OBJECTIVE: Pain, fatigue, cognitive complaints and psychiatric comorbidities are common in patients with functional movement disorder and may significantly affect their quality of life. The aim of the study was to assess the impact of motor and non-motor symptoms on health-related quality of life in patients with functional movement disorder. METHODS: Sixty-one patients with clinically established functional movement disorder and 61 matched healthy controls completed standardized questionnaires for depression, anxiety, cognitive complaints, fatigue, pain, sleepiness, apathy and health-related quality of life. Motor disorder severity was assessed using The Simplified Functional Movement Disorders Rating Scale. Personality traits were assessed using the 44-Item Big Five Inventory. RESULTS: Compared to controls, patients reported significantly lower health-related quality of life and higher levels of all assessed non-motor symptoms except for apathy. No difference was found in personality traits. In both groups, health-related quality of life scores negatively correlated with depression, anxiety, pain, cognitive complaints, apathy, and neuroticism. No correlation was found between health-related quality of life and motor symptom severity in patients with functional movement disorder. Multiple regression analysis of the predictors of health-related quality of life showed significant impact of trait anxiety and cognitive complaints scores. CONCLUSIONS: Multiple non-motor symptoms but not motor symptom severity correlated with impaired health-related quality of life in patients with functional movement disorder. Impaired health-related quality of life was predicted by anxiety and cognitive complaints. Our results highlight the importance of assessing and treating both motor and non-motor symptoms in patients with functional movement disorder.

• MeSH
• kvalita života psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pohybové poruchy diagnóza   psychologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS: A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS: Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS: There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.

• MeSH
• hodnocení výsledků zdravotní péče * MeSH
• lidé MeSH
• nemoci nervového systému diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH

OBJECTIVES: The prevalence of restless legs syndrome (RLS) in functional movement disorders (FMD) is not known. Patients with FMD often present with multiple motor and sensory symptoms. Some of these symptoms might be due to comorbid RLS. Therefore, our objective was to evaluate possible association between FMD and RLS. DESIGN: Case-control study. SETTING: Movement Disorders Center, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic. PARTICIPANTS: 96 consecutive patients with clinically established FMD (80 females, mean age (SD) 45.0 (13) years), and 76 matched controls. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was prevalence of RLS based on updated International RLS Study Group criteria. Secondary outcome measures included prevalence of periodic limb movements (PLM) using actigraphy; pain, motor and sensory symptoms in lower limbs; organic comorbidities and medication affecting RLS. RESULTS: RLS criteria were fulfilled in 43.8% of patients (95% CI 34 to 54) and in 7.9% of controls (95% CI 3 to 17, p<0.00001). Both RLS and PLM indices (PLMi) ≥22.5/hour were found in 21.2% of patients with FMD and 2.6% of controls. Patients with FMD with RLS had a higher mean PLMi (p<0.001) and a higher proportion of PLMi ≥22.5/hour (p<0.01) than RLS-negative patients. Patients with RLS had higher prevalence of pain and sensory symptoms in lower limbs, no difference was found in medication and prevalence of organic comorbidities in patients with FMD with and without RLS. CONCLUSIONS: We found an increased prevalence of RLS in patients with FMD. Clinical diagnosis of RLS was supported by actigraphic measurement of clinically relevant PLM in a significant proportion of patients with FMD. Although functional motor and sensory symptoms may mimic RLS, RLS may be unrecognised in patients with FMD. This finding may have clinical implications in management of FMD, and it raises the possibility of common pathophysiological mechanisms of FMD and RLS/PLM.

• MeSH
• dospělí MeSH
• dystonie patofyziologie   MeSH
• konverzní poruchy epidemiologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• myoklonus patofyziologie   MeSH
• neurologické poruchy chůze patofyziologie   MeSH
• pohybové poruchy epidemiologie   patofyziologie   MeSH
• poruchy hybnosti oka patofyziologie   MeSH
• poruchy řeči patofyziologie   MeSH
• prevalence MeSH
• studie případů a kontrol MeSH
• svalová slabost patofyziologie   MeSH
• syndrom neklidných nohou epidemiologie   MeSH
• tremor patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Intramural MeSH
• Geografické názvy
• Česká republika MeSH

