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1.
Rev Med Chil ; 147(6): 799-802, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859834

RESUMO

Stiff-person syndrome is characterized by persistent muscle spasms, involving agonist and antagonist muscles simultaneously, starting in the lower limbs and trunk. It tends to occur in the fourth to sixth decade of life, presenting with intermittent spasms that later become continuous and usually painful. Minor sensory stimuli, such as noise or light touch, precipitate severe spasms. Spasms do not occur during sleep and only rarely involve cranial muscles. We present a case that for two years was diagnosed and treated as a conversion disorder associated with depression. After two years she was admitted to another hospital with an unmistakable picture of stiff-person syndrome with hypertrophy and rigidity of lower limb muscles, compatible electrophysiology and positive anti-GAD antibodies. She had autoimmune hypothyroidism, that should have raised the suspicion of stiff-person syndrome earlier. She responded to intravenous immunoglobulin and mycophenolate mofetil and and to tranquilizers that have muscle relaxant properties.


Assuntos
Transtorno Conversivo/diagnóstico , Erros de Diagnóstico , Rigidez Muscular Espasmódica/diagnóstico , Transtorno Conversivo/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Rigidez Muscular Espasmódica/tratamento farmacológico , Rigidez Muscular Espasmódica/patologia , Resultado do Tratamento
2.
BMC Neurol ; 19(1): 270, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684891

RESUMO

BACKGROUND: In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder) as a "psychodynamic" lesion. Numerous advances in neuroimaging have permitted identification of the neural underpinnings of this disorder. CASE PRESENTATION: Herein we describe a case of functional neurological disorder (FND) with initial left sensorimotor deficit, in-coordinated limb movements, neglect, clouded consciousness, slurred speech and a semiology of visual impairment. A single photon emission computed tomography (SPECT) showed a right thalamic hypoperfusion, which is rather concordant with the initial semiology. Later, the semiology changed, presenting with a predominantly neurovisual complex presentation. The second SPECT showed no more thalamic abnormalities but an hypoperfusion in the right temporo-occipital junction, right inferior parietal lobe and left superior frontal lobe, which is also rather concordant with the changing semiology. CONCLUSIONS: This case illustrates the evolving neuroimaging patterns of FND but also the concordance between semiology and neuroimaging findings in FND supporting Charcot's theory of "dynamic lesion".


Assuntos
Encéfalo , Transtorno Conversivo , Neuroimagem , Tomografia Computadorizada de Emissão de Fóton Único , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Transtorno Conversivo/diagnóstico por imagem , Transtorno Conversivo/fisiopatologia , Humanos
3.
Ned Tijdschr Geneeskd ; 1632019 08 29.
Artigo em Holandês | MEDLINE | ID: mdl-31483585

RESUMO

In this case of a 54-year-old woman, severe impairment of motor and sensory function - that could not be assigned to any neurological disease - was diagnosed as a probable conversion disorder or functional neurological disorder (FND). Several psychological stressors, which occurred in the year that preceded the first development of symptoms, were linked to the disorder. Nerve conduction values had not shown any abnormalities at the onset of the disease. However, as the condition progressed, cerebrospinal fluid and nerve conduction study proved an underlying polyneuropathy. In this article we discuss the diagnostic process followed in this case. General lack of evidence for psychological conflict being related to symptoms of conversion disorder/FND led to elimination of this criterion in DSM 5. Instead, the diagnostic process of conversion disorder/FND requires not only exclusion of neurological causes for the symptoms, but also active examination of neurological findings that are discrepant with known neurological diseases; taken together this can positively support a diagnosis of conversion disorder/FND.


