Functional Neurologic Disorders

1st Edition, Volume 139 - October 6, 2016
Editors: Mark Hallett, Jon Stone, Alan J Carson
Language: English
Hardback ISBN:
9 7 8 - 0 - 1 2 - 8 0 1 7 7 2 - 2
eBook ISBN:
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Functional Neurologic Disorders, the latest volume in the Handbook of Clinical Neurology series, summarizes state-of-the-art research findings and clinical practice on this… Read more

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Functional Neurologic Disorders, the latest volume in the Handbook of Clinical Neurology series, summarizes state-of-the-art research findings and clinical practice on this class of disorders at the interface between neurology and psychiatry. This 51-chapter volume offers an historical introduction, chapters on epidemiology and pathophysiolology, a large section on the clinical features of different type of functional neurologic symptoms and disorders (including functional movement disorders, non-epileptic seizures, dizziness, vision, hearing, speech and cognitive symptoms), and then concluding with approaches to therapy.

This group of internationally acclaimed experts in neurology, psychiatry, and neuroscience represent a broad spectrum of areas of expertise, chosen for their ability to write clearly and concisely with an eye toward a clinical audience. This HCN volume sets a new landmark standard for a comprehensive, multi-authored work dealing with functional neurologic disorders (also described as psychogenic, dissociative or conversion disorders).

