Impaired sense of agency in functional movement disorders: An fMRI study

Nahab, Fatta B.; Kundu, Prantik; Maurer, Carine W.; Shen, Qian; Hallett, Mark

doi:10.1371/journal.pone.0172502

Cited by 88 publications

(88 citation statements)

References 37 publications

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“…In addition, tasked-based 6 55 and resting-state neuroimaging abnormalities [23][24][25] in the TPJ/inferior parietal lobule have been characterised in FND cohorts, and linked to impaired motor attention awareness and self-agency. Enhanced insular-TPJ link-step connectivity correlating with symptom severity in our study, and previously described taskbased 55 and functional connectivity alterations 25 across insular and TPJ areas, suggest that these epicentres both play important roles in promoting altered awareness in individuals with FND.…”

Section: Discussionsupporting

confidence: 85%

Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder

Diez

Ortiz-Terán

Williams

et al. 2019

J Neurol Neurosurg Psychiatry

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ObjectiveSome individuals with functional neurological disorder (FND) exhibit motor and affective disturbances, along with limbic hyper-reactivity and enhanced motor-limbic connectivity. Given that the multimodal integration network (insula, dorsal cingulate, temporoparietal junction (TPJ)) is implicated in convergent sensorimotor, affective and interoceptive processing, we hypothesised that patients with FND would exhibit altered motor and amygdalar resting-state propagation to this network. Patient-reported symptom severity and clinical outcome were also hypothesised to map onto multimodal integration areas.MethodsBetween-group differences in primary motor and amygdalar nuclei (laterobasal, centromedial) were examined using graph-theory stepwise functional connectivity (SFC) in 30 patients with motor FND compared with 30 healthy controls. Within-group analyses correlated functional propagation profiles with symptom severity and prospectively collected 6-month outcomes as measured by the Screening for Somatoform Symptoms Conversion Disorder subscale and Patient Health Questionnaire-15 composite score. Findings were clusterwise corrected for multiple comparisons.ResultsCompared with controls, patients with FND exhibited increased SFC from motor regions to the bilateral posterior insula, TPJ, middle cingulate cortex and putamen. From the right laterobasal amygdala, the FND cohort showed enhanced connectivity to the left anterior insula, periaqueductal grey and hypothalamus among other areas. In within-group analyses, symptom severity correlated with enhanced SFC from the left anterior insula to the right anterior insula and TPJ; increased SFC from the left centromedial amygdala to the right anterior insula correlated with clinical improvement. Within-group associations held controlling for depression, anxiety and antidepressant use.ConclusionsThese neuroimaging findings suggest potential candidate neurocircuit pathways in the pathophysiology of FND.

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Section: Discussionsupporting

confidence: 85%

Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder

Diez

Ortiz-Terán

Williams

et al. 2019

J Neurol Neurosurg Psychiatry

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“…Functional magnetic resonance imaging (fMRI) studies have shown decreased functional connectivity between the right temporoparietal junction (a critical region in the SA network) and sensorimotor regions in patients with FMDs compared to healthy controls . In another fMRI study in which a virtual reality paradigm was used to modulate SA for a motor control task in healthy control patients and those with FMD, the FMD group reported greater variability in their perceived level of control, associated with selective disruption of the SA network . These findings have led to interest in the use of fMRI findings as a biomarker for functional conditions.…”

Section: Functional Movement Disorderssupporting

confidence: 71%

Functional Movement Disorders and Placebo: A Brief Review of the Placebo Effect in Movement Disorders and Ethical Considerations for Placebo Therapy

Kaas

Humbyrd

Pantelyat

2018

Movement Disord Clin Pract

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Background Functional movement disorders are common and disabling neurologic conditions. Patients with functional neurologic disorders represent a large proportion of neurology clinic referrals, and limited availability of subspecialty care creates a considerable burden for the healthcare system. These conditions are currently treated with a combination of physical therapy and cognitive behavioral therapy, with variable success. Methods We searched the Medline database for studies on the epidemiology and physiology of functional movement disorders, as well as those on the placebo effect in movement disorders. We reviewed and summarized the literature on these topics and explored ethical issues concerning the administration of placebos to patients with functional movement disorders. Results Studies of placebos, particularly in patients with movement disorders, have shown that these “inert” agents can provide demonstrable neurophysiologic benefits, even in open‐label studies. Physician surveys have shown that many administer placebos for diagnostic and therapeutic purposes, although there are ethical concerns about this practice. We used a principle‐based approach and reviewed ethical arguments for (justice and beneficence) and against (non‐maleficence and autonomy) the use of placebos in functional movement disorders. In this context, we argue for the importance of the therapeutic alliance in preserving patient autonomy while exploring the potential benefits of placebo therapy. Conclusions An ethical argument is presented in support of nondeceptive clinical placebo use for the treatment of functional movement disorders. Patient and clinician attitudes regarding the use of placebos should be investigated before placebo‐therapy trials are conducted.

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“…An individual having a good sense of agency is capable of controlling their behaviors, which is a prerequisite for volitional qualities and independence. On the other side, impairments in the sense of agency have been reported in neurological and psychiatric disorders [57], indicating that these patients find it difficult to control their own behaviors and present poor volitional qualities. The athletes recruited in this study are professional athletes engaged in their career for at least ten years and have rich experiences in dealing with difficulties in important national and international competitions.…”

Section: Discussionmentioning

confidence: 99%

“No Pain No Gain”: Evidence from a Parcel-Wise Brain Morphometry Study on the Volitional Quality of Elite Athletes

Wei

et al. 2020

Brain Sciences

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Volition is described as a psychological construct with great emphasis on the sense of agency. During volitional behavior, an individual always presents a volitional quality, an intrapersonal trait for dealing with adverse circumstances, which determines the individual’s persistence of action toward their intentions or goals. Elite athletes are a group of experts with superior volitional quality and, thereby, could be regarded as the natural subject pool to investigate this mental trait. The purpose of this study was to examine brain morphometric characteristics associated with volitional quality by using magnetic resonance imaging (MRI) and the Scale of Volitional Quality. We recruited 16 national-level athletes engaged in short track speed skating and 18 healthy controls matched with age and gender. A comparison of a parcel-wise brain anatomical characteristics of the healthy controls with those of the elite athletes revealed three regions with significantly increased cortical thickness in the athlete group. These regions included the left precuneus, the left inferior parietal lobe, and the right superior frontal lobe, which are the core brain regions involved in the sense of agency. The mean cortical thickness of the left inferior parietal lobe was significantly correlated with the independence of volitional quality (a mental trait that characterizes one’s intendency to control his/her own behavior and make decisions by applying internal standards and/or objective criteria). These findings suggest that sports training is an ideal model for better understanding the neural mechanisms of volitional behavior in the human brain.

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Impaired sense of agency in functional movement disorders: An fMRI study

Cited by 88 publications

References 37 publications

Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder

Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder

Functional Movement Disorders and Placebo: A Brief Review of the Placebo Effect in Movement Disorders and Ethical Considerations for Placebo Therapy

“No Pain No Gain”: Evidence from a Parcel-Wise Brain Morphometry Study on the Volitional Quality of Elite Athletes

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