMCID: PMC10788481 DOI: 10.1016/j.brat.2023.104379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Altered interoception may be a pathophysiological mechanism in functional neurological disorder (FND). However, findings have been inconsistent across interoceptive dimensions in FND including functional motor symptoms (FMS) and seizures (FS). Here, individuals with FMS/FS (n = 17) and healthy controls (HC, n = 17) completed measures of interoceptive accuracy and insight (adapted heartbeat tracking task [HTT] with confidence ratings), a time estimation control task (TET) and the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) to assess interoceptive sensibility. The groups did not differ in interoceptive accuracy (p = 1.00, g = 0.00) or confidence (p = .99, g = 0.004), although the FMS/FS group displayed lower scores on the "Not-Distracting" (p < .001, g = 1.42) and "Trusting" (p = .005, g = 1.17) MAIA-2 subscales, relative to HCs. The groups did not differ in TET performance (p = .82, g = 0.08). There was a positive relationship between HTT accuracy and confidence (insight) in HCs (r = .61, p = .016) but not in FMS/FS (r = 0.11, p = .69). HTT confidence was positively correlated with MAIA-2 "Self-Regulation" (r = 0.77, p = .002) and negatively correlated with FND symptom severity (r = -0.84, p < .001) and impact (r = -0.86, p < .001) in FMS/FS. Impaired interoceptive accuracy may not be a core feature in FMS/FS, but reduced insight and altered sensibility may be relevant. Reduced certainty in self-evaluations of bodily experiences may contribute to the pathogenesis of FND symptoms.
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Affiliation(s)
- L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
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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. 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Carle-Toulemonde G, Hingray C, Alaoui OM, Aybek S, Mouchabac S, Garcin B. [Overview of care management principles in functional neurological disorders]. Encephale 2023:S0013-7006(23)00089-1. [PMID: 37400336 DOI: 10.1016/j.encep.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
After more than twenty years of academic research on functional neurological disorders (FND) throughout the world, a standardized care management strategy has emerged to allow a more adapted care offer to patients with FND, as close as possible to their experience and their needs. With regard to this special issue on FND in collaboration with L'Encéphale and at the initiative of the Neuropsychiatry section of the AFPBN (French Association of Biological Psychiatry and Neuropsychopharmacology), we would like to suggest a summary of all topics discussed in more detail in each article of this special issue, in order to facilitate its reading. We therefore cover the following themes: the initial contact with a patient with FND, the diagnostic process in favor of a positive diagnosis, the physiological, neural and psychological basis of FND, the diagnostic announcement (and its intangibles), the therapeutic patient education in FND, the general principles of therapeutic management through a personalized and multidisciplinary care program, and the validated therapeutic tools available according to the symptoms identified. This article is designed to be of broad interest on FND, supported by tables and figures showing the key points of all these steps, to keep an educational purpose at most. We hope that through this special issue, each health professional will be able to grasp this knowledge and this framework of care as easily and quickly as possible, in order to participate in the standardization of the care offer.
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Affiliation(s)
- Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, 29, rue Émile-Lecrivain, 31400 Toulouse, France.
| | - Coraline Hingray
- Pôle universitaire du Grand Nancy, CPN/unité neuropsychiatrique, CHRU de Nancy, Nancy, France
| | - Othman Mounir Alaoui
- Service de neurologie, Assistance publique-Hôpitaux de Paris, CHU d'Avicenne, 93000 Bobigny, France
| | - Selma Aybek
- Département de neurologie, unité de médecine psychosomatique, hôpital universitaire de Bern Inselspital, université de Bern, Bern, Suisse
| | - Stéphane Mouchabac
- Sorbonne université, hôpital de la Pitié-Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), institut du cerveau et de la moelle (ICM), Inserm, CNRS, Paris, France
| | - Béatrice Garcin
- Service de neurologie, Assistance publique-Hôpitaux de Paris, CHU d'Avicenne, 93000 Bobigny, France
