Functional neurological disorders in Parkinson disease

Wissel, Benjamin D.; Dwivedi, Alok; Merola, Aristide; Chin, Danielle; Jacob, Cara; Duker, Andrew P.; Vaughan, Jennifer E.; Lovera, Lilia; LaFaver, Kathrin; Levy, Ariel; Lang, Anthony E.; Morgante, Francesca; Nirenberg, Melissa J.; Stephen, Christopher D.; Sharma, Nutan; Romagnolo, Alberto; Lopiano, Leonardo; Balint, Bettina; Yu, Xin; Bhatia, Kailash P.; Espay, Alberto J.

doi:10.1136/jnnp-2017-317378

Cited by 84 publications

(100 citation statements)

References 16 publications

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“…Indeed, postencephalitic parkinsonism was the first and unexpected evidence that SFD‐related manifestations were rooted in a pathologically confirmed disease and not the mere result of psychodynamic processes. Today, high scores for SFD‐related items within several neuropsychological scales are found in 29%–67% of PD patients . We suggest that SFD symptoms, identified by neuropsychological scales and described as transient and tolerable phenomena, can be considered equivalent to early simple hallucinations.…”

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 88%

“…The presence of PD‐DLB‐related SFDs was first reconsidered by a systematic study, confirmed by others, which showed that SFDs: (1) might precede or go along for several years with the appearance of motor and nonmotor features of the disease; (2) may also have a variable pattern of presentation; (3) may occur with far higher incidence in PD and DLB compared with other neurodegenerative disorders associated with parkinsonism and/or dementia; or (4) may correlate with and predict onset of cognitive decline …”

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

“…SFD symptoms in PD‐DLB include the disproportionate concern exhibited by the patient for underlying diseases or side effects of drugs (hypochondria), inconsistent issues of drug intolerance so severe as to lead to drug discontinuation, occurrence of globus sensation when taking oral medications, inconsistent pain complaints (like in fibromyalgia or reflex sympathetic dystrophy), inconsistent gait patterns, or motor symptoms or tremor that are suppressed by distracting the patient. Interestingly, several reports have now described patients who displayed signs of functional parkinsonism years before a confirmed PD diagnosis by dopamine transporter scans or l ‐dopa binding . In PD patients who exhibit motor symptoms along with cognitive decline, somatic complaints become more complex and are characterized by the presence of psychotic elements that should be properly classified as somatic delusions .…”

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

“…7 Somatic symptom disorder (in other words, bodily symptoms that are more than motor) and functional disorders (such as distractible motor symptoms), hereafter referred to as somatic symptom and functional disorders (SFDs), were only recently reconsidered in PD and DLB by systematic studies that highlighted their critical impact on therapeutic management and their role as predictors of cognitive decline. [8][9][10][11][12][13][14][15] In this review, we propose that SFDs, which lack reality constraints and are "experiences that depart from consensual reality," as from the last broad definition of psychosis, 16 should be considered, along with hallucinations and delusions, as 1 of the 3 elements of the psychosis complex associated with synucleinopathies. Hallucinations and SFDs share similar associations with cognitive decline, 8,13,14 have similar prevalence, 11,15,17 and share a similar course of progression.…”

mentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15] In this review, we propose that SFDs, which lack reality constraints and are "experiences that depart from consensual reality," as from the last broad definition of psychosis, 16 should be considered, along with hallucinations and delusions, as 1 of the 3 elements of the psychosis complex associated with synucleinopathies. Hallucinations and SFDs share similar associations with cognitive decline, 8,13,14 have similar prevalence, 11,15,17 and share a similar course of progression. 8,15 Finally, delusions are the hallmarks of the psychotic narratives that precede or associate with onset of motor symptoms or concomitantly appear with dementia.…”

