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1.
J Neurol ; 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32193596

RESUMO

Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. These symptoms are varied and include abnormal control of movement, episodes of altered awareness resembling epileptic seizures and abnormal sensation and are often comorbid with chronic pain, fatigue and cognitive symptoms. There is increasing evidence for the role of neurologists in both the assessment and management of FND. The aim of this review is to discuss strategies for the management of FND by focusing on the diagnostic discussion and general principles, as well as specific treatment strategies for various FND symptoms, highlighting the role of the neurologist and proposing a structure for an interdisciplinary FND service.

2.
J Neurol Neurosurg Psychiatry ; 91(6): 638-649, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32111637

RESUMO

OBJECTIVES: We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS: A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS: Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS: There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.

3.
J Neuropsychiatry Clin Neurosci ; 32(1): 79-84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31587627

RESUMO

OBJECTIVE: A growing interest in functional neurological disorders (FND) has led to the development of specialized clinics. This study aimed to better understand the structure and role of such clinics. METHODS: Data were retrospectively collected from clinical records at three national referral centers, two specifically for motor FND and one for FND in general. Data were for 492 consecutive patients referred over a 9- to 15-month period: 100 from the United Kingdom clinic, 302 from the Swiss clinic, and 90 from the Canadian clinic. Data included symptom subtype and duration, comorbid pain and fatigue, disability, and treatment recommendations. RESULTS: The mean age of the 492 patients was 44 years, and most (73%) were female. Most had a prolonged motor FND (mean symptom duration of 6 years); 35% were not working because of ill health, 26% received disability benefits, and up to 38% required a care giver for personal care. In the Swiss cohort, 39% were given a diagnosis of another somatic symptom disorder rather than an FND diagnosis. Pain was common in the United Kingdom (79%) and Canada (56%), as was fatigue (48% and 47%, respectively). Most patients (61%) were offered physiotherapy; referral to neuropsychiatry or psychology differed across centers (32%-100%). CONCLUSIONS: FND specialty clinics have an important role in ensuring correct diagnosis and appropriate treatment. Most patients with motor FND require specialized neurophysiotherapy. Patients readily accepted an integrated neuropsychiatric approach. Close collaboration between FND clinics and acute neurology facilities might improve early detection of FND and could improve outcomes.

4.
J Neuropsychiatry Clin Neurosci ; 32(1): 33-42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31865871

RESUMO

The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.

5.
BMC Neurol ; 19(1): 242, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638942

RESUMO

BACKGROUND: Patients with functional motor disorder (FMD) experience persistent and disabling neurological symptoms such as weakness, tremor, dystonia and disordered gait. Physiotherapy is usually considered an important part of treatment; however, sufficiently-powered controlled studies are lacking. Here we present the protocol of a randomised controlled trial (RCT) that aims to evaluate the clinical and cost effectiveness of a specialist physiotherapy programme for FMD. METHODS/DESIGN: The trial is a pragmatic, multicentre, single blind parallel arm randomised controlled trial (RCT). 264 Adults with a clinically definite diagnosis of FMD will be recruited from neurology clinics and randomised to receive either the trial intervention (a specialist physiotherapy protocol) or treatment as usual control (referral to a community physiotherapy service suitable for people with neurological symptoms). Participants will be followed up at 6 and 12 months. The primary outcome is the Physical Function domain of the Short Form 36 questionnaire at 12 months. Secondary domains of measurement will include participant perception of change, mobility, health-related quality of life, health service utilisation, anxiety and depression. Health economic analysis will evaluate the cost impact of trial and control interventions from a health and social care perspective as well as societal perspective. DISCUSSION: This trial will be the first adequately-powered RCT of physical-based rehabilitation for FMD. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number ISRCTN56136713 . Registered 27 March 2018.


