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
Behavioral Sciences
Jonah Fox, Shilpa B. Reddy, William P. Nobis
Summary: The purpose of this study was to determine the rates of 30-day readmissions and emergency department presentations among pediatric patients with an index admission for functional seizures. The results showed that nearly one in five patients had a 30-day readmission or emergency department presentation. Index admission to the general neurology service was associated with more re-presentations to the hospital, while cognitive impairment and autism were associated with a lower likelihood of readmission.
EPILEPSY & BEHAVIOR
(2022)
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
Alejandra Ines Lanzillotti, Mercedes Sarudiansky, Nicolas Robertino Lombardi, Guido Pablo Korman, Luciana D. Alessio
Summary: Psychogenic nonepileptic seizures (PNES) are paroxysmal events that resemble epileptic seizures but are not caused by epilepsy, affecting a significant percentage of patients attending epilepsy centers. These seizures are often misdiagnosed and undertreated, with comorbidities such as depression and trauma commonly present. Helthcare providers need to consider psychological mechanisms in diagnosis and treatment of PNES.
NEUROPSYCHIATRIC DISEASE AND TREATMENT
(2021)
Article
Clinical Neurology
Alexander Lehn, Emily Watson, Elizabeth G. Ryan, Maryon Jones, Vince Cheah, Sasha Dionisio
Summary: A significant portion of patients presenting to emergency departments with symptoms resembling epileptic seizures are actually diagnosed with PNES, particularly those with prolonged or multiple events. Early recognition and accurate diagnosis of patients with psychogenic nonepileptic seizures are crucial to prevent unnecessary iatrogenic harm and provide appropriate treatment.
Article
Clinical Neurology
Lillian Wieder, Richard Brown, Trevor Thompson, Devin B. Terhune
Summary: This study found that patients with FND exhibit higher suggestibility than controls on standardised behavioural scales and are more responsive to suggestive symptom induction. These results suggest that atypical suggestibility may be a risk factor for FND and could potentially aid in diagnosis and treatment.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2021)
Review
Clinical Neurology
M. Reuber, Nicole A. Roberts, Liat Levita, Cordelia Gray, Lorna Myers
Summary: This review highlights the potential importance of shame, a self-conscious emotion, in the development and perpetuation of Psychogenic Nonepileptic Seizures (PNES). Acute shame can disrupt cognitive function and trigger responses that resemble key components of PNES. Excessive shame proneness and shame dysregulation are linked to psychopathologies associated with PNES, and they may interact with stigma to worsen the disorder. The review also discusses the neurobiological underpinnings of shame and PNES, as well as the potential role of shame in the treatment of PNES.
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY
(2022)
Review
Clinical Neurology
Lorna Myers, Cordelia Gray, Nicole Roberts, Liat Levita, Markus Reuber
Summary: This article explores the link between psychogenic non-epileptic seizures and abnormal emotion processing, with a specific focus on the role of shame. It highlights the difficulties that clinicians face in addressing and treating shame-related processes in patients with PNES and emphasizes the importance of emotional literacy and tolerance in the therapeutic relationship.
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY
(2022)
Article
Behavioral Sciences
Jonah Fox, Slavina B. Goleva, Kevin F. Haas, Lea K. Davis
Summary: This study investigates the relationship between functional seizures (FSe), cerebrovascular disease (CVD), and functional stroke. The results show that stroke is more common in patients with epileptic seizures (ES) compared to those with FSe. However, FSe is associated with both CVD and stroke when compared to nonepileptic controls. Functional stroke is more common in patients with FSe than in those with ES. Patients with FSe are also younger, more likely to be female, and more likely to have comorbid mental health needs including anxiety, PTSD or history of trauma, and bipolar disorder.
EPILEPSY & BEHAVIOR
(2022)
Article
Psychiatry
Nicole A. Roberts, Lucia Dayana Villarreal, Mary H. Burleson
Summary: Functional seizures (FS) are seizure-like symptoms without EEG-based epileptic activity. Those with FS often show emotion-related dysfunction and disrupted interpersonal relationships, in which posttraumatic stress disorder symptoms (PTS) may play a role. This study aimed to understand trauma comorbidities and socioemotional processes in FS, including the impact of affectionate touch. Questionnaires were administered to a sample of FS participants and seizure-free controls. The results revealed that FS participants with clinical-level PTS reported more emotion regulation difficulties, emotional avoidance, and perceived stress compared to controls. Additionally, FS-PTShi reported less reappraisal, more loneliness, and less frequent affectionate touch than TC-PTShi, highlighting the importance of meaningful connections in treatment.