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Rauline G, Hingray C, Carle-Toulemonde G, Hubsch C, El Hage W, Conejero I, Samalin L, Garcin B, Gharib A. [Validated care programs for patients with functional neurological disorders]. Encephale 2023:S0013-7006(23)00087-8. [PMID: 37400332 DOI: 10.1016/j.encep.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. Diagnostic delay may lead to no treatment, inappropriate treatment or even iatrogenic symptoms. Yet, several treatments significantly reduce physical symptoms and improve functioning in FND patients even though not all patients respond to the currently available treatments. This review aims to describe the range of evidence-based rehabilitative and/or psychological therapeutic approaches available for FND patients. The most effective treatments are multidisciplinary and coordinated; using an outpatient or inpatient setting. Building a network of FND-trained healthcare professionals around the patient is an essential aspect of optimal patient management. Indeed, a supportive environment coupled with a collaborative therapeutic relationship improves understanding of FND and appears to help patients engage in appropriate treatments. Patients need to be invested in their own care and have to understand that recovery may depend on their commitment. The conventional treatment combines psychoeducation, physical rehabilitation and psychotherapy (cognitive and behavioral therapy, hypnosis, psychodynamic interpersonal therapy). Early referral of patients to physical therapy is recommended; however, the optimal parameters of treatment, duration and intensity are unknown and seem to vary with the severity and chronicity of symptoms. The goal is to minimize self-awareness by diverting attention or by stimulating automatically generated movements with non-specific and gradual exercises. The use of compensatory technical aids should be avoided as much as possible. Psychotherapeutic management should encourage self-evaluation of cognitive distortions, emotional reactions and maladaptive behaviors while empowering the patient in managing symptoms. Symptom management can use anchoring strategies to fight against dissociation. The aim is to connect to the immediate environment and to enrich one's sensoriality. The psychological interventions should then be adapted to the individual psychopathology, cognitive style and personality functioning of each patient. There is currently no known curative pharmacological treatment for FND. The pharmacological approach rather consists of progressively discontinuing medication that was introduced by default and that could lead to undesirable side effects. Finally, neurostimulation (transcranial magnetic stimulation, transcranial direct current stimulation) can be effective on motor FND.
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Affiliation(s)
| | - Coraline Hingray
- Pôle universitaire du Grand Nancy, CPN/unité neuropsychiatrique, CHRU de Nancy, Nancy, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, Toulouse, France
| | - Cécile Hubsch
- Parkinson Unit, Department of Neurology, Hospital Foundation Adolphe-de-Rothschild, Paris, France
| | - Wissam El Hage
- CHRU de Tours, clinique psychiatrique universitaire, Tours, France
| | - Ismaël Conejero
- Département de psychiatrie adulte, CHU de Nîmes, Nîmes, France
| | - Ludovic Samalin
- Département de psychiatrie, CHU de Clermont-Ferrand, université de Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Béatrice Garcin
- Service de neurologie, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France
| | - Axelle Gharib
- Centre bipol-AIR 9, rue Abraham-Bloch, 69007 Lyon, France.
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Mouchabac S, Lacambre M, Carle-Toulemonde G, Drapier D. [ Functional neurological disorders and forensic medicine: Clinical and practical characteristics]. Encephale 2023:S0013-7006(23)00088-X. [PMID: 37400335 DOI: 10.1016/j.encep.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorders (FND) have long been a challenge for medicine, both on clinical and psychodynamic point of view. The medico-legal issue is often relegated to the background in medicine, and FND patients also suffer from such neglected topic. Nonetheless, despite the difficulty to properly diagnose FND and the numerous associated organic and/or psychiatric comorbidities, FND patients report a significant level of deficiency and a high alteration of quality of life when compared to other well-recognized chronic disorders such as Parkinson's disease or epilepsy. Whether it is for the estimation of a personal injury, a prejudice, after-effects following a medical accident or certain legal contexts requiring the elimination of a factitious disorder or a simulation, the uncertainty and imprecision in the medico-legal assessment can imply notable consequences on the patient. In this article, we propose to define the different medico-legal contexts in which FND can occur that of the legal expert, that of the consulting physician, that of the so-called recourse physician and finally that of the attending physician who can provide detailed medical files to the patient in order to help him/her in his/her procedures. We then explain how to use standardized objective evaluation tools validated by the learned societies and how to encourage multidisciplinary cross-evaluation. Finally, we specify how to differentiate FND from historically FND-associated disorders (factitious and simulated disorders), through the clinical criteria, considering the difficulties linked to the uncertainty in the clinical examination of these disorders in a medico-legal context. In addition to the rigorous completion of expertise missions, we aim to reduce two damaging consequences characterizing FND: diagnostic delay and the patients' suffering through stigma.