Funkční (psychogenní) poruchy hybnosti (FPH) jsou dané abnormální funkcí CNS bez známek strukturální či jiné specifické patologie. FPH jsou časté a bývají spojeny s významnou mírou disability. Přesto je stanovení diagnózy je často obtížné a pomocné vyšetřovací metody mají pouze omezenou hodnotu. Také bylo dosud stanoveno jen minimum doporučených léčebných postupů, což mimo jiné odráží naše nedostatečné porozumění etiopatogenezi FPH. Psychologické faktory, dříve považované za kauzální, hrají spíše druhotnou roli. Současný neurobiologický model zahrnuje dokumentované abnormality v pozornosti, v očekávání ve vztahu k symptomům a v percepci volního řízení hybnosti. Role genetických dispozic a neuroimunitních změn byla dosud opomíjena. Cílem projektu je nalezení neurofyziologických, laboratorních a zobrazovacích biomarkerů specifických pro FPH a hlubší poznání patofyziologie tohoto onemocnění. Nalezení biomarkerů by mohlo pomoci identifikovat podskupiny FPH s odlišnými charakteristikami a poskytnout objektivní parametry pro diagnostiku i výběr vhodného léčebného postupu.; Functional (psychogenic) movement disorders (FMD) are those that arise due to malfunction of the brain without any structural or other specific pathology. FMD are quite common and often associated with significant disability. Despite this, the diagnosis is often challenging, laboratory tests are of limited value and there is little evidence available to guide treatment decisions. This likely reflects our poor understanding of the etiopathogenesis of FMD. Psychological factors, once considered to be causal, rather play a secondary role. Recent neurobiological model reflects documented abnormalities in attention, predictions related to symptoms, and sense of agency. Surprisingly, the role of genetic predispositions and neuroimmune changes has been neglected so far. This project is designed to find neurophysiological, laboratory and neuroimaging biomarkers indicative of FMD and to deepen our understanding of the pathophysiology of FMD. Discovery of biomarkers in FMD could help to identify phenotypic subtypes and provide more objective support for diagnosis and choice of therapy.

• MeSH
• audiovizuální záznam MeSH
• biologické markery MeSH
• cytokiny MeSH
• emoce MeSH
• komorbidita MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• motorické poruchy patofyziologie   MeSH
• neurofyziologický monitoring MeSH
• pacienti bez organického nálezu MeSH
• polymorfismus genetický MeSH
• pozornost MeSH
• Check Tag
• lidé MeSH

• Konspekt
• Fyziologie člověka a srovnávací fyziologie
• NLK Obory
• psychiatrie
• neurovědy
• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

Clinical motor and non-motor effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) seem to depend on the stimulation site within the STN. We analysed the effects of the position of the stimulation electrode within the motor STN on subjective emotional experience, expressed as emotional valence and arousal ratings to pictures representing primary rewards and aversive fearful stimuli in 20 PD patients. Patients' ratings from both aversive and erotic stimuli matched the mean ratings from a group of 20 control subjects at similar position within the STN. Patients with electrodes located more posteriorly reported both valence and arousal ratings from both the rewarding and aversive pictures as more extreme. Moreover, posterior electrode positions were associated with a higher occurrence of depression at a long-term follow-up. This brain-behavior relationship suggests a complex emotion topography in the motor part of the STN. Both valence and arousal representations overlapped and were uniformly arranged anterior-posteriorly in a gradient-like manner, suggesting a specific spatial organization needed for the coding of the motivational salience of the stimuli. This finding is relevant for our understanding of neuropsychiatric side effects in STN DBS and potentially for optimal electrode placement.

• MeSH
• elektrody MeSH
• emoce fyziologie   MeSH
• hluboká mozková stimulace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nucleus subthalamicus metabolismus   fyziologie   MeSH
• Parkinsonova nemoc metabolismus   patofyziologie   terapie   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Funkční (psychogenní) poruchy hybnosti jsou charakterizované především měnlivými, nekonzistentními příznaky, které se neshodují s typickými projevy hybné poruchy způsobené organickým neurologickým onemocněním. Jejich patofyziologie je ovšem stále málo známá. V minulosti zdůrazňovaná kauzální role psychických faktorů byla zpochybněna a v současné době se přikláníme k neurobiologickému modelu jejich vzniku. Diagnóza funkčních poruch hybnosti by měla spočívat na nálezu charakteristických klinických projevů a nikoliv pouze na vyloučení organických příčin. Z hlediska prognózy je rozhodující časné stanovení diagnózy a její přijetí pacientem. Léčebné postupy zahrnují multimodální přístup s dominantní úlohou neurologa, který stanovuje a sděluje diagnózu a řídí léčebný postup.

Functional (psychogenic) movement disorders are characterized variability and inconsistency of the symptoms, which are incongruent with movement disorders known to be caused by organic neurological disease. The pathophysiology of functional movement disorders is still poorly understood. Previously emphasized causal role of psychological factors was questioned and a neurobiological model of the development of functional symptoms has been proposed. The diagnosis of functional movement disorders should rely on the presence of characteristic clinical features and not on exclusion of organic causis. Early diagnosis and its acceptance by the patient, is essential for the prognosis. Therapeutic strategies consist in multimodal approach with a dominant role of the neurologist, who establishes and communicates the diagnosis and guides the treatment.

