Article
Psychology, Clinical
Zuzana Forejtova, Tereza Serranova, Tomas Sieger, Matej Slovak, Lucia Novakova, Gabriela Vechetova, Evzen Ruzicka, Mark J. Edwards
Summary: The study explored the relationships between various symptoms in FND patients and found significant correlations between self-reported and objective measures of motor and non-motor symptoms, as well as HRQoL. Despite attempting to identify subgroups within the cohort, cluster analysis showed a homogenous patient sample, supporting the idea of a unified pathophysiology for these symptoms.
PSYCHOLOGICAL MEDICINE
(2023)
Review
Clinical Neurology
Mark Hallett, Selma Aybek, Barbara A. Dworetzky, Laura McWhirter, Jeffrey P. Staab, Jon Stone
Summary: Functional neurological disorder is a common condition in neurological practice. The positive diagnosis of this disorder focuses on identifiable patterns of symptoms and signs that show variability over time. The pathophysiology involves overactivity of the limbic system, the development of an internal symptom model, and dysfunction of brain networks related to the sense of voluntariness in movement.
Article
Clinical Neurology
Kenneith Yong, Richard F. M. Chin, Jay Shetty, Kirsty Hogg, Kieran Burgess, Max Lindsay, Ailsa McLellan, Jon Stone, Krishnaraya KamathTallur
Summary: This study aimed to report the incidence, demographic and clinical characteristics, and symptom outcome of functional neurological disorder (FND) in children. The results showed that the annual incidence of FND in children was 18.3 per 100,000, with a higher likelihood in females and older children. Functional motor and sensory symptoms were the most common, along with other somatic symptoms such as headache and pain. Self-reported psychiatric symptoms and infection/inflammation were the most common predisposing and precipitating factors. At a median follow-up of 15 months, 49% of children reported improvement or resolution of FND symptoms, with no identified prognostic factors.
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY
(2023)
Article
Clinical Neurology
Mark J. Edwards, Mahinda Yogarajah, Jon Stone
Summary: In this Perspective, the authors argue that functional neurological disorder (FND) is fundamentally different from feigning and malingering based on clinical, epidemiological, and experimental evidence. FND is a common reason for seeking help from neurologists and can significantly impact individuals' quality of life. Despite the growing evidence regarding FND, there is still uncertainty among healthcare professionals about the authenticity of symptoms reported by FND patients and whether they are comparable to feigned symptoms or malingering. The authors aim to clarify this distinction through a comprehensive review of available evidence, hoping to improve attitudes, knowledge, treatments, care pathways, and outcomes for individuals with FND.
NATURE REVIEWS NEUROLOGY
(2023)
Article
Psychology, Clinical
Ibai Diez, Benjamin Williams, Marek R. Kubicki, Nikos Makris, David L. Perez
Summary: In this study, differences in white matter integrity were observed between FND patients and healthy controls, with specific brain regions showing correlations with symptom severity, physical disability, and illness duration. These findings provide valuable insights into the neurocircuit pathways involved in the pathophysiology of FND, particularly related to salience, defensive behaviors, and emotion regulation.
PSYCHOLOGICAL MEDICINE
(2021)
Article
Clinical Neurology
Katie Yoganathan, Naveed Malek, Emma Torzillo, Menaka Paranathala, John Greene
Summary: Structural and functional imaging of the brain, such as CT, MRI, fMRI, SPECT, and PET, plays an important role in planning surgery and predicting outcomes for patients with drug-resistant focal epilepsy. In patients with negative MRI results, PET or SPECT imaging can help localize the epileptogenic zone by demonstrating hypometabolism or hyperperfusion in the area surrounding the seizure focus. These imaging techniques are less invasive than intracranial EEG and can assist in planning EEG electrode placement. Multimodal imaging allows for better characterization of focal pathology and improved surgical outcomes. This paper provides an update on the field and offers practical guidance for selecting appropriate investigations and interpreting findings in patients with drug-resistant focal epilepsy.
JOURNAL OF NEUROLOGY
(2023)
Article
Emergency Medicine
Sara A. Finkelstein, Miguel A. Cortel-LeBlanc, Achelle Cortel-LeBlanc, Jon Stone
Summary: This narrative review provides an overview of functional neurological disorder (FND) in the emergency department (ED), emphasizing the shift towards diagnosing FND based on positive clinical signs. The review covers common functional neurological presentations and offers practical advice for discussing FND diagnosis and initial workup and management plans.
