Overall comorbidities in functional neurological disorder: A narrative review

L Encéphale, Journal Year: 2023, Volume and Issue: 49(4), P. S24 - S32

Published: July 4, 2023

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Pain and functional neurological disorder: a systematic review and meta-analysis

Journal of Neurology Neurosurgery & Psychiatry, Journal Year: 2024, Volume and Issue: 95(9), P. 874 - 885

Published: Feb. 21, 2024

Background Functional neurological disorder (FND) is characterised by symptoms, such as seizures and abnormal movements. Despite its significance to patients, the clinical features of chronic pain in people with FND, FND pain, have not been comprehensively studied. Methods We systematically reviewed PubMed, Embase PsycINFO for studies adults patients pain. described proportions reporting rating timing, pain-related diagnoses responsiveness treatment. performed random effects meta-analyses who reported or were diagnosed disorders. Results Seven hundred fifteen articles screened 64 included analysis. Eight case–control 3476 symptoms a higher proportion than controls other A model 30 cohorts found that an estimated 55% (95% CI 46% 64%) 4272 Random models complex regional syndrome 22% 6% 39%) irritable bowel 16% 9% 24%) fibromyalgia 10% 8% 13%). Five among 361 identified. Most interventions did ameliorate even when improved. Conclusions Pain are common FND. Classification systems treatments should routinely consider comorbidity

Language: Английский

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Understanding Functional Neurological Disorder: Recent Insights and Diagnostic Challenges

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(8), P. 4470 - 4470

Published: April 18, 2024

Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis predicated on clinical evaluation the exclusion other medical psychiatric situations. treatment typically involves multidisciplinary technique addressing each underlying psychological factors via mixture management, psychotherapy, supportive interventions. Recent advances neuroimaging deeper exploration its epidemiology, pathophysiology, presentation have shed new light this disorder. This paper synthesizes current knowledge FND, focusing epidemiology mechanisms, insights, differentiation FND from feigning malingering. review highlights phenotypic heterogeneity diagnostic challenges it presents. It also discusses significant role unraveling complex neural underpinnings potential predicting response. underscores importance nuanced understanding informing practice guiding future research. With advancements techniques growing recognition disorder's multifaceted nature, suggests promising trajectory toward more effective, personalized strategies better overall

Language: Английский

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Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial

The Lancet Neurology, Journal Year: 2024, Volume and Issue: 23(7), P. 675 - 686

Published: May 17, 2024

Language: Английский

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Characterising alexithymia in individuals with functional motor disorders: a cross-sectional analysis of the Italian Registry of Functional Motor Disorders

Journal of Neurology Neurosurgery & Psychiatry, Journal Year: 2025, Volume and Issue: unknown, P. jnnp - 334788

Published: Feb. 17, 2025

Background Alexithymia, a personality trait characterised by difficulty in identifying and expressing emotions, may contribute to the onset clinical presentation of functional motor disorders (FMDs), although this association remains underexplored. Methods From Italian Registry FMDs, we selected individuals recruited between November 2011 January 2023, diagnosed with FMD according Gupta Lang criteria assessed for various neurological psychological features validated rating scales. The main statistical analysis included regression models using Toronto Alexithymia Scale 20 items as an explanatory variable set measures, adjusting sociodemographic factors correcting multiple testing. Results In cohort 483 individuals, 20.7% had possible alexithymia 31.5% definite alexithymia. Higher levels were strongly associated increased severity depression (β=0.31, p<0.001), anxiety (β=0.32, general distress (β=−0.27, fatigue (β=0.05, p<0.001) pain moderately slower (β=0.02, p=0.003). Subscale analyses revealed that difficulties feelings contributed most these associations. No significant was observed symptom severity. Conclusions Emotional processing might increase their vulnerability mental health problems, fatigue, possibly aggravating overall prognosis. Further research is needed elucidate underlying mechanisms linking explore efficacy interventions targeting emotional awareness regulation population prevent long-term burdens.