FRONTIERS IN PSYCHIATRY
(2023)
Review
Psychiatry
Malcolm C. C. Campbell, Abigail Smakowski, Maya Rojas-Aguiluz, Laura H. H. Goldstein, Etzel Cardena, Timothy R. R. Nicholson, Antje A. T. S. Reinders, Susannah Pick
Summary: This study systematically reviewed the severity of dissociative symptoms and the prevalence of comorbid dissociative disorders in functional neurological disorder (FND), as well as their biological and clinical associations. The findings revealed that dissociative disorders were frequently comorbid in FND and were associated with more severe functional symptoms, worse quality of life, and brain alterations.
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
Clinical Neurology
Charles Hebert, Jay M. Behel, Gian Pal, Ravi Kasi, Katie Kompoliti
Summary: Multidisciplinary inpatient rehabilitation can improve the function, depression, anxiety, and somatic symptoms of FMD patients, but the sustained improvement after one year is minimal.
PARKINSONISM & RELATED DISORDERS
(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)
Article
Psychiatry
Karim Hamouda, Philine Anna Senf-Beckenbach, Carola Gerhardt, Freddy Irorutola, Matthias Rose, Kim Hinkelmann
Summary: This study found that patients with PNES showed significantly higher levels of childhood trauma, depression, and dissociation compared to healthy controls, as well as poorer performance in executive functions. Childhood trauma scores may be the main driving factor behind the differences between PNES patients and controls.
PSYCHOSOMATIC MEDICINE
(2021)
Article
Rehabilitation
[Anonymous]
Review
Clinical Neurology
Johannes Jungilligens, Sara Paredes-Echeverri, Stoyan Popkirov, Lisa Feldman Barrett, David L. Perez
Summary: Functional neurological disorder is characterized by impairments in brain networks leading to distressing motor, sensory, and cognitive symptoms that show clinical signs incongruent with other conditions. The debate regarding the role of emotions in the mechanistic and etiological aspects of the disorder often overlooks fundamental questions about the nature of emotions. Understanding the theory of constructed emotion can provide new insights into the generation and maintenance of symptoms, offering an integrated viewpoint across neurology, psychiatry, psychology, and cognitive-affective neuroscience.
Article
Behavioral Sciences
Lada Zelinski, Ibai Diez, David L. Perez, Sonja A. Kotz, Jorg Wellmer, Uwe Schlegel, Stoyan Popkirov, Johannes Jungilligens
Summary: This study investigates gray matter variations and their relationship with clinical features in patients with dissociative seizures. The results show that the duration of illness and seizure duration are inversely correlated with cortical thickness in specific areas of the brain. Further research is needed to understand the etiological factors contributing to these neuroanatomical variations related to self-referential processing in patients with dissociative seizures.
EPILEPSY & BEHAVIOR
(2022)
Review
Clinical Neurology
Sarah C. Lidstone, Michael Costa-Parke, Emily J. Robinson, Tommaso Ercoli, Jon Stone
Summary: Functional movement disorder (FMD) is a common manifestation of functional neurological disorder with diverse phenotypes. This meta-analysis examined the relationship between age at onset, phenotype, and gender in FMD. The study found that women had an earlier age of onset than men, and mixed FMD, tremor, and weakness were the most common phenotypes. The data supports the concept of both grouping FMD as a unitary disorder and splitting it into individual phenotypes.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2022)
Article
Behavioral Sciences
Petr Sojka, Matej Slovak, Gabriela Vechetova, Robert Jech, David L. Perez, Tereza Serranova
Summary: This study investigates the gray matter volumetric profiles in functional movement disorder (FMD) and their relationship with resting-state functional connectivity (rsFC) profiles. The study finds that FMD is a multinetwork disorder and symptom severity-related structural alterations are mapped onto multiple brain regions, with an important role for the temporoparietal junction and its related connectivity.