• MeSH
• antidepresiva MeSH
• časná diagnóza MeSH
• diagnostické techniky neurologické využití   MeSH
• hypnóza MeSH
• klinický obraz nemoci MeSH
• lidé MeSH
• pohybové poruchy diagnóza   etiologie   terapie   MeSH
• posuzování pracovní neschopnosti MeSH
• prognóza MeSH
• psychosomatické poruchy diagnóza   etiologie   terapie   MeSH
• psychoterapie MeSH
• techniky fyzikální terapie využití   MeSH
• Check Tag
• lidé MeSH

Fyzioterapie má dnes klíčovou úlohu v multidisciplinárním managementu funkčních poruch hybnosti (FPH). Přes rostoucí počet prací, které svědčí pro její účinnost, zatím chybí doporučení založená na důkazech, jaké techniky by měla zahrnovat. V tomto příspěvku uvádíme obecné postupy i specifické techniky fyzioterapie, které se v léčbě pacientů s FPH osvědčily na základě dosavadních studií a zkušeností předních pracovišť. Fyzioterapie se zaměřuje na práci s abnormální pozorností a abnormálními hybnými vzorci prostřednictvím edukace, přeučování hybných vzorců a samostatnou práci pacienta na režimových a dalších léčebných strategiích.

Physiotherapy has a key role in the multidisciplinary management of patients with functional motor disorder (FMD). Despite growing evidence that physiotherapy is an effective treatment, we still lack evidence-based guidelines on what physiotherapy for FMD should consist of. Here we present recommendations for approach towards patients with FMD and physiotherapy that have been successful in FMD and which are based on existing evidence and experience from leading experts in this field. Physiotherapy should address self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies.

• Klíčová slova
• Funkční poruchy hybnosti - FPH, automatické a reflexní pohybové vzorce - využití,
• MeSH
• adherence pacienta psychologie   MeSH
• anamnéza MeSH
• diagnostické techniky neurologické * trendy   využití   MeSH
• klinické zkoušky jako téma MeSH
• klinický obraz nemoci MeSH
• komorbidita MeSH
• lidé MeSH
• mezioborová komunikace MeSH
• motorické poruchy * diagnóza   etiologie   terapie   MeSH
• neurologické poruchy chůze diagnóza   etiologie   terapie   MeSH
• parkinsonské poruchy diagnóza   etiologie   terapie   MeSH
• psychosomatické poruchy * diagnóza   etiologie   terapie   MeSH
• psychoterapie metody   trendy   MeSH
• svalová slabost diagnóza   etiologie   psychologie   MeSH
• tremor etiologie   terapie   MeSH
• vzdělávání pacientů jako téma MeSH
• Check Tag
• lidé MeSH

The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.

• MeSH
• hodnocení výsledků zdravotní péče * MeSH
• konverzní poruchy * MeSH
• lidé MeSH
• nemoci nervového systému * MeSH
• psychosomatické poruchy * MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Patients with functional movement disorders also typically have functional somatic symptoms, including pain, fatigue, and sensory disturbance. A potentially unifying mechanism for such symptoms is a failure in processing of sensory inputs. Prepulse inhibition is a neurophysiological method that allows for the study of preconscious somatosensory processing. OBJECTIVE: The objective of this study was to assess prepulse inhibition in patients with functional movement disorders and healthy control subjects. METHODS: We analyzed the effect of a weak electrical stimulus to the index finger (prepulse) on the magnitude of the R2 response of the blink reflex induced by electrical stimuli delivered to the supraorbital nerve in 22 patients with clinically established functional movement disorders and 22 matched controls. Pain, depression, anxiety, and obsessive-compulsive symptoms were assessed using self-rated questionnaires. In addition, in patients we assessed motor symptom severity. RESULTS: Prepulses suppressed the R2 response of the blink reflex in both groups, by 36.4% (standard deviation: 25.6) in patients and by 67.3% (standard deviation: 16.4) in controls. This difference was significant (P < 0.001). There was no significant correlation between motor and nonmotor symptom measures and prepulse inhibition size. CONCLUSIONS: Impaired prepulse inhibition of the blink reflex suggests an abnormal preconscious processing of somatosensory inputs, which can be interpreted within predictive coding accounts of both functional movement disorders and functional somatic syndromes. Our results, along with previous findings of a reduced prepulse inhibition in fibromyalgia syndrome, support a possible unified pathophysiology across functional neurological and somatic syndromes with noteworthy implications for diagnostic classification and development of novel biomarkers and treatments. © 2019 International Parkinson and Movement Disorder Society.

• MeSH
• dospělí MeSH
• elektrická stimulace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrkání fyziologie   MeSH
• nervový útlum fyziologie   MeSH
• pohybové poruchy patofyziologie   MeSH
• prepulsní inhibice fyziologie   MeSH
• prsty ruky patofyziologie   MeSH
• úleková reakce fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• dospělí MeSH
• dystonie epidemiologie   patofyziologie   MeSH
• incidence MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření pohybů očí MeSH
• mladý dospělý MeSH
• neurologické poruchy chůze epidemiologie   patofyziologie   MeSH
• oční konvergence fyziologie   MeSH
• pohyby očí fyziologie   MeSH
• poruchy hybnosti oka epidemiologie   patofyziologie   MeSH
• sakadické oční pohyby fyziologie   MeSH
• tremor epidemiologie   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• práce podpořená grantem MeSH