Cover image
Title page
Table of Contents
Copyright
Handbook of Clinical Neurology 3rd Series
Foreword
Preface
Contributors
Section 1: History
Chapter 1: A brief history of hysteria: From the ancient to the modern
Abstract
Introduction
Babylon and assyria
Ancient egypt
Greece and rome
Middle Ages
Mass hysteria
Willis (1621–1675) and the beginnings of neurology
18th and 19th centuries
Conclusions
Chapter 2: Charcot, hysteria, and simulated disorders
Abstract
Introduction
The protagonist
Charcot's nosology: organic diseases and the névroses
Charcot and the cause of neurologic diseases
Charcot and hysteria
Hysteria and psychologic influences: the role of suggestion
Charcot and Freud: the mentor's never-sated obsession
Simulation
Charcot in a modern context
Chapter 3: Neurologic approaches to hysteria, psychogenic and functional disorders from the late 19th century onwards
Abstract
Introduction
Neurologic approaches to hysteria from charcot to world war I
World war I
The 1920S to the 1960S
1970S to 1990S
Developments since 2000 and the future
Conclusions
Acknowledgments
Chapter 4: Freud's hysteria and its legacy
Abstract
Introduction
Freud's hysteria
Repression
Conversion
The third ingredient
Shell shock and psychosomatics
Scientists and philosophers
Hysteria is dead; long live functional neurologic symptoms
Section 2: Epidemiology, etiology, and mechanism
Chapter 5: Epidemiology
Abstract
Introduction: which diagnosis in which population?
A technical barrier to epidemiologic research
Incidence
Prevalence
Onset
Physical symptom and disease comorbidity
Disability
Psychologic comorbidity
Outcome: misdiagnosis
Risk factors
Epidemiology of functional neurologic disorder subtypes: lumping or splitting?
Patient outcomes and mortality
Economics
Conclusion
Chapter 6: Neurophysiologic studies of functional neurologic disorders
Abstract
Introduction
Functional weakness and paralysis
Functional sensory loss
Functional movement disorders
Other functional movement disorders
Acknowledgment
Chapter 7: Imaging studies of functional neurologic disorders
Abstract
Background
Structural Imaging
Summary
Acknowledgments
Chapter 8: Dissociation and functional neurologic disorders
Abstract
Introduction
Psychiatric classification and the dissociative experiences scale
“Trait dissociation” and functional neurologic symptoms
“State” dissociation and functional neurologic symptoms
Compartmentalization and FND
Evidence for compartmentalization in functional neurologic disorders
Trauma and functional neurologic disorders
Summary, implications, and future developments
Chapter 9: Hypnosis as a model of functional neurologic disorders
Abstract
Hypnosis as a model
Hypnosis and suggestibility
Explanatory models in scientific explanation
The initial construction of hypnosis as a model for hysteria
Contemporary versions of hypnosis as a model for functional symptoms
Relationships between functional symptoms, suggestive processes, and hypnosis
Conclusion
Chapter 10: Psychologic theories in functional neurologic disorders
Abstract
Introduction
Psychodynamic theories
Illness behavior
Abnormal illness behavior
Diagnostic operationalization
Learning theories
Mindfulness
Conclusions
Chapter 11: Voluntary or involuntary? A neurophysiologic approach to functional movement disorders
Abstract
Introduction
What are we aware of when we act?
Neurophysiology of action awareness
Action awareness and agency in functional movement disorders
Expected and experienced control
Generation of “involuntary” movements in fmd
Conclusions and research agenda
Chapter 12: Neurobiologic theories of functional neurologic disorders
Abstract
Introduction
Historic neurobiologic theories
20th-century neurobiologic theories
21st-century neurobiologic models
Concluding remarks
Chapter 13: Stress, childhood trauma, and cognitive functions in functional neurologic disorders
Abstract
Introduction
Trauma and life events in conversion disorder: a literature review
Other vulnerability factors
Explanatory models
Towards an integration
Summary and research agenda
Acknowledgments
Chapter 14: Do (epi)genetics impact the brain in functional neurologic disorders?
Abstract
Introduction
Environmental effects
Link between environmental factors like stress and the brain systems
Genetics
Environment–gene interactions and epigenetics
Conclusions
Section 3: Symptoms (including signs and investigations)
Chapter 15: Assessment of patients with functional neurologic disorders
Abstract
Introduction
Preparation and start of the consultation
The assessment of physical symptoms in the history
Exploring the patient's beliefs
The psychologic assessment of patients with functional disorders
Physical examination
Principles of diagnosis and diagnostic pitfalls
Conclusion
Chapter 16: The classification of conversion disorder (functional neurologic symptom disorder) in ICD and DSM
Abstract
Introduction
Conversion disorder in the international classification of diseases (ICD)
Conversion disorder in the DSM, 1952–2000
Conversion disorder in DSM-5
Chapter 17: Neurologic diagnostic criteria for functional neurologic disorders
Abstract
Introduction
Functional motor, sensory, and gait disorders
Psychogenic nonepileptic seizures
