Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.

BACKGROUND: Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE: The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability. PATIENTS AND METHODS: Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign. RESULTS: A score of ≥ 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate). CONCLUSIONS: Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.

Structural basis for map formation in the thalamocortical pathway of the barrelless mouse.

Barrelless mice (BRL) homozygous for the BRL mutation that disrupts the gene coding for adenylyl cyclase type I on chromosome 11 lack spatial segregation of layer IV cortical cells and of the thalamocortical axons (TCAs) into barrel domains. Despite these morphological perturbations, a functional topographic map has been demonstrated. We reconstructed individual biocytin-injected TCAs from thalamus to barrel cortex in NOR (normal) and BRL mice to analyze to what extent the TCA arborization pattern and bouton distribution could explain the topographic representation of the whisker follicles. In BRL, the geometry of TCA is modified within layer IV as well as in infragranular layers. However, in both strains, the spatial distribution of TCA in layer IV reflects the spatial relationship of their cell bodies in the ventrobasal nucleus of the thalamus. The morphometric analysis revealed that TCAs of both strains have the same length, branch number, and number of axonal boutons in layer IV. However, in barrelless, the boutons are distributed within a larger tangential extent. Analysis of the distribution of boutons from neighboring thalamic neurons demonstrated the existence in layer IV of domains of high bouton density that in both strains equal the size and shape of individual barrels. We propose that the domains of high bouton density are at the basis of the whisker map in barrelless mice.

Schizophrenia and oxidative stress: glutamate cysteine ligase modifier as a susceptibility gene.

Oxidative stress could be involved in the pathophysiology of schizophrenia, a major psychiatric disorder. Glutathione (GSH), a redox regulator, is decreased in patients' cerebrospinal fluid and prefrontal cortex. The gene of the key GSH-synthesizing enzyme, glutamate cysteine ligase modifier (GCLM) subunit, is strongly associated with schizophrenia in two case-control studies and in one family study. GCLM gene expression is decreased in patients' fibroblasts. Thus, GSH metabolism dysfunction is proposed as one of the vulnerability factors for schizophrenia.