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Affiliation(s)
- Stéphane Mouchabac
- Département de psychiatrie, hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France.
| | - Mathieu Lacambre
- Département urgence et post-urgence psychiatrique, Coordination de la filière psychiatrie légale, pôle urgences, CHU de Lapeyronie, Montpellier, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, Toulouse, France
| | - Dominique Drapier
- Département de psychiatrie adulte, CH Guillaume-Régnier, université de Rennes 1, centre d'investigation clinique CIC Inserm 1414, Rennes, France
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Cavanna AE, Purpura G, Riva A, Nacinovich R, Seri S. Neurodevelopmental versus functional tics: A controlled study. J Neurol Sci 2023; 451:120725. [PMID: 37421881 DOI: 10.1016/j.jns.2023.120725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND An unprecedented increase in newly developed functional tics, mainly in young females, has been reported during the COVID-19 pandemic. We set out to complement existing case series with the largest controlled study to date on the clinical phenomenology of functional tics versus neurodevelopmental tics. METHODS Data from 166 patients were collected at a specialist clinic for tic disorders during a three-year period overlapping with the COVID-19 pandemic (2020-2023). We compared the clinical features of patients who developed functional tics during the COVID-19 pandemic (N = 83) to patients with Tourette syndrome matched for age and gender (N = 83). RESULTS Female adolescents and young adults accounted for 86% of the clinical sample of patients with functional tics, who were less likely to report a family history of tic disorders than their matched controls with Tourette syndrome. Co-morbidity profiles were significantly different: anxiety and other functional neurological disorders were more strongly associated with functional tics, whereas attention-deficit and hyperactivity disorder and tic-related obsessive-compulsive behaviors co-occurred more frequently with neurodevelopmental tics. Overall, absence of tic-related obsessive-compulsive behaviors (t = 8.096; p < 0.001) and absence of a family history of tics (t = 5.111; p < 0.001) were the strongest predictors of the diagnosis of functional tics. Compared to neurodevelopmental tics, functional tics were more likely to present acutely/subacutely at a later age (21 versus 7 years), without a clear rostro-caudal progression. Coprophenomena, self-injurious behaviors, and complex clinical manifestations such as blocking tics, throwing tics, and tic attacks, were all over-represented in the functional group. CONCLUSIONS Our findings provide robust confirmation of both patient-related variables and tic characteristics contributing to the differential diagnosis between functional tics developed during the pandemic and neurodevelopmental tics reported by patients with Tourette syndrome.
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Affiliation(s)
- Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom; School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anna Riva
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Stefano Seri
- School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
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Higson L, Hipgrave W, O'Brien TJ, Rayner G, Alpitsis R, Kanaan RA, Winton-Brown T. Improving the treatment of functional seizures through a public specialist outpatient clinic. Epilepsy Behav 2023; 144:109259. [PMID: 37271019 DOI: 10.1016/j.yebeh.2023.109259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES We performed an audit of the first 12 months of clinical operations to assess the feasibility of a newly established public outpatient clinic for the assessment and treatment of functional (psychogenic nonepileptic) seizures (FS). METHOD Clinical notes for the first 12 months of the FSclinic weresystematicallyreviewed with data compiled onreferral pathways, clinic attendance, clinical features, treatments, and outcomes. RESULTS Of eighty-two new FS patients referred to the clinic, over 90% attended. Patients were diagnosed with FS after comprehensive epileptological and neuropsychiatric review, mostly with typical seizure-like episodes captured during video-EEG monitoring, and most accepted the diagnosis. Most had FS at least weekly, with little sense of control and significant impairment. The majority of individuals had significant psychiatric and medical comorbidity. Predisposing, precipitating, and perpetuating factors were readily identified in >90% of cases. Of 52 patients with follow-up data within12 months, 88% were either stable or improved in terms of the control of their FS. CONCLUSION The Alfred functional seizure clinic model, the first dedicated public outpatient clinic for FS in Australia, provides a feasible and potentially effective treatment pathway for this underserved and disabled patient group.
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Affiliation(s)
- Lana Higson
- Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.