Functional movement disorders
Concluding remarks
Chapter 18: Functional limb weakness and paralysis
Abstract
Introduction
Historic descriptions
Epidemiology
Clinical features in the history
Physical signs of functional limb weakness
Mechanism, etiology, and treatment
Conclusion
Chapter 19: Functional tremor
Abstract
Introduction
Symptoms and signs
Supportive ancillary examinations
Chapter 20: Functional dystonia
Abstract
Introduction
Historic background
Diagnosis of functional dystonia
Regional functional dystonia phenotypes
Psychopathology
Pathophysiology
Prognosis
Management
Conclusions and future steps
Chapter 21: Functional jerks, tics, and paroxysmal movement disorders
Abstract
Introduction
Epidemiology and clinical picture
Pathophysiology of functional jerks
The neurophysiologic examination
Summary and conclusion
Chapter 22: Psychogenic (functional) parkinsonism
Abstract
Introduction
Epidemiology
Clinical history
Clinical signs
Ancillary testing
Future directions
Chapter 23: Functional gait disorder
Abstract
Introduction
Normal gait
Characteristics of some classic organic gaits
Characteristics of some complex organic gaits
Psychogenic gait
Conclusions
Chapter 24: Functional sensory symptoms
Abstract
Introduction
Historic background
Epidemiology
Hypoesthesia/sensory loss
Hyperesthesia/paresthesia and pain
Unusual (but nonfunctional) sensory symptoms
Pathophysiology
Treatment specific for sensory symptoms
Acknowledgment
Chapter 25: Nonepileptic seizures – subjective phenomena
Abstract
Introduction
Methodologic considerations
Temporal characteristics of subjective symptoms associated with PNES
Impairment of consciousness
Clinical significance of subjective PNES experience
Conclusion
Chapter 26: Nonepileptic seizures – objective phenomena
Abstract
Introduction
Diagnosis
Semiology
Classification
Other characteristics to help clinicians differentiate PNES from ES
Conclusions
Chapter 27: Psychogenic nonepileptic seizures: EEG and investigation
Abstract
Introduction
Inpatient video-EEG monitoring
The use of video-EEG in practice
The value of medium-term residential monitoring
Conclusions
Chapter 28: Functional coma
Abstract
Introduction
Terminology, assessment, and differential diagnosis
Functional stupor and coma (including “nonepileptic pseudostatus”)
Stupor in psychiatric disorders, such as depression, mania, and catatonia
Factitious unresponsiveness
Functional coma: clinical features and review of published cases
EEG
Conclusion
Chapter 29: Functional and simulated visual loss
Abstract
Introduction
Nonorganic visual loss
Evaluation
Monocular vision loss
Binocular vision loss
Visual field loss
Imaging and ancillary testing
Management
Conclusions
Disclosures
Chapter 30: Functional eye movement disorders
Abstract
Introduction
The eye movement examination
Epidemiology
Functional eye movement syndromes
Management options
Chapter 31: Functional facial and tongue movement disorders
Abstract
Introduction
Epidemiology
Clinical features
Diagnosis
Differential diagnosis
Management
Chapter 32: Functional auditory disorders
Abstract
Introduction
Nonorganic hearing loss
Disorders of auditory processing
Tinnitus
Musical hallucination (MH)
Low-frequency noise complaint
Disorders of loudness perception
Misophonia
Acoustic shock
Conclusion
Chapter 33: Functional speech disorders: clinical manifestations, diagnosis, and management
Abstract
Introduction
The spectrum of functional speech disorders
Prevalence
Examination and differential diagnosis
Broad categories of functional speech disorders
Foreign-accent syndrome and other prosodic disturbances
Other manifestations of functional speech disorders
Management
Conclusion
Chapter 34: Functional voice disorders: Clinical presentations and differential diagnosis
Abstract
Introduction
Complexities of laryngeal function
Terminologies and diagnostic classification
Clinical voice evaluation and differential diagnosis
Muscle tension voice disorders – clinical features
Psychogenic voice disorders – clinical features
Etiology
Prevalence
Biographic details for individuals with functional voice disorders
Diagnostic dilemmas between functional and neurologic voice disorders
Functional voice disorders versus neurologic voice disorders
Management
Conclusion
Chapter 35: Psychologic/functional forms of memory disorder
Abstract
Introduction
Memory clinics
Neurologic causes of memory symptoms other than dementia
Psychological/functional causes of memory symptoms
Exaggeration/malingering of memory symptoms
Approaches to assessment
Approaches to treatment
Conclusion and future directions
Chapter 36: Functional (dissociative) retrograde amnesia
Abstract
Introduction
Content-based memory systems
Measurement problems of retrograde amnesia
Retrograde amnesia: organic or psychogenic?
Short review of retrograde amnesia after structural brain damage
Dissociative amnesia with and without tbi
The puzzle of retrograde amnesia occurrence
Inability of access hypothesis
How can recovery occur?
Why is anterograde learning of autobiographic episodes usually unimpaired or much less impaired than retrograde memory?
Conclusions
Chapter 37: Functional (psychogenic) dizziness
Abstract