Language: Английский

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Functional neurological disorder: defying dualism

World Psychiatry, Journal Year: 2024, Volume and Issue: 23(1), P. 53 - 54

Published: Jan. 12, 2024

Functional neurological disorder (FND) is classified in the DSM-5-TR as "functional symptom (conversion disorder)" and chapter on mental disorders of ICD-11 "dissociative disorder". Neurologists, who most commonly make initial diagnosis, are usually barely aware such classification systems, use a variety terms – "functional", "psychogenic" or "non-organic" to describe symptoms paralysis, tremor, seizures blindness that were once encompassed under label "hysteria". This diversity reflects has been passed back forward between neurology psychiatry for 150 years. Over time, FND pendulum swung brain late 19th century purely psychological condition 20th century. Today, researchers suggesting rest middle. Defying dualism may cause dissonance clinicians, those seeking tidy explanatory theories, systems. But it an essential platform towards understanding improving care millions people around world have it. For grew up with "conversion disorder" DSM-IV, idea was simple, hydraulic comfortingly Freudian. Someone stressful event, which repressed converted motor sensory symptoms, not be symbolic, perhaps reducing stress, sometimes point belle indifférence. Conversion often considered rare condition, could only diagnosed by exclusion, would respond quickly therapy. Historian E. Shorter declared "hysteria" had largely disappeared favour other somatic fatigue1. In last 20 years, this narrow view systematically dismantled evidence. common one commonest seen neurologists both outpatient inpatient settings, making 5-15% patients2. It accounts 50% rushed into hospital suspected status epilepticus, 8% admitted stroke. transient. A 14-year study functional limb weakness found 80% still their at follow-up. Physical disability distress high epilepsy Parkinson's disease2. diagnosis inclusion, diagnostic stability similar conditions psychiatry2. People clinical features characteristic disorder. Hoover's sign describes impairment voluntary hip extension presence normal automatic during contralateral flexion. tremor stops entrains rhythm examiner entrainment test way does occur disorders. having seizure typically experience brief prodrome autonomic arousal dissociation, followed event eyes closed, there either vigorous tremor-like movements, they fall down lie more than minute ways condition. Injury, pain infection triggers disorders, appear least relevant adverse experiences2. Stressful events, childhood experiences, psychiatric comorbidity remain important story many FND. The frequency experiences (odds ratio: 3-4) recent stress 2-3) increased, but different where risk factor "the cause"3. There patients whom conversion model makes sense, others preposterous. dropping requirement DSM-5, change name from (functional DSM-5 DSM-5-TR, keeping that. wider set hypotheses, considering multiple levels neuron society, required sense "predictive brain" offers potential solution puzzling phantom phenomena, strong predictions "is there" outweigh input contrary. Similarly, hypothesis predicts (and thus cannot moved) so strongly outweighs telling normal4. predictive builds older notions "ideas" "beliefs" being FND, conditioned responses threat, illness injury operate below level awareness. Neurodevelopmental including autism spectrum disorder, attention-deficit/hyperactivity joint hypermobility because interoceptive machinery. first neuroimaging patient appeared 1997. shock news brain. number networks then involved attention, control, salience emotion regulation2. Perhaps interesting replicated finding hypoactivation network agency parts let you know "you" made movement right temporoparietal junction. Poor activation consistent what we see clinically ("it looks like movement") us doesn't feel my control"). biomarker even day become available5. example, resting state imaging able classify healthy controls using scans alone accuracy 72%6. If considers higher movement, hardly surprising confused wilful exaggeration malingering. whole range neuroscientific evidence, geographical historical consistency well remarkable neurophysiological experiments, increased tests attenuation, show feigning poor explanation phenomenon FND7. Treatment new multidisciplinary approach, starting emphasizes mechanisms brain, also factors when present. FND-focused physiotherapy promotes over differences recognized conditions, shows lot promise randomised trials8. evidence-based therapy addresses adversity, recognizes physiology similarity panic9. International Society, founded 2019, embodies co-operative complemented patient-led organizations Hope Action. Together defying prevented progress disabling

Language: Английский

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Management of Psychological Complications Following Mild Traumatic Brain Injury