Assuntos
Transtorno Conversivo/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Polineuropatias/diagnóstico , Estresse Psicológico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/patologia , Exame Neurológico , Polineuropatias/etiologia
4.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413052

RESUMO

Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare cause of genetic prion disease. Overlapping neurological, cognitive and psychiatric symptoms make GSS difficult to diagnose based on clinical features alone. We present a 40-year-old man without relevant medical or family history who developed progressive neurocognitive and behavioural symptoms over 3 years. Initial extensive diagnostic workup of his variable motor symptoms was unrevealing and he was diagnosed with conversion disorder. This diagnosis persisted for over 2 years, despite progressive neurocognitive symptoms. He eventually developed dementia and severe neurological impairment. Repeat brain MRI revealed generalised cortical volume loss, establishing the diagnosis of a rapidly progressive neurodegenerative process. He ultimately died from aspiration pneumonia at age 43. Postmortem neuropathological examination showed widespread multicentric prion protein amyloid plaques characteristic of GSS. Ultimately, genetic testing of brain tissue revealed a heterozygous A117V variant in the PNRP gene, confirming the diagnosis.


Assuntos
Doença de Gerstmann-Straussler-Scheinker/diagnóstico , Adulto , Transtorno Conversivo/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Evolução Fatal , Humanos , Masculino
5.
Neuroimage Clin ; 22: 101798, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31146322

RESUMO

Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A "software" vs. "hardware" analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including "disease staging" discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a "software" and "hardware" problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.


Assuntos
Transtorno Conversivo/patologia , Transtorno Conversivo/fisiopatologia , Neuroimagem , Transtornos Somatoformes/patologia , Transtornos Somatoformes/fisiopatologia , Transtorno Conversivo/diagnóstico por imagem , Humanos , Transtornos Somatoformes/diagnóstico por imagem
6.
Med Leg J ; 87(2): 73-76, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31107169

RESUMO

Delusional health beliefs can be difficult and costly for practitioners to diagnose and manage. Patients often deny that mental distress is the cause of their illness, when it may be the most significant factor. Such patients can be relentless in their pursuit of a physical cause and go from doctor to doctor to find one who agrees with them, using up significant NHS resources. The number of negative investigations increases year on year, with the patient being referred back to their general practitioner without a working diagnosis. The recent publication of Susanne O'Sullivan's book, "It's All in your Head - True Stories of Imaginary Illness", shines a bright and necessary light on the difficulties of getting these patients to accept that their problems originate in their minds. Doctors, alerted by fat files, may be well advised to question any previous diagnosis, if it is not borne out by physical evidence and does not conform to known diagnostic criteria and disease patterns. In this context, it is timely to consider the true cause of Stephen Hawking's illness, which he has called into question in his last book, published after his death. Allegedly, he had been suffering from motor neurone disease, diagnosed when he was a very young man.Yet he survived to the age of 76, albeit in his later years in an increasingly crippled and distressed state. Such longevity is totally inconsistent with MND. What then was the cause of Hawking's illness? Is there any firm evidence that a consultant neurologist ever made that diagnosis, and on what grounds? The interplay between mind and body is mysterious and complex, but we need to question every symptom, if it is not grounded in objective reality.


Assuntos
Delusões/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/complicações , Transtorno Conversivo , Alfabetização em Saúde/normas , Alfabetização em Saúde/tendências , Humanos , Transtornos Mentais/psicologia
9.
Rev Prat ; 69(2): 214-218, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30983230

RESUMO

Non-epileptic psychogenic seizures: a renewal approach of conversion disorders. Psychogenic non-epileptic seizures (PNES) are characterized by a paroxystic modification of behaviour or consciousness that resemble to an epileptic seizure. They are classified as dissociative or somatoform disorders. Their diagnostic remains difficult and the recording of a typical event through video-EEG is the gold standard. PNES are a symptom of the underlying disease related to disturbances in the management and regulation of emotions. Thus, the predisposing, the precipitating and the perpetuating factors must be evaluated carefully. A multidisciplinary diagnosis announcement is an essential and effective therapeutic step and treatment has to be adapted case by case.