Introduction
Functional causes of vestibular symptoms
Psychiatric causes of vestibular symptoms
Chapter 38: Urologic symptoms and functional neurologic disorders
Abstract
Introduction
Lower urinary tract functions in health
Current models of the brain–bladder axis
Assessment of functional urologic disorders
Psychogenic urinary retention
Fowler's syndrome
Paruresis
Dysfunctional voiding and Hinman–Allen syndrome
Overactive bladder
Interstitial cystitis/bladder pain syndrome and functional somatic syndromes
Frequency of urologic symptoms in functional/psychogenic disorders
Opiate use and LUT dysfunction
Is there an association between LUT dysfunction and functional disorders?
Acknowledgments
Chapter 39: Functional disorders of swallowing
Abstract
Introduction
Swallowing
Dysphagia
Functional dysphagia
Globus sensation
Conclusion
Chapter 40: Pediatric functional neurologic symptoms
Abstract
Pediatric functional neurologic symptoms
How common are pediatric functional neurologic symptoms?
How do children with functional neurologic disorders present?
Historic features
Diagnosis of functional neurological disorders
Are functional neurologic disorders psychogenic?
Informing the child and family of the diagnosis
Treatment of functional neurologic disorders
Prognosis
Functional or psychogenic?
Chapter 41: Posttraumatic functional movement disorders
Abstract
Peripheral trauma and movement disorders – evolution of a concept
Distinct phenotypes of movement disorders following peripheral trauma and their overlap with functional movement disorders
Pathophysiologic considerations
Management of movement disorders induced by peripheral trauma < liz >
Conclusion
Chapter 42: Factitious disorders and malingering in relation to functional neurologic disorders
Abstract
Introduction
Historic context
Diagnosis of simulated illness
Growing interest in illness deception
Psychosocial context
Factitious disorders
Malingering
Clinical presentations relating to neuropsychiatric practice
Conclusions
Section 4: Treatment
Chapter 43: Prognosis of functional neurologic disorders
Abstract
Introduction
Methodologic issues
Symptom outcome
Quality of life and functioning at follow-up
Working status
Cross-over
Prognostic factors
Misdiagnosis
Pediatric studies
Conclusion
Chapter 44: Explanation as treatment for functional neurologic disorders
Abstract
Introduction
Evidence for the importance of good communication / explanation
Barriers to explanation
Evidence about explanations in clinical practice
Chapter 45: Physical treatment of functional neurologic disorders
Abstract
Introduction
Pathophysiologic Model and Rationale for Physical Treatment
Evidence for Physical Rehabilitation
Referral to Physical Treatment
Assessment
Treatment Agreement
Components of Treatment
Components of Physical Treatment and Therapeutic Adjuncts
Adaptive Aids, Equipment, and Environmental Modifications
Setting Intensity and Duration
Measuring Outcome
Discharge
Symptom-Specific Treatment Approaches
Conclusions
Financial disclosures
Acknowledgment
Chapter 46: Psychologic treatment of functional neurologic disorders
Abstract
Introduction
What is the treatment evidence base?
Implications of treatment studies
Chapter 47: Hypnosis as therapy for functional neurologic disorders
Abstract
Introduction
Suggestion, hypnosis, and functional symptoms: a brief history
Hypnosis and treatment of functional symptoms in the 20th century to the present
Assessment and treatment approaches employing hypnotic techniques
Symptom-oriented techniques
Expressive techniques
Future directions
Conclusions
Chapter 48: Nature of the placebo and nocebo effect in relation to functional neurologic disorders
Abstract
Definition
Characterization of the neurobiologic underpinnings
Disruption of placebo effects
Beyond the healing context
What is the difference between placebos and drugs?
Conclusions
Acknowledgments
Chapter 49: The role of placebo in the diagnosis and treatment of functional neurologic disorders
Abstract
Evolving controversy over therapeutic placebo
Placebo for psychogenic disorders
Ethical and legal concerns
Future directions
Conclusions
Chapter 50: Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders
Abstract
Introduction
Transcranial magnetic stimulation
Future directions
Sedation
Acknowledgments and Funding
Chapter 51: Inpatient treatment for functional neurologic disorders
Abstract
Pioneering inpatient treatment of psychogenic (functional) movement disorders (PMDs)
A rehabilitation model for conversion paralysis
Strategic intervention in inpatient rehabilitation of severe functional/factitious disorders
A multimodal program-based inpatient approach
A neuropsychiatry-led multimodal intervention
A unique randomized trial of inpatient physical rehabilitation therapies
An exemplar of a very brief multidisciplinary inpatient rehabilitation program
Principles of therapy within the MoRe program
Pediatric inpatient services
A move to day-patient treatment?
Some considerations on psychogenic nonepileptic seizures (PNES)
The interdigitating roles of the neurologist and mental health practitioner (MHP) in diagnostic assessment and treatment of inpatients with FND
Conclusions
Errata
Index

