Astasia-abasia, ¿Psicógena u orgánica? No es fácil / 50 / 5,000 Translation results Astasia-abasia, psychogenic or organic? Is not easy

La astasia-abasia fue descrita por Paul Blocq como un cuadro de origen psicógeno aunque posteriormente se han descrito numerosas lesiones orgánicas cerebrales que pueden justificarla. Presentamos el caso de una mujer de 19 años que tras un intento de ahorcamiento presenta un cuadro compatible con una astasia-abasia que inicialmente fue etiquetado como conversivo ante la ausencia de otra clínica neurológica distinta de la incapacidad para la marcha y la ausencia de hallazgos patológicos en RMN y estudios neurofisiológicos. La reevalución y reexploración profunda de la paciente puso en duda este diagnóstico y tras la realización de un PET TAC se descubrió la presencia de hipometabolismo hemisferio cerebral izquierdo, de ambos cuerpos estriados, tálamos y cerebelo. Se discute sobre el diagnóstico diferencial de la astasiaabasia y se aportan datos que hagan posible un diagnóstico clínico fiable.(AU)

Astasia-abasia was described by Paul Blocq as a psychogenic condition; later, several brain injuries have been described for its explanation too. We present a case of a 19-year-old woman who, after a hanging attempt, presents an astasia-abasia syndrome, initially labeled as functional, in the absence of other neurological clinic than the inability for walking and the absence of pathological findings in IMR and neurophysiological studies. The reassessment and re-exploration of the patient questioned this diagnosis and after performing a PET scan, the presence of hypometabolism in left cerebral hemisphere, both striatum bodies, thalamus and cerebellum was discovered. Differential diagnosis of astasia-abasia is discussed and data are provided for a reliable clinical diagnosis.(AU)

Symptom-severity-related brain connectivity alterations in functional movement disorders.

BACKGROUND: Functional movement disorders, a common cause of neurological disabilities, can occur with heterogeneous motor manifestations including functional weakness. However, the underlying mechanisms related to brain function and connectivity are unknown. OBJECTIVE: To identify brain connectivity alterations related to functional weakness we assessed network centrality changes in a group of patients with heterogeneous motor manifestations using task-free functional MRI in combination with different network centrality approaches. METHODS: Task-free functional MRI was performed in 48 patients with heterogeneous motor manifestations including 28 patients showing functional weakness and 65 age- and sex-matched healthy controls. Functional connectivity differences were assessed using different network centrality approaches, i.e. global correlation, eigenvector centrality, and intrinsic connectivity. Motor symptom severity was assessed using The Simplified Functional Movement Disorders Rating Scale and correlated with network centrality. RESULTS: Comparing patients with and without functional weakness showed significant network centrality differences in the left temporoparietal junction and precuneus. Patients with functional weakness showed increased centrality in the same anatomical regions when comparing functional weakness with healthy controls. Moreover, in the same regions, patients with functional weakness showed a positive correlation between motor symptom severity and network centrality. This correlation was shown to be specific to functional weakness with an interaction analysis, confirming a significant difference between patients with and without functional weakness. CONCLUSIONS: We identified the temporoparietal junction and precuneus as key regions involved in brain connectivity alterations related to functional weakness. We propose that both regions may be promising targets for phenotype-specific non-invasive brain stimulation.

Microstructural Changes in Motor Functional Conversion Disorder: Multimodal Imaging Approach on a Case.

BACKGROUND: Functional motor conversion disorders are characterized by neurological symptoms unrelated to brain structural lesions. The present study was conducted on a woman presenting motor symptoms causing motor dysfunction, using advanced multimodal neuroimaging techniques, electrophysiological and neuropsychological assessment. METHODS: The patient underwent fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) and functional magnetic resonance imaging (fMRI) with both task and resting-state paradigms and was compared with 11 healthy matched controls. To test differences in structural parameters, Bayesian comparison was performed. To test differences in functional parameters, a first- and second-level analysis was performed in task fMRI, while a seed-to-seed analysis to evaluate the connections between brain regions and identify intersubject variations was performed in resting-state fMRI. RESULTS: FDG-PET showed two patterns of brain metabolism, involving the cortical and subcortical structures. Regarding the diffusion data, microstructural parameters were altered for U-shape fibers for the hand and feet regions. Resting-state analysis showed hypoconnectivity between the parahippocampal and superior temporal gyrus. Neurophysiological assessment showed no alterations. Finally, an initial cognitive impairment was observed, paralleled by an anxiety and mild depressive state. CONCLUSIONS: While we confirmed no structural alterations sustaining this functional motor disorder, we report microstructural changes in sensory-motor integration for both the hand and feet regions that could functionally support clinical manifestations.