Assuntos
Transtorno Conversivo , Transtornos Somatoformes , Eletroencefalografia , Humanos , Transtornos Psicofisiológicos , Convulsões
11.
J Clin Neurosci ; 64: 174-179, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30940452

RESUMO

BACKGROUND: A century ago, Janet was the first to conceptualize conversion reactions as having a neurocognitive component, as disorders of memory processing that arise in the wake of trauma. The available evidence suggests that this impairment might arise from dysfunction in the fronto-subcortical circuits. Our aim was to examine the cognitive functions regulating deception in patients with functional motor symptoms (FMS), using a computerised task, the Guilty Knowledge Task (GKT). We also tested a group of healthy subjects (HS) as a control group. MATERIALS AND METHODS: Thirteen patients affected by FMS and 14 HS underwent a modified version of the GKT, a computer-controlled procedure used to detect truthful and deceptive responses. All participants were also screened for depression, anxiety, alexithymia and for moral sense (moral judgment task). RESULTS: The reaction times (RTs) were significantly longer for lie responses than for true responses (F(1,26) = 50.47; p < 0.001) in the two groups. Total RTs were significantly longer for patients with FMS than for HS, in true responses (F(1,25) = 4,36; p = 0.047) and lie responses (F(1,25) = 4.26; p = 0.05). No differences were found between the two groups for accuracy in producing true responses (F(1,25) = 0.09, p = 0.77), and lie responses (F(1,25) = 0,12, p = 0.73. CONCLUSIONS: When tested with the GKT, patients with FMS were slower than HS in producing truthful and lying responses. Current knowledge along with our new findings in patients with FMS - possibly arising from individually unrecognised extremely mild, cognitive difficulties - should help in designing specific rehabilitative programmes to improve cognitive and behavioural disturbances in these patients.


Assuntos
Cognição/fisiologia , Transtorno Conversivo/fisiopatologia , Detecção de Mentiras , Testes Neuropsicológicos , Adulto , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Transtorno Conversivo/complicações , Decepção , Feminino , Culpa , Humanos , Masculino , Tempo de Reação/fisiologia
12.
Neurology ; 92(9): e895-e904, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30804064

RESUMO

OBJECTIVE: This retrospective study explores to what extent additional information from event witnesses provided using the novel 31-item Paroxysmal Event Observer (PEO) Questionnaire improves the differentiation among epilepsy, syncope, and psychogenic nonepileptic seizures (PNES) achievable with information provided by patients alone. METHODS: Patients with transient loss of consciousness caused by proven epilepsy (n = 86), syncope (n = 79), or PNES (n = 84) attending specialist neurology/syncope services in the United Kingdom and event observers provided Paroxysmal Event Profile (PEP), PEO, and personal information (PI) (e.g., sex, age, medical history) data. PEO data were subjected to exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). PEO, PEP, and PI data were used separately and in combination to differentiate diagnoses by pairwise and multinomial logistic regressions. Predicted diagnoses were compared with gold standard medical diagnoses. RESULTS: EFA/CFA identified a 4-factor structure of the PEO based on 26/31 questionnaire items with loadings ≥0.4. Observer-reported factors alone differentiated better between syncope and epilepsy than patient-reported factors (accuracy: 96% vs 85%, p = 0.0004). Observer-reported data improved accuracy over differentiation based on patient-reported data alone from 90% to 100% between syncope and epilepsy (p = 0.005), 76% to 83% between epilepsy and PNES (p = 0.006), and 93% to 95% between syncope and PNES (p = 0.098). CONCLUSIONS: Information from observers can make an important contribution to the differentiation of epilepsy from syncope or PNES but adds less to that of syncope from PNES.


Assuntos
Transtorno Conversivo/diagnóstico , Epilepsia/diagnóstico , Observação , Síncope/diagnóstico , Inconsciência/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Análise Fatorial , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Reino Unido , Adulto Jovem
13.
Semin Neurol ; 39(1): 102-114, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30743296

RESUMO

Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a "rule-out" diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a "rule-in" diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.


