Pathophysiologie funktioneller Bewegungsstörungen

ZUSAMMENFASSUNG

Die Ursache funktioneller neurologischer Bewegungsstörungen ist multifaktoriell. Es ist denkbar, dass es eine genetische Prädisposition gibt, die zu einer verminderten Belastbarkeit und Verarbeitungsfähigkeit externer Stressoren führt. Zu den Risikofaktoren zählen Traumata in der Kindheit; insbesondere eine psychische Vernachlässigung (Neglect), innerfamiliäre Schwierigkeiten, Mobbing, erhöhter sozialer Druck und sexueller Missbrauch. Dazu passt, dass ein hoher Prozentsatz betroffener Patienten an psychiatrischen Komorbiditäten wie Depressionen, Angststörungen oder posttraumatischen Belastungsstörungen leidet. Oftmals gehen der Erstmanifestation andere organische Erkrankungen, Operationen oder Unfälle voraus. Es gibt zahlreiche neurophysiologische und bildgebende Untersuchungen, die ein zugrunde liegendes gestörtes Handlungsbewusstsein nahelegen. Hierbei ist insbesondere die Wahrnehmung der Kontrolle eigener Handlungen und deren Konsequenzen gestört. Verortet wird das Handlungsbewusstsein im temporo-parietalen Knotenpunkt, der eine reduzierte Aktivierung bei Patienten mit einem funktionellen Tremor zeigt. Zudem wurde eine verminderte funktionelle Konnektivität zwischen rechtem temporo-parietalem Übergang und bilateralen sensomotorischen Regionen beschrieben. Das beeinträchtigte Handlungsbewusstsein ist vermutlich Folge einer fehlerhaften Integration motorischer Feedforward- und sensorischer Feedback-Mechanismen. In dieser Übersichtsarbeit werden wir diese Aspekte beleuchten, um anschließend ein pathophysiologisches Modell zu erstellen.

ABSTRACT

Functional movement disorders are multifactorial in their origin. It is conceivable that there is a genetic predisposition with an impaired ability to manage lifetime stressors. Additional environmental determents may occur and lead to a functional movement disorder. Risk factors include childhood trauma such as emotional neglect or problematic family structures with sexual abuse or intimidation. Further predisposing factors comprise psychiatric co-morbidities. Some patients might have had organic diseases such as trauma, surgery, or neurological illnesses. Several neurophysiological and neuroimaging studies have been published in the past years. They point to an abnormal sense of agency that has been associated with hypofunction in the right temporo-parietal junction. Functional magnetic resonance imaging studies revealed reduced functional connectivity from that junction to sensorimotor and limbic regions. Impaired sense of agency has also been attributed to disturbed integration of motor feedforward and sensory feedback mechanisms. In this review article we will illustrate the different pathophysiological aspects and provide a model to integrate those aspects.

Schlüsselwörter

Funktionelle Bewegungsstörungen - prädisponierende Faktoren - funktionelle und strukturelle Bildgebung - elektrophysiologische Kriterien - Handlungsbewusstsein

Key words

Functional movement disorders - predisposing factors - functional and structural imaging - electrophysiological criteria - sense of agency