| | - Walter Hipgrave
- Department of Psychiatry, Alfred Hospital, Melbourne, Victoria, Australia; Department of Psychiatry, Perth Children's Hospital
| | - Terence J O'Brien
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Genevieve Rayner
- Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Rubina Alpitsis
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Richard A Kanaan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Dept of Psychiatry, University of Melbourne, Austin Health, Heidelberg, VIC 3084
| | - Toby Winton-Brown
- Department of Psychiatry, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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Cavanna AE, Purpura G, Riva A, Nacinovich R, Seri S. New-onset functional tics during the COVID-19 pandemic: clinical characteristics of 105 cases from a single centre. Eur J Neurol 2023. [PMID: 37183565 DOI: 10.1111/ene.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic has been associated amongst others with a sharp increase in adolescents and young adults presenting acutely with functional tics. Initial reports have suggested clinically relevant differences between functional tics and neurodevelopmental tics seen in primary tic disorders such as Tourette syndrome. We aimed to provide confirmatory findings from the largest single-centre cohort to date. METHODS In the present study, we present data from 105 consecutive patients who developed functional tics during a three-year period overlapping with the COVID-19 pandemic (April 2020 to March 2023). All patients underwent a comprehensive neuropsychiatric assessment at a single specialist centre for tic disorders. RESULTS Female adolescents and young adults accounted for 69% of our sample. Functional tics had an acute/subacute onset in most cases (75% with a peak of severity within one month). We found a disproportionately high frequency of complex movements (81%) and vocalizations (75%). A subset of patients (23%) had a pre-existing primary tic disorder (Tourette syndrome with functional overlay). The most common psychiatric co-morbidities were anxiety (70%) and affective disorders (40%). Moreover, 41% of patients had at least one functional neurological disorder in addition to functional tics. Exposure to tic-related social media content was reported by half of the patients. CONCLUSIONS Our findings confirm substantial clinical differences between functional tics developed during the pandemic and neurodevelopmental tics. Both patient- and tic-related red flags support the differential diagnostic process and inform ongoing monitoring in the post-pandemic era.
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Affiliation(s)
- Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom
- School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anna Riva
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Stefano Seri
- School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
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Depierreux F, Moonen G. [ Functional neurological disorders: gait and movement disorders]. Rev Med Liege 2023; 78:267-272. [PMID: 37350200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Functional neurological disorders consist of a group of neurological symptoms and syndromes for which a known "organic" cause cannot be identified. They still represent one of the most difficult diagnostic challenge for the neurologist, who can only rely on clinical criteria. Functional gait and movement disorders represent an important subgroup of these conditions and a frequent reason for consultation. The neurobiological basis of these manifestations remains poorly understood despite the progress of functional neuroimaging. Beyond the diagnosis process, its communication to the patient and its meaning represent another challenge, which requires tactful explanations as a prerequisite to a successful management.
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Affiliation(s)
- Frédérique Depierreux
- Unité de Mouvements Anormaux, Département de Neurologie, CHU Liège, Belgique
- GIGA - CRC in vivo Imaging, ULiège, Belgique
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Baumans J, Scantamburlo G. [From preconceived ideas on hysteria to functional neurological disorder]. Rev Med Liege 2023; 78:261-266. [PMID: 37350199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Functional neurological disorders (FND), formerly called «conversion hysteria», are still poorly understood diseases that suffer from an outdated, sometimes erroneous and stigmatizing conception on the part of health care teams. Enlightened by historical concepts, we propose a modern reading of FND with the aim of deconstructing preconceived ideas and proposing a global, benevolent and individualized approach.
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Molero-Mateo P, Molina-Rueda F. Physiotherapy for patients with functional movement disorder: A systematic review. Neurologia 2023:S2173-5808(23)00033-0. [PMID: 37116691 DOI: 10.1016/j.nrleng.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/15/2022] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Functional movement disorder (FMD), a type of functional neurological disorder, is a common reason for consultation with the neurology department. The efficacy of physiotherapy for motor rehabilitation of these patients has been widely studied. The aim of this review is to analyse the available evidence on the effects of physiotherapy on motor symptoms, activity (gait, mobility, balance), perceived health, quality of life, and the cognitive/emotional state of patients with FMD. METHODS This review follows the PRISMA recommendations. Four electronic databases were searched for relevant articles. Our review included randomised controlled trials investigating the effects of a specialised physiotherapy intervention alone or in combination with other therapies as part of a multidisciplinary approach, with results compared against standard physiotherapy. RESULTS We reviewed 4 studies, including a total of 188 patients. We gathered data on the study population, outcome measures, protocols, and results. According to the Oxford quality scoring system, 3 studies had moderate methodological quality (3-4/5) and the remaining study presented poor methodological quality (<3). CONCLUSIONS Physiotherapy improves motor symptoms, activity, perceived health, and quality of life in patients with FMD.
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Affiliation(s)
- P Molero-Mateo
- Escuela de Máster Oficial, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain; Clínica San Vicente, Rehabilitación Daño Cerebral, Madrid, Spain
| | - F Molina-Rueda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain.