Assuntos
Transtornos Motores/reabilitação , Modalidades de Fisioterapia , Projetos de Pesquisa , Adulto , Humanos , Masculino , Método Simples-Cego
6.
Disabil Rehabil ; : 1-6, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30669889

RESUMO

BACKGROUND: Patients with functional motor disorder are perceived as difficult by health care professionals, but we know very little about the patients' perspective. Understanding the experiences and perceptions of patients could help to improve clinical services and patient outcomes. PURPOSE: To explore the experiences and perspectives of patients with functional motor disorder using qualitative research methods. METHODS: This qualitative study was embedded within a feasibility study of specialist physiotherapy. Eleven patients with functional motor disorder participated in semi-structured qualitative interviews prior to receiving treatment. The interview transcripts were subjected to an inductive thematic analysis. RESULTS: The data were arranged into six themes: (1) the burden of living with functional motor disorder; (2) nobody knew what was wrong; (3) dissatisfaction with psychological explanations; (4) patients feel abandoned; (5) iatrogenic harm; and (6) powerlessness. DISCUSSION AND CONCLUSION: The study participants experienced substantial physical and emotional burdens associated with functional motor disorder. They were generally dissatisfied with psychological explanations for their symptoms and commonly felt misunderstood and abandoned by health care professionals, which appeared to leave them vulnerable to iatrogenic harm. A lack of understanding of functional motor disorder left participants feeling unable to help themselves. This research highlights a number of inadequacies within current clinical services for patients with functional motor disorder. Implications for rehabilitation Careful communication is required to help patients understand and accept the diagnosis of functional motor disorder. It is important to listen to the patient's narrative in order to help them make sense of their illness experience. A nuanced biopsychosocial explanatory model is needed to help patients understand how psychological factors can be relevant to physical symptoms and symptoms that are often perceived to be precipitated by a physical event. A lack of understanding and acceptance of the diagnosis may leave patients vulnerable to iatrogenic harm and powerless to help themselves.

7.
J Food Sci Technol ; 55(8): 3314-3324, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30065443

RESUMO

This study was designed to compare the performances of four different non-destructive methods of assessing onion quality, one of which was based on near-infrared spectroscopy, and three of which were based on spectral imaging. These methods involve a combination of wavelengths from visible to near-infrared with different acquisition systems that were applied to discriminate between pre-sorted onions by in situ measurements of the onion surface. Compared with the partial least squares discriminant analysis classification models associated with different methods, hyperspectral imaging (HSI) with both static horizontal and rotating orientation obtained a higher level of sensitivity and specificity with a lower classification error than did other methods. Moreover, models built with the reduced variables did not lower the model performances. Overall, these results demonstrate that HSI with selected wavelengths would be useful for further developing an improved real-time system for sorting onion bulbs.

8.
Appl Spectrosc ; 72(10): 1467-1478, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30008226

RESUMO

A firm texture of dry onions is important for consumer acceptance. Both the texture and dry matter content decline during storage, influencing the market value of onions. The main goal of this study was to develop predictive models that in future might form the basis for automated sorting of onions for firmness and dry matter content in the industry. Hyperspectral scanning was conducted in reflectance mode for six commercial batches of onions that were monitored three times during storage. Mean spectra from the region of interest were extracted and partial least squares regression (PLSR) models were constructed. Feature wavelengths were identified using variable selection techniques resulting from interval partial least squares and recursive partial least squares analyses. The PLSR model for firmness gave a root mean square error of cross-validation (RMSECV) of 0.84 N, and a root mean square error of prediction (RMSEP) of 0.73 N, with coefficients of determination ( R2) of 0.72 and 0.83, respectively. The RMSECV and RMSEP of the PLSR model for dry matter content were 0.10% and 0.08%, respectively, with a R2 of 0.58 and 0.79, respectively. The whole wavelength range and selected wavelengths showed nearly similar results for both dry matter content and firmness. The results obtained from this study clearly reveal that hyperspectral imaging of onion bulbs with selected wavelengths, coupled with chemometric modeling, can be used for the noninvasive determination of the firmness and dry matter content of stored onion bulbs.