Current Neurology and Neuroscience Reports, Journal Year: 2023, Volume and Issue: unknown

Published: Feb. 10, 2023

Language: Английский

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Intrinsic timescales and predictive allostatic interoception in brain health and disease

Neuroscience & Biobehavioral Reviews, Journal Year: 2023, Volume and Issue: 157, P. 105510 - 105510

Published: Dec. 15, 2023

The cognitive neuroscience of brain diseases faces challenges in understanding the complex relationship between structure and function, heterogeneity phenotypes, lack dimensional transnosological explanations. This perspective offers a framework combining predictive coding theory allostatic interoceptive overload (PAIO) intrinsic neural timescales (INT) to provide more dynamic health psychiatry neurology. PAIO integrates allostasis interoception assess interaction internal patterns environmental stressors, while INT shows that different regions operate on timescales. can be understood as failure INT, which involves breakdown proper temporal integration segregation. lead disbalances exteroceptive/interoceptive inputs across whole-body levels (cardiometabolic, cardiovascular, inflammatory, immune). approach new insights, presenting novel perspectives spatiotemporal hierarchies interactions. By integrating these theories, paper opens innovative paths for studying dynamics, inform future research disease.

Language: Английский

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Prevalence of autistic traits in functional neurological disorder and relationship to alexithymia and psychiatric comorbidity

Journal of the Neurological Sciences, Journal Year: 2023, Volume and Issue: 446, P. 120585 - 120585

Published: Feb. 12, 2023

IntroductionIn a cohort of adults with Functional Neurological Disorder (FND), we aim to:1)Report the prevalence autistic traits and alexithymia.2)Report psychiatric comorbidity associated alexithymia.3)Explore whether alexithymia mediates association between comorbidity.Methods91 patients participating in FND 5-week outpatient program completed baseline self-report questionnaires for total phobia, somatic symptom severity, attention deficit hyperactivity disorder (ADHD) dyslexia. Patients were grouped by Autism Spectrum Quotient (AQ-10) score <6 or ≥ 6 compared significant differences tested variables. This analysis was repeated status. Simple effects using pairwise comparisons. Multistep regression models direct relationships scores, mediation alexithymia.Results36 (40%) AQ-10 positive (scoring ≥6 on AQ-10). A further 36 (across negative groups) screened alexithymia. scored significantly higher alexithymia, depression, generalised anxiety, social ADHD, Alexithymia symptoms found to mediate relationship trait depression scores.ConclusionWe demonstrate high proportion alexithymic traits, FND. may highlight need specialised communication approaches management. Mechanistic conclusions are limited. Future research could explore links interoceptive data.

Language: Английский

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Incongruence in FND: time for retirement

Practical Neurology, Journal Year: 2024, Volume and Issue: unknown, P. pn - 003897

Published: Jan. 11, 2024

The diagnosis of functional neurological disorder (FND) has rested traditionally on two key features: inconsistency and incongruency. Inconsistency usually refers to between movement, sensory or cognitive performance in a voluntary versus an 'automatic' scenario. This is the principle Hoover's sign leg weakness, tremor entrainment test for range tests disorder. It often helpful share these with patients as they show potential improvement, give insight into 'software' mechanism FND brain also feed FND-specific therapies. For example, physiotherapist might actively use distraction promote automatic movement discourage overlearned abnormal patterns movement. Incongruency, other hand, clinical feature that not present superficially similar conditions, apparently violates laws anatomy, biology physics. I have always struggled incongruency but now am breaking my silence, assisted by intriguing case patient 'functional freezing gait' from Jorik Nonnekes colleagues this issue Practical Neurology .1 described paper accompanying video gait But it reasonable, authors suggest, make diagnosis, part, because does look like another disorder, principally Parkinsonism, which we are more familiar? In view, incongruence needs retirement. should be sent section neuromythology graveyard where can join 'la belle indifférence',2 'non-organic'3 universal application 'conversion disorder'.4 Here what object to, find incongruent, about still being used assessment (box 1). Box 1 ### Reasons why abandoned

Language: Английский

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