Publication History

Article published online:
02 August 2023

• Literatur

• 1 Aybek S, Nicholson TR, O’daly O. et al Emotion-Motion Interactions in Conversion Disorder: An fMRI Study. PLOS ONE 2015: 10e0123273
• 2 Baek K, Doñamayor N, Morris LS. et al Impaired awareness of motor intention in functional neurological disorder: implications for voluntary and functional movement. Psychol Med 2017; 47: 1624-1636
• 3 Baizabal-Carvallo JF, Hallett M, Jankovic J. Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiology of disease 2019; 127: 32-44
• 4 Baizabal-Carvallo JF, Jankovic J. Gender differences in functional movement disorders. Movement Disorders Clinical Practice 2020; 07: 182-187
• 5 Edwards MJ, Moretto G, Schwingenschuh P. et al Abnormal sense of intention preceding voluntary movement in patients with psychogenic tremor. Neuropsychologia 2011; 49: 2791-2793
• 6 Ekanayake V, Kranick S, Lafaver K. et al Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): neuroticism and perfectionism. Journal of psychosomatic research 2017; 97: 23-29
• 7 Epstein SA, Maurer CW, Lafaver K. et al Insights into chronic functional movement disorders: the value of qualitative psychiatric interviews. Psychosomatics 2016; 57: 566-575
• 8 Espay AJ, Ries S, Maloney T. et al Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology 2019; 93: e1787-e1798
• 9 Faul L, Knight LK, Espay AJ. et al Neural activity in functional movement disorders after inpatient rehabilitation. Psychiatry Research: Neuroimaging 2020; 303: 111125
• 10 Feinstein A, Stergiopoulos V, Fine J. et al Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Cognitive and Behavioral Neurology 2001; 14: 169-176
• 11 Frith CD, Friston K, Liddle PF. et al Willed action and the prefrontal cortex in man: a study with PET. Proceedings of the Royal Society of London. Series B: Biological Sciences 1997; 244: 241-246
• 12 Haggard P, Clark S, Kalogeras J. Voluntary action and conscious awareness. Nat Neurosci 2002; 05: 382-385
• 13 Hallett M, Aybek S, Dworetzky BA. et al Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol 2022; 21: 537-550
• 14 Hassa T, Sebastian A, Liepert J. et al Symptom-specific amygdala hyperactivity modulates motor control network in conversion disorder. Neuroimage Clin 2017; 15: 143-150
• 15 Huys AML, Haggard P, Bhatia KP. et al Misdirected attentional focus in functional tremor. Brain 2021; 144: 3436-3450
• 16 Keynejad RC, Frodl T, Kanaan R. et al Stress and functional neurological disorders: mechanistic insights. J Neurol Neurosurg Psychiatry 2019; 90: 813-821
• 17 Kranick S, Ekanayake V, Martinez V. et al Psychopathology and psychogenic movement disorders. Movement Disorders 2011; 26: 1844-1850
• 18 Kranick SM, Moore JW, Yusuf N. et al Action-effect binding is decreased in motor conversion disorder: implications for sense of agency. Mov Disord 2013; 28: 1110-1116
• 19 Libet B, Gleason CA, Wright EW. et al Time of conscious intention to act in relation to onset of cerebral activity (readiness-potential). The unconscious initiation of a freely voluntary act. Brain 1983; 106: 623-642
• 20 Maurer CW, Lafaver K, Ameli R. et al Impaired self-agency in functional movement disorders. Neurology 2016; 87: 564-570
• 21 Maurer CW, Lafaver K, Limachia GS. et al Gray matter differences in patients with functional movement disorders. Neurology 2018; 91: e1870-e1879
• 22 Nahab FB, Kundu P, Maurer C. et al Impaired sense of agency in functional movement disorders: An fMRI study. PLoS One 2017; 12: e0172502
• 23 Parees I, Brown H, Nuruki A. et al Loss of sensory attenuation in patients with functional (psychogenic) movement disorders. Brain 2014; 137: 2916-2921
• 24 Pick S, Goldstein LH, Perez DL. et al Emotional processing in functional neurological disorder: A review, biopsychological model and research agenda. J Neurol Neurosurg Psychiatry 2019; 90: 704-711
• 25 Rowe JB, Stephan KE, Friston K. et al The Prefrontal Cortex shows Context-specific Changes in Effective Connectivity to Motor or Visual Cortex during the Selection of Action or Colour. Cerebral Cortex 2005; 15: 85-95
• 26 Sadnicka A, Daum C, Meppelink AM. et al Reduced drift rate: a biomarker of impaired information processing in functional movement disorders. Brain 2020; 143: 674-683
• 27 Verrel J, Chwolka F, Filevich E. et al Impaired Metacognition of Voluntary Movement in Functional Movement Disorder. Mov Disord 2023; 38 (03) 435-443
• 28 Voon V, Brezing C, Gallea C. et al Emotional stimuli and motor conversion disorder. Brain 2010; 133: 1526-1536
• 29 Voon V, Brezing C, Gallea C. et al Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder. Movement Disorders 2011; 26: 2396-2403
• 30 Voon V, Gallea C, Hattori N. et al The involuntary nature of conversion disorder. Neurology 2010; 74: 223-228