Assuntos
Transtorno Conversivo , Serviço Hospitalar de Emergência , Doenças do Sistema Nervoso/diagnóstico , Transtornos Psicofisiológicos , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/psicologia , Transtorno Conversivo/terapia , Humanos , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/psicologia , Transtornos Psicofisiológicos/terapia
14.
Pract Neurol ; 19(3): 259-263, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30755460

RESUMO

Dissociative seizures are common in routine neurological practice and cause considerable morbidity. However, explaining such episodes to patients is rarely straightforward. Taking a neuropsychological perspective, we present a strategy for communicating this diagnosis to both patients and families.


Assuntos
Transtorno Conversivo/diagnóstico , Transtornos Dissociativos/diagnóstico , Convulsões/diagnóstico , Cognição/fisiologia , Transtorno Conversivo/complicações , Diagnóstico Diferencial , Humanos , Testes Neuropsicológicos
15.
Seizure ; 66: 22-25, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30772644

RESUMO

PURPOSE: The purpose of this study was to investigate the long-term outcome of patients with psychogenic nonepileptic seizures (PNES), who never visited a psychologist and never received a proper therapy for their condition (due to lack of resources). We also aimed to investigate factors potentially associated with the outcome in these patients. METHODS: We studied all patients with PNES, who were admitted to the epilepsy monitoring unit at the Shiraz Comprehensive Epilepsy Center, from 2008 until 2013. In a phone call interview to the patients in November and December 2018, we obtained the following information: seizure outcome, history of receiving any psychotherapy after confirming their diagnosis at referral, and finally, their current marital status, education, and employment status. RESULTS: 69 patients had the inclusion criteria. Thirty-six patients (52%) were seizure-free during the past 12 months, but 33 (48%) still suffer from seizures. The only variable (at diagnosis), which was significantly associated with their outcome, was duration of their condition before they received a definite diagnosis. CONCLUSION: More than half of the patients with untreated PNES may become free of seizures after they receive a definite diagnosis and with the passage of time. Longer duration of PNES before the patients received a definite diagnosis may affect their long-term outcome.


Assuntos
Transtorno Conversivo , Convulsões , Transtornos Somatoformes , Adulto , Transtorno Conversivo/complicações , Transtorno Conversivo/psicologia , Transtorno Conversivo/reabilitação , Eletroencefalografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Psicoterapia/métodos , Convulsões/complicações , Convulsões/psicologia , Convulsões/reabilitação , Transtornos Somatoformes/complicações , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/reabilitação , Resultado do Tratamento , Adulto Jovem
16.
Neurology ; 92(7): e675-e679, 2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30610097

RESUMO

OBJECTIVE: We conducted a prospective cohort study of patients with psychogenic nonepileptic seizures (PNES) to examine the association between adherence with psychotherapy and outcomes, including significant (≥50%) reduction in PNES frequency, PNES freedom, improvement in quality of life, and reduction in emergency department (ED) utilization. METHODS: A total of 105 participants were referred to receive psychotherapy either at Brigham and Women's Hospital or with a local therapist. We called participants at 12-24 months follow-up and obtained detailed follow-up data from 93 participants (89%). Participants were considered adherent with psychotherapy if they attended at least 8 sessions within a 16-week period starting at the time of referral. RESULTS: Adherence with psychotherapy was associated with reduction in seizure frequency (84% in adherent group vs 61% in nonadherent, p = 0.021), improvement in quality of life (p = 0.044), and reduction in ED utilization (p = 0.040), with medium effect sizes; there was no difference in PNES freedom. The association between adherence and ≥50% reduction in PNES frequency persisted when controlling for potential confounders in a multivariate model. Psychotherapy nonadherence was associated with baseline characteristics of self-identified minority status (odds ratio 7.47, p = 0.019) and history of childhood abuse (odds ratio 3.30, p = 0.023). CONCLUSIONS: Our study is limited in that it cannot establish a causal relationship between adherence with psychotherapy and outcomes, and the results may not generalize beyond the single quaternary care center study site. Among participants with documented PNES, adherence with psychotherapy was associated with reduction in PNES frequency, improvement in quality of life, and decrease in ED visits.


