Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings

Pick, Susannah; Millman, L.S. Merritt; Sun, Yiqing; Short, Eleanor; Stanton, Biba; Winston, Joel S.; Mehta, Mitul A.; Nicholson, Timothy R.; Reinders, Antje A.T.S.; David, Anthony S.; Edwards, Mark J.; Goldstein, Laura H.; Hotopf, Matthew; Chalder, Trudie

doi:10.1080/13803395.2023.2245110

Cited by 4 publications

(2 citation statements)

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“…Feedback was elicited from participants, which has now been incorporated into this protocol. The findings of the pilot study have been reported elsewhere [ 10 , 23 – 25 ].…”

Section: Methodsmentioning

confidence: 67%

Investigating psychobiological causes and mechanisms in functional seizures and functional motor symptoms: Study protocol

Pick,

David,

Edwards

et al. 2024

PLoS ONE

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Introduction Advances have been made in understanding the aetiology of functional neurological disorder (FND); however, its pathophysiological mechanisms have not been definitively demonstrated. Evidence suggests interacting roles for altered emotional processing and interoception, elevated autonomic arousal, and dissociation, but there is limited evidence demonstrating their causal influence on specific FND symptoms. Our superordinate aim is to elucidate potentially shared and distinct aetiological factors and mechanisms in two common FND subtypes, functional seizures (FS) and functional motor symptoms (FMS). Methods This study has a multimodal, mixed between- and within-groups design. The target sample is 50 individuals with FS, 50 with FMS, 50 clinical controls (anxiety/depression), and 50 healthy controls. Potential aetiological factors (e.g., adverse life events, physical/mental health symptoms, dissociative tendencies, interoceptive insight/sensibility) will be assessed with a detailed medical history interview and self-report questionnaires. A laboratory session will include a neurocognitive battery, psychophysiological testing, cardiac interoception and time estimation tasks and an isometric handgrip task. A subsample will undergo magnetic resonance imaging, including structural, resting-state and task-based scans combined with psychophysiological recording. Remote monitoring with ecological momentary assessment and wearables will measure variability in FND symptoms and their potential predictors/correlates for ≥2 weeks in patients’ daily lives. Longitudinal follow-ups at 3, 6, and 12-months will monitor longer-term outcomes in the clinical groups. Discussion This study employs multimodal research methods to rigorously examine several putative mechanisms in FND, at subjective/experiential, behavioural, and physiological levels. The study will test causal hypotheses about the role of altered emotional processing, autonomic arousal, dissociation and interoception in the initiation or exacerbation of FND symptoms, directly comparing these processes in FS and FMS to healthy and clinical controls. This is the first study of its kind, with potential to reveal important targets for prevention and treatment of FND in future.

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“…Feedback was elicited from participants, which has now been incorporated into this protocol. The findings of the pilot study have been reported elsewhere [ 10 , 23 – 25 ].…”

Section: Methodsmentioning

confidence: 67%

Investigating psychobiological causes and mechanisms in functional seizures and functional motor symptoms: Study protocol

Pick,

David,

Edwards

et al. 2024

PLoS ONE

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“…The recruitment/screening processes and eligibility criteria for the study are detailed in online supplemental table 1 and previous publications. 16 38 The FND sample were recruited through FND charities (FND Hope UK, FND Action) and social media (eg, Twitter). HCs were recruited from the local area.…”

Section: Participantsmentioning

confidence: 99%

Unravelling the influence of affective stimulation on functional neurological symptoms: a pilot experiment examining potential mechanisms

Pick,

Millman,

Ward

et al. 2023

J Neurol Neurosurg Psychiatry

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BackgroundDifferences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored.MethodIndividuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (n=14) viewed Positive, Negative and Neutral images in blocks, while passively observing the stimuli (‘Watch’) or detaching themselves (‘Distance’). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heart rate (HR) were monitored continuously.ResultsFNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, ηp2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, ηp2=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r values=0.527–0.672, p values=0.006–0.035). The groups did not differ in subjective affect or perceived arousal (p values=0.541–0.919, ηp2=<0.001–0.015).ConclusionsEmotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.

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Unravelling the influence of affective stimulation on functional neurological symptoms: A pilot experiment examining potential mechanisms

Pick,

Merritt Millman,

Ward

et al. 2023

Preprint

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Background: Differences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored. Methods: Individuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (HCs; n=14) viewed Positive, Negative, and Neutral images in blocks, whilst passively observing the stimuli (Watch) or detaching themselves (Distance). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heartrate (HR) were monitored continuously. Results: FNS ratings were higher after Negative compared to Positive and Neutral blocks in the FND group (p=0.002, np2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, np2=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r-values: 0.527-0.672, p-values: 0.035-0.006). The groups did not differ in subjective affect or perceived arousal (p-values: 0.541-0.919, np2: <0.001-0.015). Conclusions: Emotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.

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Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings

Cited by 4 publications

References 88 publications

Investigating psychobiological causes and mechanisms in functional seizures and functional motor symptoms: Study protocol

Investigating psychobiological causes and mechanisms in functional seizures and functional motor symptoms: Study protocol

Unravelling the influence of affective stimulation on functional neurological symptoms: a pilot experiment examining potential mechanisms

Unravelling the influence of affective stimulation on functional neurological symptoms: A pilot experiment examining potential mechanisms

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