Mark Hallett

Dr. Hallett is the President of the International Federation of Clinical Neurophysiology. He also serves as the Chief of the Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. Dr. Hallett obtained his M.D. at Harvard University, interned at the Peter Bent Brigham Hospital and trained in Neurology at Massachusetts General Hospital. He had fellowships in Neurophysiology at the National Institutes of Health and at the Institute of Psychiatry in London. From 1976 to 1984, Dr. Hallett was the Chief of the Clinical Neurophysiology Laboratory at the Brigham and Women's Hospital and worked up to Associate Professor of Neurology at Harvard Medical School. From 1984, he has been at the National Institute of Neurological Disorders and Stroke where he also served as Clinical Director of NINDS until July 2000. He is past President of the American Association of Neuromuscular and Electrodiagnostic Medicine and the International Parkinson and Movement Disorder Society and also served as Vice-President of the American Academy of Neurology. He has served as Editor of many journals and books and has had many honors. His work mainly deals with principles of motor control and the pathophysiology of movement disorders. Dr. Hallett’s interests in motor control are wide-ranging, and include brain plasticity and its relevance to neurological disorders and the pathophysiology of dystonia, parkinsonism, and myoclonus. In recent years, he has become interested in disorders of volition, including tic and functional movement disorders.

Affiliations and expertise

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

Jon Stone

Dr. Jon Stone FRCP PhD is a Consultant Neurologist and Honorary Reader in Neurology in Edinburgh.

He has had a research interest in functional disorders in neurology since 1999 and completed his PhD thesis on a case control study of patients with functional limb weakness. He has published widely in the area including systematic reviews, large cohort studies, imaging studies and treatment studies. He has contributed to new diagnostic criteria for DSM-5 and ICD-11 and the development of professional organisations in this area.

In 2009 he made a website for patients with functional neurological disorders at www.neurosymptoms.org which has been translated by other neurologists in to 12 other languages and receives 60,000 visits a month. As of August 2012 is a National Research Strategy (NHS Scotland) Career Fellow. His work has been recognised with plenary sessions at the World Congress of Neurology, American Academy of Neurology, Movement Disorders World Congress and Association of British Neurologists as well as the Jean Hunter Award for Nervous Diseases (Royal College of Physicians).

Affiliations and expertise

Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK

Alan J Carson

Alan John Carson, MBCHB, MPHIL, MD, FRCPSYCH, FRCP is Consultant Neuropsychiatrist in Edinburgh, U.K. His interest in neuropsychiatry began during a spell working in Kenya, as a Wellcome Research Registrar, conducting a study on the psychiatric and cognitive effects of HIV infection. He then completed his higher training in Edinburgh, under the guidance of Professors Michael Sharpe and Charles Warlow, where he developed an interest in functional neurological symptoms. Dr. Carson currently works as a Consultant Neuropsychiatrist in Edinburgh, split between the brain injury units at the Astley Ainslie Hospital and the Regional Neurosciences Unit at the Western General Hospital, where along with Dr. Jon Stone, he is engaged in a series of studies on functional neurological symptoms. He has led a number of epidemiological studies on functional disorders, most notably the Scottish Neurological Symptoms Study. He has a particular interest in development of treatment strategies for functional disorders and has led development of novel brief psychotherapies for functional symptoms, and is one of the lead investigators for the CODES trial of CBT for dissociative seizures. Dr. Carson holds a number of advisory posts in neuropsychiatry and he is the chair of the National MCN for acquired brain injury. He is the associate editor of Journal of Neurology, Neurosurgery and Psychiatry and the President of the British Neuropsychiatry Association.

Affiliations and expertise

Department of Rehabilitation Medicine and Department of Clinical Neurosciences NHS Lothian, & Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK

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Mark Hallett

Jon Stone

Alan J Carson