Impaired Action Control in Patients With Functional Movement Disorders

Wouwe, Nelleke C. van; Mohanty, Diksha; Lingaiah, Anushree; Wylie, Scott A.; LaFaver, Kathrin

doi:10.1176/appi.neuropsych.19030076

Cited by 8 publications

(5 citation statements)

References 20 publications

(20 reference statements)

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“…23 R-cluster effects were associated with activation differences in the inferior frontal gyrus, that is, BA44, a hub region of inhibitory control processes to implement executive control, 59,60 which have been shown to be altered in FMD. 61 Our study also shows that translation processes between stimulus processing and responding (C-cluster) are affected in FMD. In fact, C-cluster effects were associated with different activity modulations in the inferior parietal cortex, that is, BA40, an area well known to be relevant for event file coding.…”

Section: Discussionsupporting

confidence: 62%

“…The latter finding does not contradict the conceptualization of altered perception–action integration in FMD because both sensory and motor processes (R‐cluster) 57,58 constitute processes occurring in an event file 23 . R‐cluster effects were associated with activation differences in the inferior frontal gyrus, that is, BA44, a hub region of inhibitory control processes to implement executive control, 59,60 which have been shown to be altered in FMD 61 …”

Section: Discussionmentioning

confidence: 74%

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Perception–Action Integration Is Altered in Functional Movement Disorders

et al. 2023

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BackgroundAlthough functional neurological movement disorders (FMD) are characterized by motor symptoms, sensory processing has also been shown to be disturbed. However, how the integration of perception and motor processes, essential for the control of goal‐directed behavior, is altered in patients with FMD is less clear. A detailed investigation of these processes is crucial to foster a better understanding of the pathophysiology of FMD and can systematically be achieved in the framework of the theory of event coding (TEC).ObjectiveThe aim was to investigate perception–action integration processes on a behavioral and neurophysiological level in patients with FMD.MethodsA total of 21 patients and 21 controls were investigated with a TEC‐related task, including concomitant electroencephalogram (EEG) recording. We focused on EEG correlates established to reflect perception–action integration processes. Temporal decomposition allowed to distinguish between EEG codes reflecting sensory (S‐cluster), motor (R‐cluster), and integrated sensory–motor processing (C‐cluster). We also applied source localization analyses.ResultsBehaviorally, patients revealed stronger binding between perception and action, as evidenced by difficulties in reconfiguring previously established stimulus–response associations. Such hyperbinding was paralleled by a modulation of neuronal activity clusters, including reduced C‐cluster modulations of the inferior parietal cortex and altered R‐cluster modulations in the inferior frontal gyrus. Correlations of these modulations with symptom severity were also evident.ConclusionsOur study shows that FMD is characterized by altered integration of sensory information with motor processes. Relations between clinical severity and both behavioral performance and neurophysiological abnormalities indicate that perception–action integration processes are central and a promising concept for the understanding of FMD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 74%

Perception–Action Integration Is Altered in Functional Movement Disorders

et al. 2023

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“…Van Wouwe et al [ 11 ] investigated the ability of FMD patients to control their actions using choice-reaction, stop-signal, and Simon tasks compared to healthy controls. Patients displayed impaired selective impulse inhibition and global action cancellation, suggesting two forms of abnormal inhibitory control in FMD.…”

Section: Updates On Pathophysiologymentioning

confidence: 99%

Updates in Functional Movement Disorders: from Pathophysiology to Treatment Advances

Kola

LaFaver

2022

Curr Neurol Neurosci Rep

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Purpose of Review This review discusses advances in functional movement disorders (FMD) over the past 3 years, with a focus on risk factors, diagnosis, pathophysiology, neuroimaging studies, and treatment. Recent Findings The past decade has brought a revived interest in functional movement disorders, with a growing number of studies exploring pathophysiological mechanisms. Here, we review recent studies demonstrating changes in attention, emotional and sensorimotor function in FMD. Through international collaborative efforts, progress has been made in defining biomarkers and outcome measures, an important prerequisite towards standardization of diagnosis and reporting of outcomes in clinical trials. Of particular interest are neuroimaging studies demonstrating functional and structural changes in motor and emotional brain circuits, deepening our understanding of FMD as a neurocircuit disorder and potentially paving the way towards new treatments. Currently available treatment modalities have shown successful outcomes via outpatient, inpatient, and virtual delivery. Summary The last 3 years have seen tremendous efforts to better understand, diagnose, and treat FMD. The disease model has been broadened to include a biopsychosocial formulation, and insights on the pathophysiology on FMD are informing treatment efforts. Several international multidisciplinary research collaborations are underway to define biomarkers and best outcome measures, highlighting the path towards improved standardization of future treatment trials. Additionally, the rise of telemedicine during the COVID-19 pandemic has reduced geographic barriers and paved the way for virtual therapy sessions and self-guided programs. Supplementary Information The online version contains supplementary material available at 10.1007/s11910-022-01192-9.

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“…Recent studies have identified various neurophysiological and neuropsychological factors associated with DCD, including the role of executive control dysregulation. 14 – 15 Researchers have also highlighted possible connections between the amygdala and orbitofrontal cortex (OFC) to process emotional stressors in dissociative symptoms. 16 The connections between OFC and amygdala are necessary for making an effective decision with proper utilization of outcome-related feedback in terms of reward and punishment, as there is a role of these connections in processing emotional and social stimuli.…”

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confidence: 99%

Arousability, Personality, and Decision-Making Ability in Dissociative Disorder

Ghosh¹,

Mukhopadhyay

Chatterjee

et al. 2021

Indian Journal of Psychological Medicine

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Background: There is a gap in understanding the pathogenesis of dissociative conversion disorder (DCD), despite the disorder having a strong historical root. The role of personality and neurocognitive factors are now highlighted; however, inconsistencies are reported. This study explores the personality disposition, arousability, and decision-making ability of patients with DCD, in reference to a healthy control group (HCG). Methods: In this cross-sectional study, the sample comprised ten adult psychiatric patients with DCD. Ten participants of the HCG were matched according to age, gender, education, economic status, domicile, religious background, and handedness. The study assessed personality disposition with Temperament and Character Inventory, arousability with reaction time task, and decision-making ability with the Iowa Gambling Task (IGT PEBL version). Results: The DCD group differed significantly on personality disposition related to both temperament and character. There was also evidence of easy arousability and frustration along with deficit in executive function related to decision-making ability. Conclusion: This study highlights the presence of both temperamental and characterological factors associated with DCD. Moreover, this study identifies the role of cognitive arousability and decision-making or feedback utilization ability in the psychopathology of DCD.

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Impaired Action Control in Patients With Functional Movement Disorders

Cited by 8 publications

References 20 publications

Perception–Action Integration Is Altered in Functional Movement Disorders

Perception–Action Integration Is Altered in Functional Movement Disorders

Updates in Functional Movement Disorders: from Pathophysiology to Treatment Advances

Arousability, Personality, and Decision-Making Ability in Dissociative Disorder

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