Motor inhibition in hysterical conversion paralysis

Cojan, Yann; Waber, Lakshmi; Carruzzo, Alain; Vuilleumier, Patrik

doi:10.1016/j.neuroimage.2009.05.023

Cited by 208 publications

(192 citation statements)

References 79 publications

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“…Moreover, this right fronto-parietal network is similarly recruited for left or right hand motor inhibition [19]. Patients with left motor conversion paralysis showed the same pattern of increases in right inferior frontal and parietal cortices on NoGo trials but, more critically, no such activation on the left Go trials where they failed to move the left/paralyzed hand [18,49]. This suggests that despite preserved motor preparation, the lack of motor execution with their left hand was not due to active voluntary inhibition.…”

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 95%

“…These abnormalities in basal ganglia and thalamus disappeared when scanning was repeated after [16,18,19]. This allowed testing for brain activity during failure to move on Go trials with the paralyzed hand and comparison with inhibitory control activity during NoGo trials, in addition to motor preparation.…”

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

“…To do so, we designed a modified Go/NoGo paradigm allowing us to probe brain activity related to various motor control stages including motor intention, execution, and inhibition. Two patients with left motor conversion were examined using slightly different versions of the same paradigm [18,49], as well as a group of healthy controls [18,19]. In this task (Fig.…”

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

“…As expected, however, a loss of motor activation was seen in the right motor cortex at the time of the instructed movement execution with the left/paralyzed hand (in accordance with the lack of movement, but in In the patient, left paralysis was not associated with increased activity in right IFG as seen during voluntary inhibition of simulation; whereas activation in VMPFC was selective for preparing or attempting to move the left/paralyzed hand. Adapted from Cojan et al, [18,19].…”

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

“…These two areas did not activate in healthy controls [19] nor in simulators [18] during the same Go/NoGo task, but were specifically recruited during left hand conditions in conversion patients, particularly during the motor preparation or execution phases for the VMPFC, and Brain circuits implicated in psychogenic paralysis Figure 3 Brain activity patterns in different conversion disorders. A.…”

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

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Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Vuilleumier¹

2014

Neurophysiologie Clinique/Clinical Neurophysiology

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Please cite this article in press as: Vuilleumier P. Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis. REVIEW/MISE AU POINT Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis Circuits cérébraux des paralysies psychogènes liées aux troubles de conversion et à l'hypnose P. Vuilleumier Laboratory for Behavioral Neurology and Imaging of Cognition (LABNIC), Department of Neuroscience (NEUFO), University Medical Center (CMU), 1, rue Micheli du Crest, 1205 Geneva, SwitzerlandReceived 27 December 2013; accepted 12 January 2014 KEYWORDSConversion; Hysteria; Hypnosis; Paralysis; Brain; Neuroimaging; Affect; Self; Precuneus; VMPFC Summary Conversion disorders are defined as neurological symptoms arising without organic damage to the nervous system, presumably in relation to various emotional stress factors, but the exact neural substrates of these symptoms and the mechanisms responsible for their production remain poorly understood. In the past 15 years, novel insights have been gained with the advent of functional neuroimaging studies in patients suffering from conversion disorders in both motor and non-motor (e.g. somatosensory, visual) domains. Several studies have also compared brain activation patterns in conversion to those observed during hypnosis, where similar functional losses can be evoked by suggestion. The current review summarizes these recent results and the main neurobiological hypotheses proposed to account for conversion symptoms, in particular motor deficits. An emerging model points to an important role of ventromedial prefrontal cortex (VMPFC), precuneus, and perhaps other limbic structures (including amygdala), all frequently found to be hyperactivated in conversion disorders in parallel to impaired recruitment of primary motor and/or sensory pathways at the cortical or subcortical (basal ganglia) level. These findings are only partly shared with hypnosis, where increases in precuneus predominate, together with activation of attentional control systems, but without any activation of VMPFC. Both VMPFC and precuneus are key regions for access to internal representations about the self, integrating information from memory and imagery with affective relevance (in VMPFC) and sensory or agency representations (in precuneus). It is therefore postulated that conversion deficits might result from an alteration of conscious sensorimotor functions and self-awareness under the influence of affective and sensory representations generated in these regions, which might promote certain patterns of behaviors in response to self-relevant emotional states. © 2014 Elsevier Masson SAS. All rights reserved. IntroductionConversion disorders have been known to physicians since ancient times and consist of neurological dysfunction that occurs in the absence of organic lesions within the nervous system, but is distinct from other major psychiatric symptoms such as psychosis or depression. Thus, patients may present with a paralysis of one or ...

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Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 95%

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

Section: Empirical Investigations Of Motor Conversion Disordersmentioning

confidence: 99%

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Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Vuilleumier¹

2014

Neurophysiologie Clinique/Clinical Neurophysiology

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Conversion Disorder/Functional Neurological Disorder

Stone

Carson

2015

The Encyclopedia of Clinical Psychology

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Conversion disorder (previously called hysteria) describes neurological symptoms such as paralysis, movement disorder, or sudden collapses that are genuine but not related to disease. Although affected patients may appear to have a neurological disease such as multiple sclerosis or epilepsy, no structural disease process is evident, nor are symptoms deliberately feigned. Instead, brain function is disordered; hence, current preference for the term “functional neurological disorder.” Conversion symptoms exist at the interface between neurology and psychiatry and remain a common cause of disability and distress. The conundrum of hysteria was essential to the development of Freudian psychoanalytic theory, which today is only one of many competing hypotheses to explain these intriguing symptoms.

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The influence of individual motor imagery ability on cerebral recruitment during gait imagery

Meulen

Allali

Rieger

et al. 2012

Human Brain Mapping

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Motor imagery (MI) is often used in combination with neuroimaging techniques to study the cognitive control of gait. However, imagery ability (IA) varies widely across individuals, potentially influencing the pattern of cerebral recruitment during MI. The aim of the current study was to investigate this effect of IA on the neural correlates of gait control using functional magnetic resonance imaging (fMRI). Twenty healthy young subjects were subdivided into a good and bad imagers group, on the basis of their performance on two mental chronometry tests. For the whole group, MI activated a bilateral network of areas highly consistent with previous studies, encompassing primary motor cortex (BA 4), supplementary motor area, and other frontal and parietal areas, anterior insula, and cerebellum. Compared to bad imagers, good imagers showed higher activation in the right BA 4, left prefrontal cortex (BA 10), right thalamus, and bilateral cerebellum. Good imagers thus appear better able to recruit motor areas during MI, but also activate a prefrontal executive area (BA 10), which integrates information from the body and the environment and participates in higher-order gait control. These differences were found even though the two groups did not differ in other imagery abilities according to a standard questionnaire for vividness of motor and visual imagery. Future studies on MI should take into account these effects, and control for IA when comparing different populations, using appropriate measures. A better understanding of the neural mechanisms that underlie MI ability is crucial to accurately evaluate locomotor skills in clinical measures and neurorehabilitation techniques. Hum Brain Mapp 00:000-000, 2012. V C 2012 Wiley-Periodicals, Inc.

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Motor inhibition in hysterical conversion paralysis

Cited by 208 publications

References 79 publications

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Conversion Disorder/Functional Neurological Disorder

The influence of individual motor imagery ability on cerebral recruitment during gait imagery

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