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confidence: 99%

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Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

et al. 2019

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Hallucinations, delusions, and functional neurological manifestations (conversion and somatic symptom disorders) of Parkinson's disease (PD) and dementia with Lewy bodies increase in frequency with disease progression, predict the onset of cognitive decline, and eventually blend with and are concealed by dementia. These symptoms share the absence of reality constraints and can be considered comparable elements of the PD‐dementia with Lewy bodies psychosis. We propose that PD‐dementia with Lewy bodies psychotic disorders depend on thalamic dysfunction promoting a theta burst mode and subsequent thalamocortical dysrhythmia with focal cortical coherence to theta electroencephalogram rhythms. This theta electroencephalogram activity, also called fast‐theta or pre‐alpha, has been shown to predict cognitive decline and fluctuations in Parkinson's disease with dementia and dementia with Lewy bodies. These electroencephalogram alterations are now considered a predictive marker for progression to dementia. The resulting thalamocortical dysrhythmia inhibits the frontal attentional network and favors the decoupling of the default mode network. As the default mode network is involved in integration of self‐referential information into conscious perception, unconstrained default mode network activity, as revealed by recent imaging studies, leads to random formation of connections that link strong autobiographical correlates to trivial stimuli, thereby producing hallucinations, delusions, and functional neurological disorders. The thalamocortical dysrhythmia default mode network decoupling hypothesis provides the rationale for the design and testing of novel therapeutic pharmacological and nonpharmacological interventions in the context of PD, PD with dementia, and dementia with Lewy bodies. © 2019 International Parkinson and Movement Disorder Society

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Section: Somatic Symptom and Functional Disordersmentioning

confidence: 88%

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

et al. 2019

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Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders

et al. 2018

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IMPORTANCE-Functional neurological disorders (FND) are common sources of disability in medicine. Patients have often been misdiagnosed, correctly diagnosed after lengthy delays, and/or subjected to poorly delivered diagnoses that prevent diagnostic understanding and lead to inappropriate treatments, iatrogenic harm, unnecessary and costly evaluations, and poor outcomes. OBSERVATIONS-Functional Neurological Symptom Disorder/Conversion Disorder was adopted by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, replacing the term psychogenic with functional and removing the criterion of psychological stress as a Funding/Support: This article presents independent research part-funded by the

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Functional dystonia: A case‐control study and risk prediction algorithm

Stephen

Perez

Chibnik

et al. 2021

Ann Clin Transl Neurol

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Objective Functional dystonia (FD) is a disabling and diagnostically challenging functional movement disorder (FMD). We sought to identify historical predictors of FD vs. other primary dystonias (ODs) and develop a practical prediction algorithm to guide neurologists. Methods 1475 consecutive new patient medical records were reviewed at an adult/pediatric tertiary‐referral dystonia clinic from 2005 to 2017. Ninety‐nine met criteria for clinically established FD (85 adults and 14 pediatric), paired with 99 age/dystonia distribution‐matched OD. Univariate and multivariate regression analyses were performed to identify predictors of FD and disability. We formed a prediction algorithm, assessed using the area under the receiver operating curve (AUC). Results Multivariate logistic regression analysis investigating independent predictors of FD (P < 0.001) followed by development of a prediction algorithm showed that the most robust predictors included abrupt onset, spontaneous resolution/recurrence, pain, cognitive complaints, being on or pursuing disability, lifetime mood/anxiety disorder, comorbid functional somatic disorders, and having ≥3 medication allergies. The prediction algorithm had utility for both adult and pediatric FD, with excellent sensitivity/specificity (89%/92%) and an area under the curve (AUC) 0.95 (0.92‐0.98). Greater disability (modified Rankin Scale) independently correlated with a number of functional examination features, unemployment/not attending school, number of medication allergies, and younger age of presentation. FD patients were high health‐care utilizers and were more frequently prescribed opiates/opioids and benzodiazepines (P < 0.003). Interpretation This case‐control study provides an algorithm to guide clinicians in gauging their index of suspicion for a FD, with diagnostic confirmation subsequently informed by neurological examination. While this algorithm requires prospective validation, health‐care utilization data underscore the importance and need for more research in FD.

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Functional neurological disorders in Parkinson disease

Cited by 84 publications

References 16 publications

Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders

Functional dystonia: A case‐control study and risk prediction algorithm

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