Sensory Processing Difficulties in Functional Neurological Disorder: A Possible Predisposing Vulnerability?

Ranford, Jessica; MacLean, Julie; Alluri, Priyanka R; Comeau, Olivia; Godena, Ellen; LaFrance, W. Curt; Hunt, Amelia R.; Stephen, Christopher D.; Perez, David L.

doi:10.1016/j.psym.2020.02.003

Cited by 29 publications

(26 citation statements)

References 56 publications

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“…Compared to normative data, most patients with FNSDs reported sensory processing tendencies toward low registration, sensory sensitivity, and sensation avoiding. In uncorrected univariate analyses only, the subset with FS was more likely to report increased sensory sensitivity and elevated low registration 52 53 .…”

Section: Discussionmentioning

confidence: 94%

Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures

et al. 2022

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Objective: This study was undertaken to determine whether undiagnosed illness duration (time between functional seizures [FS] onset and diagnosis) is linked to differences in neural response and functional connectivity during processing of stressful experiences.Methods: Forty-nine participants with traumatic brain injury preceding the onset of FS confirmed by video-electroencephalography were recruited prospectively. Participants completed psychiatric symptom assessments before undergoing functional magnetic resonance imaging (fMRI) with an acute psychosocial stress task. Linear mixed effects (LME) analyses identified significant interactions between the factors of group (early vs. delayed diagnosis) and time lag to diagnosis on neural responses to stressful math performance and auditory feedback (corrected α = .05). Functional connectivity analysis utilized clusters from initial LME analyses as seed regions to determine significant interactions between these factors on network functional connectivity.Results: Demographic and psychiatric symptom measures were similar between early (n = 25) and delayed (n = 24) groups. Responses to stressful math performance within the left anterior insula and functional connectivity between the anterior insula seed region and a precentral gyrus cluster were significantly negatively correlated with time lag to diagnosis for the early but not the delayed FS diagnosis group. There was no correlation between fMRI findings and psychiatric symptoms.Significance: This study indicates that aberrant left anterior insula activation and its functional connectivity to the precentral gyrus underlie differences in processing of stressful experiences in patients with delayed FS diagnosis. Follow-up comparisons suggest changes are associated with undiagnosed illness duration rather than psychiatric comorbidities and indicate a potential mechanistic association between neuropathophysiology, response to stressful experiences, and

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Section: Discussionmentioning

confidence: 94%

Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures

et al. 2022

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“…36 Some FND patients may have difficulty with sensory processing, that is, integrating sensory information from their body and the outside world to effectively adapt to their environment. 47,48 For example, experts who treat FND are familiar with patients who display hypersensitivity to sound, tactile stimulation, movement, and crowded spaces; additionally, some patients endorse that sensory experiences can trigger paroxysmal functional neurological symptoms. A retrospective review of the sensory profiles of 44 FND patients showed that they had, on average, increased sensitivity and sensation avoiding tendencies compared with normative population data.…”

Section: Occupational Therapymentioning

confidence: 99%

“…A retrospective review of the sensory profiles of 44 FND patients showed that they had, on average, increased sensitivity and sensation avoiding tendencies compared with normative population data. 48 As such, the potential role for OTs in assessing sensory processing profiles and engaging patients therapeutically in sensory modulation training is a promising therapeutic intervention that requires more research. 47 Anecdotally, we have found that those with paroxysmal FND symptoms that also endorse sensory triggers may benefit from this OT-based intervention.…”

Section: Occupational Therapymentioning

confidence: 99%

Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide

et al. 2022

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There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.

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“…People with FND are commonly seen by neurological occupational therapists in the United Kingdom and abroad in a variety of settings (Gardiner et al, 2018; Paget and Rigby, 1996; Ranford et al, 2020a), but little is known about the experiences or interventions of occupational therapists working in community settings. A systematic review of studies of physical interventions for people with FND from 2013 found no examples of occupational therapy or home-based treatments (Nielsen et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…The TDF provides a framework in which influences on behaviour (delivery of occupational therapy intervention) and behaviour change (changes in clinical practice) can be systematically explored. Published descriptions of occupational therapy interventions for FND are limited (Gardiner et al, 2018;Nicholson et al, 2020;Ranford et al, 2020aRanford et al, , 2020b, and it remains unclear as to whether occupational therapy interventions vary between practice settings; hence, this study also sought to review the practice of neurological occupational therapists working in community settings.…”

Section: Introductionmentioning

confidence: 99%

Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: An interview study with occupational therapists in the United Kingdom

Nicholson

Francis

Nielsen

et al. 2021

British Journal of Occupational Therapy

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Introduction Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom. Methods Community-based neurological occupational therapists ( n = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach. Findings Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists’ dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations. Conclusion Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings.

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Sensory Processing Difficulties in Functional Neurological Disorder: A Possible Predisposing Vulnerability?

Cited by 29 publications

References 56 publications

Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures

Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures

Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide

Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: An interview study with occupational therapists in the United Kingdom

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