ACADEMIC EMERGENCY MEDICINE
(2021)
Review
Clinical Neurology
Myles Gutkin, Loyola McLean, Richard Brown, Richard A. Kanaan
Summary: Functional neurological disorder (FND) is a common and disabling disorder which is often challenging to treat. Psychological therapies, including cognitive behavioral therapy (CBT) and psychodynamic therapy (PDT), have shown medium-sized benefits for FND patients in terms of physical symptoms, mental health, well-being, function, and resource use. However, better quality studies are needed to further validate these findings.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2021)
Article
Clinical Neurology
Mirta Fiorio, Miriam Braga, Angela Marotta, Bernardo Villa-Sanchez, Mark J. Edwards, Michele Tinazzi, Diletta Barbiani
Summary: Functional neurological disorder (FND) refers to neurological symptoms that cannot be explained by structural neurological causes. The Bayesian predictive coding model suggests that perception relies on top-down cortical predictions to infer sensory information. This model may also apply to placebo and nocebo effects. The relationship between FND and placebo and nocebo effects extends beyond diagnosis and treatment, and shared cognitive, personality, and neuroanatomical factors may be involved. This new perspective offers potential insights into the pathogenesis of FND and the identification of therapeutic targets.
NATURE REVIEWS NEUROLOGY
(2022)
Review
Clinical Neurology
Mark Hallett, Lourdes M. DelRosso, Rodger Elble, Raffaele Ferri, Fay B. Horak, Stephan Lehericy, Martina Mancini, Masao Matsuhashi, Riki Matsumoto, Muthuraman Muthuraman, Jan Raethjen, Hiroshi Shibasaki
Summary: Clinical neurophysiology studies play a crucial role in understanding the physiology of human movement and the pathophysiology and diagnosis of various movement disorders, utilizing a range of methods and techniques such as EMG, EEG, MEG, etc.
CLINICAL NEUROPHYSIOLOGY
(2021)
Review
Cell Biology
Fei Liang, Qiuyue Xu, Mingchen Jiang, Rou Feng, Shan Jiang, Bin Yuan, Shijun Xu, Ting Wu, Fushun Wang, Jason H. Huang
Summary: Functional neurologic disorders, also known as conversion disorder, exhibit symptoms similar to other neurological diseases, but research on the impact of emotional developmental variables is lacking. Recent studies focus on emotional stress and the role of monoamine neuromodulators, highlighting the significance of psychosocial adversity as a risk factor for FND.
FRONTIERS IN CELL AND DEVELOPMENTAL BIOLOGY
(2021)
Article
Clinical Neurology
Tina Mainka, Jan-Frederik Fischer, Julius Huebl, Alexandra Jung, Dinah Lier, Alexandra Mosejova, Matej Skorvanek, Tom J. de Koning, Andrea A. Kuehn, Peter Freisinger, Athanasia Ziagaki, Christos Ganos
Summary: This study identified a range of neurological and neuropsychiatric symptoms in late-treated PKU adults, including developmental delay, intellectual disability, movement disorders, and neuropsychiatric characteristics. The presence of these symptoms in adults should raise suspicion for PKU, and adherence to treatment can help alleviate symptom severity.
PARKINSONISM & RELATED DISORDERS
(2021)
Review
Clinical Neurology
Petra Schwingenschuh, Alberto J. Espay
Summary: Functional tremor is the most common functional movement disorder characterized by inconsistent and incongruent features. It can be diagnosed without additional neurological investigations and is associated with impaired emotion processing and abnormal connectivity in the brain. Treatment options are limited but interventions such as physiotherapy and cognitive behavioral therapy are being studied for their efficacy in reducing this neurological disability.
JOURNAL OF THE NEUROLOGICAL SCIENCES
(2022)
Article
Neurosciences
Petr Sojka, Ibai Diez, Martin Bares, David L. Perez
Summary: This study explored the relationship between interoception and neuroanatomy in motor functional neurological disorders (mFND), compared white matter characteristics between mFND patients and healthy controls, and found right-lateralized tract disruptions distinguished FND-seiz subgroup from HCs. Individual differences in interoceptive accuracy and trait prediction error correlated with fiber bundle integrity in mFND patients.
HUMAN BRAIN MAPPING
(2021)
Article
Clinical Neurology
Andrea E. Cavanna, Giulia Purpura, Anna Riva, Renata Nacinovich, Stefano Seri
Summary: Functional tics were considered rare before the COVID-19 pandemic, but this study found that patients with functional tics had earlier onset of symptoms compared to other functional movement disorders. Exposure to social media content was reported in functional tics, but not in other disorders. Both groups had similar comorbidity profiles, including high rates of anxiety/affective symptoms and other functional neurological symptoms. These findings highlight the importance of tailored diagnostic and treatment approaches for patients with this newly defined phenotype.
EUROPEAN JOURNAL OF NEUROLOGY
(2023)