Functional motor disorders: mechanism, prognosis and treatment

Abstract

A detail from the same artwork is used in each part of this thesis Op de voorkant van dit proefschrift staat een afbeelding van een schilderij van Paul Klee (1879-1940) uit 1930, genaamd Belastete Kinder. Het schilderij is in bezit van het Tate in London. Hier wordt het kunstwerk getypeerd als: 'taking a line for a walk'. Het schilderij lijkt te bestaan uit een grotendeels ononderbroken lijn, die zowel beweging als veelzijdigheid uitstraalt. Om die reden is deze afbeelding gekozen: Observatie van beweging is essentieel bij het diagnosticeren van bewegingsstoornissen. Ook moet er aandacht zijn voor de vele facetten waaruit de patiënt bestaat, hiervoor zijn soms de perspectieven van verschillende specialisaties nodig. Daarnaast past deze afbeelding goed bij hoofdstuk 5, waarin we onder andere de beleving van het lichaamsschema van patiënten onderzoeken. I am very thankful for the financial support of the following sponsors: GSMS graduate school University of Groningen, De Stichting De Cock-Hadders, UMCG Pilot Doelmatigheid HAP subsidie, stichting MIND (voorheen Fonds Psychische Gezondheid) en de dystonie-vereniging. Introduction Functional motor disorders (FMD) consist of involuntary movements, posturing, gait disorder and paresis. They are defined by signs that demonstrate the functional nature of the mechanism like variability, influence of attention and distraction and incongruity with anatomical boundaries. FMD exists at the interface between neurology and psychiatry. Functional motor disorders are part of the broader group of functional neurological disorders (FND). FND account for between 15-30% of neurology outpatients depending how they are defined and may co-exist with neurological disease [1-4]. Having FMD often impacts the lives of patients to a large extent Quality of life and impairment have been found to be comparable to disabling neurological conditions like Parkinson's disease [5] and Multiple Sclerosis [6]. At the start of this thesis, the clinical research field of functional neurological disorders was rapidly changing. New insights changed the leading theories on the mechanism, diagnosis and approach to patients with FMD. This has been pivotal for the composition of this thesis, which explores the mechanism, prognosis (natural history) and treatment of FMD. Therefore these important developments in the field are briefly discussed below, followed by an outline of the thesis. THE NEW NORMAL What we call "functional neurological disorder" now, has been in and out of fashion within academic circles over the centuries. Interestingly, the symptoms of patients with FND in neurology clinics nowadays are highly comparable to historical descriptions and photos. For example the presentation of functional limb weakness through the 18 th to 20 th century is strikingly similar to the present with the typical dragging gate, the same inconsistencies in the examination, and highly comparable precipitating factors [7]. However, the concepts explaining these symptoms and the names they were given were subject to ch...

Neuromodulation of safety and surprise in the early stages of infant development: affective homeostatic regulation in bodily and mental functions

“…While antidepressants, antipsychotics, and neuroleptics are used for symptom management, their mechanisms of action concerning symptoms are not yet fully understood. Additionally, therapy cannot act on the neural mechanisms of the disease (Gelauff, 2020;Perjoc et al, 2023).…”