9.
JAMA Neurol ; 75(9): 1132-1141, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29868890

RESUMO

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 prerequisite for FND. A diagnosis can now be made in an inclusionary manner by identifying neurological signs that are specific to FNDs without reliance on presence or absence of psychological stressors or suggestive historical clues. The new model highlights a wider range of past sensitizing events, such as physical trauma, medical illness, or physiological/psychophysiological events. In this model, strong ideas and expectations about these events correlate with abnormal predictions of sensory data and body-focused attention. Neurobiological abnormalities include hypoactivation of the supplementary motor area and relative disconnection with areas that select or inhibit movements and are associated with a sense of agency. Promising evidence has accumulated for the benefit of specific physical rehabilitation and psychological interventions alone or in combination, but clinical trial evidence remains limited. Conclusions and Relevance: Functional neurological disorders are a neglected but potentially reversible source of disability. Further research is needed to determine the dose and duration of various interventions, the value of combination treatments and multidisciplinary therapy, and the therapeutic modality best suited for each patient.


Assuntos
Transtorno Conversivo/diagnóstico , Transtorno Conversivo/terapia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Encéfalo/fisiopatologia , Transtorno Conversivo/complicações , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Doenças do Sistema Nervoso/complicações
10.
Neurology ; 90(3): e247-e253, 2018 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-29273688

RESUMO

OBJECTIVE: To determine whether sensorimotor beta-frequency oscillatory power is raised during motor preparation in patients with functional movement disorders (FMD) and could therefore be a marker of abnormal "body-focused" attention. METHODS: We analyzed motor performance and beta-frequency cortical oscillations during a precued choice reaction time (RT) task with varying cue validity (50% or 95% congruence between preparation and go cues). We compared 21 patients with FMD with 13 healthy controls (HCs). RESULTS: In HCs, highly predictive cues were associated with faster RT and beta desynchronization in the contralateral hemisphere (contralateral slope -0.045 [95% confidence interval (CI) -0.057 to -0.033] vs ipsilateral -0.033 [95% CI -0.046 to -0.021], p < 0.001) and with a tendency for reaching lower contralateral end-of-preparation beta power (contralateral -0.482 [95% CI -0.827 to -0.137] vs ipsilateral -0.328 [95% CI -0.673 to 0.016], p = 0.069). In contrast, patients with FMD had no improvement in RTs with highly predictive cues and showed an impairment of beta desynchronization and lateralization before movement. CONCLUSIONS: Persistent beta synchronization during motor preparation could reflect abnormal explicit control of movement in FMD. Excessive attention to movement itself rather than the goal might maintain beta synchronization and impair performance.


Assuntos
Ritmo beta , Atividade Motora/fisiologia , Transtornos dos Movimentos/fisiopatologia , Adulto , Ritmo beta/fisiologia , Comportamento de Escolha/fisiologia , Sincronização Cortical/fisiologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Transtornos dos Movimentos/reabilitação , Tempo de Reação/fisiologia , Resultado do Tratamento
11.
Mov Disord Clin Pract ; 4(5): 710-716, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30363505

RESUMO

Background: The Psychogenic Movement Disorders Rating Scale (PMDRS) has potential as a useful objective assessment in clinical research, but the current scale has limitations. We developed a simplified version (S-FMDRS) and assessed inter-rater reliability, concurrent validity, and sensitivity. Methods: Fifty-two videos of subjects with functional (psychogenic) movement disorders (FMD) were rated according to the PMDRS and S-FMDRS by three neurologists. Inter-rater reliability was assessed using intraclass correlation coefficient (ICC). Agreement of symptomatic body regions and movement disorder classification was assessed using Light's kappa. Spearman's correlation coefficient was used to assess concurrent validity. A physiotherapist also rated videos on the S-FMDRS. The simplified scale was piloted in a feasibility study of physiotherapy for FMD to assess sensitivity. Results: ICC of total scores was 0.84 for the original scale and 0.85 for the simplified scale. Light's kappa for agreement of symptomatic body regions and movement disorder classification was moderate to low. Concurrent validity was demonstrated by Spearman's correlation between the two scales ranging from 0.84 to 0.95. The simplified scale was sensitive to change, with an effect size in the feasibility study of 0.79. Inter-rater reliability between physiotherapist and neurologist was high (ICC 0.85). Discussion: Both versions of the scale had good inter-rater reliability for the total score. Low agreement on movement disorder classification and identification of symptomatic body regions support our argument for a simplified scale. Conclusions: The S-FMDRS has high inter-rater reliability and good sensitivity to change. Further psychometric evaluation is warranted.

