Neurostimulation for Functional Neurological Disorder: Evaluating Longitudinal Neurophysiology

Burke, Matthew J.; Isayama, Reina; Jegatheeswaran, Gaayathiri; Gunraj, Carolyn; Feinstein, Anthony; Lang, Anthony E.; Chen, Robert

doi:10.1002/mdc3.12651

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…However, in this context, the cognitive/behavioural demonstration combined with extrinsic activation of a functionally suppressed circuit, could potentially trigger indirect downstream changes in relevant motor networks. Indeed, the two potential mechanisms may overlap and are not necessarily mutually exclusive 32…”

Section: Discussionmentioning

confidence: 99%

Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review

Oriuwa

Mollica

Feinstein

et al. 2022

J Neurol Neurosurg Psychiatry

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Functional neurological disorder and somatic symptom disorder are complex neuropsychiatric conditions that have been linked to circuit-based dysfunction of brain networks. Neuromodulation is a novel therapeutic strategy capable of modulating relevant brain networks, making it a promising potential candidate for the treatment of these patient populations. We conducted a systematic review of Medline, Embase and PsycINFO up to 4 March 2021. Trials investigating neuromodulation devices for the treatment of functional neurological disorder or somatic symptom disorder were selected. Extracted variables included study design, demographic and clinical characteristics, psychiatric comorbidity, neurostimulation protocols, clinical outcome measures and results. 404 studies were identified with 12 meeting inclusion criteria. 221 patients were treated in the included studies with mean study sample size of 18 (4–70). Five studies were randomised clinical trials. Functional motor symptoms (six weakness, four movement disorders) were the most studied subpopulations. Transcranial magnetic stimulation (TMS) was the most frequently used device (10 studies), followed by electroconvulsive therapy (one study) and direct-current stimulation (one study). Treatment protocols varied in intended therapeutic mechanism(s): eight studies aimed to modulate underlying network dysfunction, five aimed to demonstrate movement (one also leveraged the former) and three boosted their primary mechanism with enhanced suggestion/expectation. All but one study reported positive results; however, methodological/outcome heterogeneity, mixed study quality and small sample sizes precluded quantitative meta-analysis. Neuromodulation, particularly TMS for the treatment of functional motor symptoms, shows preliminary promise in a growing line of research. Larger, sham-controlled studies are needed to further establish efficacy and better understand therapeutic mechanisms.

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Section: Discussionmentioning

confidence: 99%

Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review

Oriuwa

Mollica

Feinstein

et al. 2022

J Neurol Neurosurg Psychiatry

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View full text Add to dashboard Cite

show abstract

“…Changes in diffusion tension imaging measured with MRI, functional MRI and EEG measurements have been associated with neurological improvement after FES, when used alone or in combination with task specific training in patients with stroke ( 57 , 58 ). Although FES is more commonly used for motor rehabilitation following conditions such as stroke and spinal cord injury, other potential applications of this technique have been recently reported in movement disorders and functional neurological disorders ( 15 , 59 ). Some of the results are summarized below.…”

Section: Non-invasive Peripheral Electrical Stimulationmentioning

confidence: 99%

“…The minimum stimulus intensities used to induce visible muscle contractions were 10–18 mA. The patient had no immediate change in symptoms after treatment but reported gradual improvement over several weeks and full recovery by six months ( 59 ). Another report studied three patients with refractory fixed equinovarus dystonia.…”

Section: Non-invasive Peripheral Electrical Stimulationmentioning

confidence: 99%

Use of non-invasive neurostimulation for rehabilitation in functional movement disorders

Grippe

Desai

Arora

et al. 2022

Front. Rehabilit. Sci.

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Functional movement disorders (FMD) are a subtype of functional neurological disorders which involve abnormal movements and include multiple phenomenologies. There is a growing interest in the mechanism, diagnosis, and treatment of these disorders. Most of the current therapeutic approaches rely on psychotherapy and physiotherapy conducted by a multidisciplinary team. Although this approach has shown good results in some cases, FMD cause a great burden on the health system and other treatment strategies are urgently needed. In this review, we summarize past studies that have applied non-invasive neurostimulation techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and peripheral nerve stimulation as a treatment for FMD. There is an increasing number of studies related to TMS including randomized controlled trials; however, the protocols amongst studies are not standardized. There is only preliminary evidence for the efficacy of non-invasive neuromodulation in reducing FMD symptoms, and further studies are needed. There is insufficient evidence to allow implementation of these techniques in clinical practice.

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Placebo Effects and Functional Neurological Disorder: Helpful or Harmful?

Burke

Lidstone

2022

Current Clinical Neurology

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Neurostimulation for Functional Neurological Disorder: Evaluating Longitudinal Neurophysiology

Cited by 6 publications

References 9 publications

Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review

Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review

Use of non-invasive neurostimulation for rehabilitation in functional movement disorders

Placebo Effects and Functional Neurological Disorder: Helpful or Harmful?

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