BRAIN AND BEHAVIOR
(2022)
Article
Clinical Neurology
Kristina Thurin, Viharkumar Patel, David L. Perez, Bradford C. Dickerson, Daisy Hochberg, Megan Quimby, Michael B. Miller, Mel Feany, David Silbersweig, Scott M. McGinnis, Kirk R. Daffner, Seth A. Gale
JOURNAL OF NEUROPSYCHIATRY AND CLINICAL NEUROSCIENCES
(2022)
Article
Clinical Neurology
Julie Maggio, Kevin Kyle, Christopher D. Stephen, David L. Perez
Summary: This article summarizes the experiences of a physical therapist practicing in a multidisciplinary outpatient clinic and highlights the role of the biopsychosocial model and neuroscience constructs in physical therapy interventions. The importance of team-based care and the delivery of physical therapy through video telehealth services are also outlined.
JOURNAL OF NEUROLOGIC PHYSICAL THERAPY
(2023)
Editorial Material
Medicine, General & Internal
David L. L. Perez, Daniel B. B. Hoch, Jonah N. N. Cohen
NEW ENGLAND JOURNAL OF MEDICINE
(2023)
Correction
Psychiatry
Sara Paredes-Echeverri, Andrew J. J. Guthrie, David L. L. Perez
FRONTIERS IN PSYCHIATRY
(2023)
Review
Clinical Neurology
Peter White, Susan Abbey, Brian Angus, Harriet A. Ball, Dedra S. Buchwald, Christine Burness, Alan J. Carson, Trudie Chalder, Daniel J. Clauw, Jan Coebergh, Anthony S. David, Barbara A. Dworetzky, Mark J. Edwards, Alberto J. Espay, John Etherington, Per Fink, Signe Flottorp, Beatrice Garcin, Paul Garner, Paul Glasziou, Willie Hamilton, Peter Henningsen, Ingrid Hoeritzauer, Mujtaba Husain, Anne-Catherine M. L. Huys, Hans Knoop, Kurt Kroenke, Alexander Lehn, James L. Levenson, Paul Little, Andrew Lloyd, Ira Madan, Jos W. M. van der Meer, Alastair Miller, Maurice Murphy, Irwin Nazareth, David L. Perez, Wendy Phillips, Markus Reuber, Winfried Rief, Alastair Santhouse, Tereza Serranova, Michael Sharpe, Biba Stanton, Donna E. Stewart, Jon Stone, Michele Tinazzi, Derick T. Wade, Simon C. Wessely, Vegard Wyller, Adam Zeman
Summary: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The recent guideline from the National Institute for Health and Care Excellence (NICE) sparked controversy by recommending against graded exercise therapy (GET) and downgrading the importance of cognitive-behavioural therapy for recovery. The anomalies in evidence processing and interpretation by the NICE committee, such as creating a new definition, omitting data, and deviating from accepted practices, contributed to this controversy.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2023)
Article
Clinical Neurology
Sara A. Finkelstein, Alan Carson, Mark J. Edwards, Kasia Kozlowska, Sarah C. Lidstone, David L. Perez, Ginger Polich, Jon Stone, Selma Aybek
NEUROLOGIC CLINICS
(2023)
Article
Clinical Neurology
Alexa N. Goldstein, Sara Paredes-Echeverri, Sara A. Finkelstein, Andrew J. Guthrie, David L. Perez, Jennifer L. Freeburn
Summary: This case series retrospectively reports the treatment outcomes and clinical characteristics of FND-speech patients who attended outpatient SLT as part of a multidisciplinary program for FND. The results demonstrate the positive impact of outpatient SLT in the assessment and management of FND-speech patients, and provide clarity for treatment expectations.
NEUROREHABILITATION
(2023)
Article
Psychiatry
Ellen J. Godena, Jennifer L. Freeburn, Noah D. Silverberg, David L. Perez
HARVARD REVIEW OF PSYCHIATRY
(2023)
Letter
Psychiatry
Daniel J. Millstein, David L. Perez
JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY
(2023)
Meeting Abstract
Clinical Neurology
Ana Maria Rivas-Grajales, David L. Perez
JOURNAL OF NEUROPSYCHIATRY AND CLINICAL NEUROSCIENCES
(2022)