12.
J Neurol Neurosurg Psychiatry ; 86(10): 1113-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25433033

RESUMO

BACKGROUND: Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment. METHODS: A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience. RESULTS: We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms. CONCLUSIONS: Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package.


Assuntos
Transtornos dos Movimentos/terapia , Modalidades de Fisioterapia , Consenso , Medicina Baseada em Evidências , Guias como Assunto , Humanos , Transtornos Mentais/complicações , Transtornos dos Movimentos/diagnóstico , Alta do Paciente , Educação de Pacientes como Assunto , Educação Física e Treinamento , Encaminhamento e Consulta , Autocuidado
13.
J Psychosom Res ; 75(2): 93-102, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23915764

RESUMO

OBJECTIVE: Functional (psychogenic) motor symptoms (FMS), also called motor conversion disorder or non-organic motor symptoms are a common cause of disability and distress among patients attending neurology and neurorehabilitation services. Patients with FMS are often referred for physiotherapy but it is not clear whether this is effective. Here we aim to systematically review the literature regarding physiotherapy interventions for patients with functional motor symptoms. METHODS: Systematic review of databases with reference search for period 1950 to September 2012. RESULTS: There was only one controlled intervention study with a historical control group and 28 case series or reports describing interventions. The total number of patients in all studies was 373. Physiotherapy most commonly occurred in the context of multidisciplinary treatment and involved a motor learning approach. Novel approaches included the use of distraction techniques and transcutaneous electrical nerve stimulation (TENS) machine. Deceptive behavioural techniques have also been described. Most studies reported benefit from physical treatment, including some studies with long-term follow up. CONCLUSIONS: Patients with FMS are commonly encountered in neurological practice and are often referred for physiotherapy. The existing data to guide physiotherapy treatment for FMS is of low quality and limited in scope. However, it suggests potential positive effects and provides a useful resource for developing and testing physiotherapy interventions in future studies.


Assuntos
Transtorno Conversivo/terapia , Modalidades de Fisioterapia , Humanos , Atividade Motora , Resultado do Tratamento
14.
J Neurol Neurosurg Psychiatry ; 83(6): 655-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22496582

RESUMO

BACKGROUND: Functional (psychogenic) motor symptoms are commonly encountered in clinical neurology. Physiotherapy has face validity as a treatment for such symptoms and, anecdotally, referral of patients with functional motor symptoms (FMS) to physiotherapy services is common practice by neurologists. Here the authors sought to explore exposure to and attitudes towards patients with FMS among neurophysiotherapists. METHOD: The authors used an internet survey to gather information on the knowledge and attitudes of patients with FMS among 1402 members of a UK neurophysiotherapy organisation. RESULTS: The response rate was 61%. Most physiotherapists saw patients with FMS, and for 25% of respondents these patients made up over 10% of their workload. Respondents were moderately interested in treating these patients (ranking them sixth out of 10 neurological conditions), but had low self-judged knowledge. Most respondents felt physiotherapy had more to offer patients with FMS, but felt poorly supported by referring neurologists and by inadequate service structures. CONCLUSIONS: Neurologists frequently refer patients with FMS to neurophysiotherapy services. Physiotherapists in general are interested in treating such patients and feel physiotherapy to be an appropriate treatment. However, inadequate service structures, knowledge and support from non-physiotherapy colleagues are judged to be barriers to provision of care.


Assuntos
Distúrbios Distônicos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Fisioterapeutas/psicologia , Adulto , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Reino Unido
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