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Weil EJ, Keyserling H, Feuerstein B, Murphy O. Close Your Eyes and See: Stroke Sequelae versus Functional Neurological Disorder in a Physician. Eur Neurol 2023; 86:287-294. [PMID: 37080179 PMCID: PMC10614251 DOI: 10.1159/000530753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
The first author is a left-handed, 51-year-old nephrologist who experienced a neurologic event. She underwent neurosurgery complicated by hemorrhage. Postoperatively, she developed persistent vertigo and unilateral tongue pain which persisted for over 5 years. Early neuroimaging revealed expected encephalomalacia but no neuroanatomical basis for her symptoms. A functional neurological disorder was suspected, and she was seen by several psychiatrists and psychotherapists. However, she suspected a neuroanatomical lesion would better explain her unrelenting symptoms. After seeing many neurologists, a neuroanatomical diagnosis was finally made. The theory and practice of medicine mandate that subjective complaint guides the modality and interpretation of objective evidence. The final neurologist knew where on neuroimaging to look because she was guided by the patient's complaints - vertigo and unilateral tongue pain. In this case, detailed scrutiny of neuroimaging by a neurologist, after encephalomalacia and gliosis were fully completed, gave a more accurate neuroanatomical diagnosis and a more realistic prognosis.
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Affiliation(s)
- E. Jennifer Weil
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Harold Keyserling
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Burt Feuerstein
- Departments of Child Health and Neurology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Olwen Murphy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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Barth R, Gegusch M. [ Functional Neurological Disorders - A Common but Often Unrecognized Diagnosis]. Praxis (Bern 1994) 2023; 112:329-334. [PMID: 37042404 DOI: 10.1024/1661-8157/a003997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Functional Neurological Disorders - A Common but Often Unrecognized Diagnosis Abstract: Functional neurological disorders are frequent and diverse in the clinical presentation. Psychological factors are part of the development and perpetuation of symptoms; psychiatric comorbidities may be present, but are not an obligatory diagnostic criterion. The diagnosis is primarily made on the basis of anamnesis and positive clinical signs. The commonness and reversibility of the symptoms should be emphasised in the clinical consultation, and the positive clinical signs should be demonstrated. Science-based explanations as well as the bio-psycho-social model can help patients to understand their diagnosis, which is relevant for a successful therapeutic outcome. It is recommended to use the neutral and descriptive term "functional neurological disorder". Treatment of the potentially reversible disease will be interdisciplinary and multimodal.
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Affiliation(s)
- Rike Barth
- Universtitätsklinik für Neurologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Michaela Gegusch
- Klinik für Neurologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
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Bratanov C, Hot P, Vercueil L. The natural history of terms describing functional (neurological) disorders in the medical literature of the last 60 years. J Neurol 2023; 270:2010-2017. [PMID: 36547718 DOI: 10.1007/s00415-022-11526-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Functional neurological disorders (FND), a subtype of functional disorders (FD), are a frequent motive for neurology referrals. The various presentations and the unknown physiopathology of FD have led to the multiplication of terms describing these disorders over the years. METHODS We examined the FD-related articles published from 1960 to 2020 in PubMed and PsycINFO databases. We searched for: psychogenic, somatization, somatoform, medically unexplained symptoms, hysteria, conversion disorder, dissociative, functional neurological disorder, and functional disorder. Use rates in the title, abstract, keyword, or MeSH fields were collected over successive 5-year periods. After correcting for off-topic results, we examined proportional distribution over time, term associations, and disciplinary fields (neurology and psychiatry). Term impact was estimated via H-index and number of citations. RESULTS We found that none of the terms is prevailing in the recent medical literature. We observed three trends in the use rates: stability, increase, and decrease of use over time. While most of the terms were present in a stable proportion of the publications, hysteria and psychogenic lost popularity over time. We found a differential preference for terminology between disciplines. Functional neurological disorder showed the highest citation impact, yielding 10% of highly cited publications. CONCLUSION We found a dynamic and evolving use of the different terms describing FD in the last 60 years. Despite the tendency to use the term functional in the recent highly cited publications, its low prevalence and coexistence with several other terms suggest that a precise, explanatory and non-offensive term remains yet to be found.
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Affiliation(s)
- Christo Bratanov
- Neurology Department, CHU Grenoble Alpes, Av. des Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France.
| | - Pascal Hot
- Department of Psychology, Univ. Savoie Mont Blanc, CNRS, LPNC, Chambéry, France
- Institut Universitaire de France, Paris, France
| | - Laurent Vercueil
- Grenoble Institute Neurosciences, Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, 38000, Grenoble, France
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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: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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