Decade of progress in motor functional neurological disorder: continuing the momentum

Abstract

Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurology–psychiatry intersection. After being marginalised in the late 20th century, there has been renewed interest in this field. In this article, we review advances that have occurred over the past decade (2011–2020) across diagnosis, mechanisms, aetiologies, treatments and stigma in patients with motor FND (mFND, that is, functional movement disorder and functional limb weakness). In each content area, we also discuss the implications of recent advances and suggest future directions that will help continue the momentum of the past decade. In diagnosis, a major advance has been the emphasis on rule-in physical signs that are specific for hyperkinetic and hypokinetic functional motor symptoms. Mechanistically, greater importance has been given to determining ‘how’ functional neurological symptoms develop, highlighting roles for misdirected attention, expectation and self-agency, as well as abnormal influences of emotion/threat processing brain areas on motor control circuits. Aetiologically, while roles for adverse life experiences remain of interest in mFND, there is recognition of other aetiologic contributors, and efforts are needed to investigate links between aetiological factors and mechanisms. This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. Across patients, clinicians, healthcare systems and society, stigma remains a major concern. While challenges persist, a patient-centred integrated clinical neuroscience approach is primed to carry forward the momentum of the past decade into the future.

Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey

“…Functional neurological disorders (FND) are disabling neurological conditions characterized by clinical signs that are incongruent with known neurological disease [1][2][3]. The etiology of FND has been long linked to psychological factors [4].…”

“…Research in the last decades has challenged this assumption, however, by demonstrating that the disease can be more consistently explained within a biopsychosocial framework in which neurobiological, psychological, and social factors are crucially involved in the etiology of the disease [5][6][7]. Recent findings have suggested new diagnostic approaches and treatment [8] in which diagnosis is based on cardinal clinical signs, such as inconsistency (remissions or exacerbations over time) with susceptibility to distraction (e.g., variation in tremor frequency and amplitude), and incongruity (discordance with other known neurological disorders) [3]. A multidisciplinary approach in which care is provided by a specialist team (e.g., neurologist, psychiatrist, psychotherapist, physiotherapist) is recommended [8,9], with a growing body of evidence suggesting its efficacy for managing FND [10][11][12][13][14].…”

Asylum-seeking children in shutdown: Neurobiological models

“…7For a summary of functional somatic symptoms involving activation of central arousal systems, see Chapter 11 in Kozlowska et al (2020) (Kozlowska et al, 2020), summary of functional neurological motor symptoms by Perez et al (2021) }(Perez et al, 2021), and summary pertaining to pain by Vachon-Presseau (2016) (Vachon-Presseau et al, 2016). …”

COVID-19: neurological sequelae

“…к гиперкоагулирующему состоянию, вызвать повышенный риск артериального и венозного тромбоза. В то время как для острой фазы заболевания нормальным является доминирование легочной и сердечно-сосудистой дисфункции, многие пациенты также жалуются на неврологические симптомы (головная боль, тошнота, усталость, снижение или потеря обоняния и вкуса, миалгия) и признаки (изменившееся психическое состояние), а также на появление необычных / редких расстройств (таких как припадки, менингит, энцефалит, энцефалопатия, миелит и синдром Гийена -Барре) [19][20][21][22][23][24][25][26][27][28]. COVID-19 не привел к увеличению заболеваемости эпилепсией, но все же стал результатом новых терапевтических вызовов в лечении пациентов [29,30].…”

“…Помимо этого значительная доля взрослых и детей, включая переболевших COVID-19 в легкой форме, страдают от последствий SARS-CoV-2 (постковидный синдром) [45,46], вызванных региональным пониженным метаболизмом в головном мозге, который может сохраняться как минимум в течение шести месяцев после завершения острой фазы заболевания [47, 48] (рисунок). Его симптомы сходны с последствиями синдрома SARS, а также с синдромом хронической усталости и функционального неврологического расстройства [24,28,49].…”