Multi-profile procedures for motor conversion disorders in children - a case report. / Wieloprofilowe postepowanie w konwersyjnych zaburzeniach ruchu u dzieci ­ opis przypadku.

OBJECTIVES: The most common motor deficits in patients with conversion disorder are tremors, weakness of limbsand gait disturbance. The proper diagnosis and treatment aswell as the patient and their family's cooperation during therapy are essential to achieve fast recovery. The aim of this paper is to provide an overview of multidisciplinary interventions successfully applied in the treatment of conversion disorders in children, illustrated with an example of a case study. METHODS: Case report: The 9 years old boy, with trembling of the limbs, trunk ataxia, impaired balance, and significant disability in self-locomotion, caused by conversion disorders, was admitted to stationary rehabilitation treatment because of the lack of progress in the current, four-month treatment, which consisted of hydroxyzin administration and irregular psychotherapy. Behavioural modifications in rehabilitation, individual psychotherapy, family counselling and psychoeducation, and sertralinepharmacologicaltreatmentwereimplemented at the same time. Particular attention was paid to obtain the parents'approval for multidisciplinary therapy, considering that the previous treatment was ineffective because of parents being unconvinced about psychogenic causes of symptoms. They were focused on over diagnosing the child's symptoms making it difficult to manage the proper treatment. RESULTS: After a three-week period of comprehensive treatment the patient recovered completely and returned to independent mobility and social functioning relative to his age. CONCLUSIONS: The simultaneous implementation of multi-profile treatment is an effective approach in children motor conversion disorders. In order to achieve therapeutic success it is necessary to convince the parents about the psychogenic ground of the symptoms and a need of multi-profile treatment.

Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness.

OBJECTIVE: There has been a recent resurgence of interest in physical treatments for functional motor disorders (FMD) including Transcranial Magnetic Stimulation (TMS). This pilot study aimed to test the effectiveness of a single session of motor cortex TMS as a treatment for functional upper limb weakness. METHODS: Ten subjects with a diagnosis of functional upper limb weakness were randomised to immediate (n=7) or delayed (3months) (n=3) TMS treatment. Median age was 35 (range 23-52) and median symptom duration was 2.3years (range 5months - 20years). 46-70 single pulses were applied to the motor cortex at 120-150% motor threshold. We used a verbal protocol designed to standardized the effects of suggestion. Primary outcome measures were self-reported symptom severity, grip strength and tapping frequency immediately after treatment, and symptom severity and disability (SF-12 and Modified Rankin Scale (MRS)) after 3months. RESULTS: There was a small significant reduction in symptom severity immediately after treatment, but no improvement in grip strength or tapping frequency and no change in symptom severity, SF-12 or MRS 3months after treatment. Small numbers precluded comparison of immediate treatment with delayed treatment. Four of eight subjects responding to three-month follow-up reported late-onset adverse effects. CONCLUSION: This pilot study suggests limited benefits for TMS as a one-off non-neuromodulatory treatment for stable chronic outpatients. TMS may still have a role alongside more intensive multidisciplinary therapy input, or in patients with severe deficits where the possibility of normal movement can be hard to demonstrate. TRIAL REGISTRATION: NCT02102906.

Neural correlates of conversion disorder: overview and meta-analysis of neuroimaging studies on motor conversion disorder.

BACKGROUND: Conversion Disorders (CD) are prevalent functional disorders. Although the pathogenesis is still not completely understood, an interaction of genetic, neurobiological, and psychosocial factors is quite likely. The aim of this study is to provide a systematic overview on imaging studies on CDs and investigate neuronal areas involved in Motor Conversion Disorders (MCD). METHODS: A systematic literature search was conducted on CD. Subsequently a meta-analysis of functional neuroimaging studies on MCD was implemented using an Activation Likelihood Estimation (ALE). We calculated differences between patients and healthy controls as well as between affected versus unaffected sides in addition to an overall analysis in order to identify neuronal areas related to MCD. RESULTS: Patients with MCD differ from healthy controls in the amygdala, superior temporal lobe, retrosplenial area, primary motor cortex, insula, red nucleus, thalamus, anterior as well as dorsolateral prefrontal and frontal cortex. When comparing affected versus unaffected sides, temporal cortex, dorsal anterior cingulate cortex, supramarginal gyrus, dorsal temporal lobe, anterior insula, primary somatosensory cortex, superior frontal gyrus and anterior prefrontal as well as frontal cortex show significant differences. CONCLUSIONS: Neuronal areas seem to be involved in the pathogenesis, maintenance or as a result of MCD. Areas that are important for motor-planning, motor-selection or autonomic response seem to be especially relevant. Our results support the emotional unawareness theory but also underline the need of more support by conduction imaging studies on both CD and MCD.