Assuntos
Transtorno Conversivo/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Psicoterapia , Qualidade de Vida , Convulsões/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Razão de Chances , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
17.
J Shoulder Elbow Surg ; 28(6): e175-e181, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30685281

RESUMO

BACKGROUND: Conversion disorder in children presents a challenge to orthopedic surgeons. The condition is frequently associated with unnecessary diagnostic tests, treatments, and cost. The purpose of this study was to report a series of children with upper extremity conversion disorder to raise awareness for this uncommon condition and to assist with its diagnosis and management. METHODS: A retrospective review was conducted of 4 pediatric patients with upper extremity conversion disorder at a tertiary pediatric hospital from 2015 to 2017. Medical records were reviewed for patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and cost of care. RESULTS: Patients presented with upper extremity muscle stiffness, unremitting dysmorphic muscle spasms, weakness, pain, very limited shoulder range of motion, and complaints of recurrent shoulder dislocations. All patients had been evaluated by multiple specialists and had an extensive prior diagnostic workup that was inconclusive. Two patients had a history of prior psychiatric illness and suicidal ideation, and all patients expressed despair and depression. All patients had normal physical examination findings under anesthesia. Two patients with muscle stiffness were treated with botulism injections and improved their shoulder range of motion. The average total charge for care since presentation was $42,729. CONCLUSIONS: Conversion disorder should be considered in patients with an extensive prior diagnostic workup, deficits inconsistent with anatomic patterns or imaging findings, and a history of prior psychiatric illness. Examination under anesthesia is a successful diagnostic approach in children with suspected conversion disorder.


Assuntos
Transtorno Conversivo/psicologia , Luxação do Ombro/psicologia , Extremidade Superior , Adolescente , Criança , Serviços de Saúde da Criança , Transtorno Conversivo/diagnóstico , Diagnóstico Diferencial , Feminino , Hospitais Pediátricos , Humanos , Masculino , Medição da Dor , Amplitude de Movimento Articular , Estudos Retrospectivos
18.
Neuroimage ; 190: 269-274, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-29601954

RESUMO

A patient with motor conversion disorder presented with a functional paresis of the left hand. After exclusion of structural brain damage, she was repeatedly examined with whole-brain functional magnetic resonance imaging, while she performed visually paced finger-tapping tasks. The dorsal premotor cortex showed a bilateral deactivation in the acute-subacute phase. Recovery from unilateral hand paresis was associated with a gradual increase in task-based activation of the dorsal premotor cortex bilaterally. The right medial prefrontal cortex displayed the opposite pattern, showing initial task-based activation that gradually diminished with recovery. The inverse dynamics of premotor and medial prefrontal activity over time were found during unimanual finger-tapping with the affected and non-affected hand as well as during bimanual finger-tapping. These observations suggest that reduced premotor and increased medial prefrontal activity reflect an effector-independent cortical dysfunction in conversion paresis which gradually disappears in parallel with clinical remission of paresis. The results link the medial prefrontal and dorsal premotor areas to the generation of intentional actions. We hypothesise that an excessive 'veto' signal generated in medial prefrontal cortex along with decreased premotor activity might constitute the functional substrate of conversion disorder. This notion warrants further examination in a larger group of affected patients.


Assuntos
Transtorno Conversivo/fisiopatologia , Dedos/fisiopatologia , Neuroimagem Funcional , Atividade Motora/fisiologia , Córtex Motor/fisiopatologia , Paresia/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Adulto , Transtorno Conversivo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Córtex Motor/diagnóstico por imagem , Paresia/diagnóstico por imagem , Córtex Pré-Frontal/diagnóstico por imagem
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