SEE BURGESS DOI101093/BRAIN/AWW092 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE : Analogical reasoning is at the core of the generalization and abstraction processes that enable concept formation and ...creativity. The impact of neurological diseases on analogical reasoning is poorly known, despite its importance in everyday life and in society. Neuroimaging studies of healthy subjects and the few studies that have been performed on patients have highlighted the importance of the prefrontal cortex in analogical reasoning. However, the critical cerebral bases for analogical reasoning deficits remain elusive. In the current study, we examined analogical reasoning abilities in 27 patients with focal damage in the frontal lobes and performed voxel-based lesion-behaviour mapping and tractography analyses to investigate the structures critical for analogical reasoning. The findings revealed that damage to the left rostrolateral prefrontal region (or some of its long-range connections) specifically impaired the ability to reason by analogies. A short version of the analogy task predicted the existence of a left rostrolateral prefrontal lesion with good accuracy. Experimental manipulations of the analogy tasks suggested that this region plays a role in relational matching or integration. The current lesion approach demonstrated that the left rostrolateral prefrontal region is a critical node in the analogy network. Our results also suggested that analogy tasks should be translated to clinical practice to refine the neuropsychological assessment of patients with frontal lobe lesions.
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.
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.
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).
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.
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in ...2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
Les troubles neurologiques fonctionnels représentent 5 à 10 % des motifs de consultation en neurologie, et sont aussi invalidants que les autres pathologies neurologiques. Il existe aujourd’hui un ...défaut de formation des neurologues et 75 % des internes et assistants en neurologie considèrent qu’ils ne sont pas assez formés à cette pathologie. La place du neurologue est avant tout de rechercher les arguments cliniques et éventuellement paracliniques en faveur du diagnostic, en recherchant des signes de diagnostic positif. L’annonce diagnostique est une étape importante de la prise en charge, dont l’impact sur le pronostic a été démontré. Ensuite, plusieurs traitements ont montré un effet bénéfique et peuvent être proposés avec idéalement une approche multidisciplinaire impliquant kinésithérapeutes et psychologues. Des traitements complémentaires tels que la stimulation magnétique transcrânienne ou l’hypnose peuvent être proposés. Lors du suivi, les rechutes et la persistance de symptômes au long cours sont fréquentes et touchent la majorité des patients. Il est alors nécessaire de rechercher des facteurs perpétuant les symptômes, et notamment l’absence d’adhésion au diagnostic.
Le trouble cognitif fonctionnel (TCF) est une entité peu caractérisée qui comprendrait différentes typologies. L’objectif de ce travail est de présenter les différentes formes de TCF et de discuter ...de leurs tableaux.
Cinq vignettes cliniques sont présentées afin de décrire les formes de TCF et de mettre en exergue leurs différences aux examens réalisés (examen neurologique et neuropsychologique, prise de sang et imagerie cérébrale). Le premier patient présente un trouble cognitif fonctionnel isolé dont le bilan neuropsychologique met en évidence de nombreuses inconsistances internes avec dissociation entre capacités cognitives implicites et explicites. Le deuxième patient présente des troubles cognitifs associés à un trouble neurologique fonctionnel (TNF) et son bilan met également en évidence des signes d’inconsistance au sein même de l’évaluation neuropsychologique. Le troisième patient présente une anxiété liée à la peur de développer une maladie neurodégénérative, avec un bilan neuropsychologique mettant en évidence une faiblesse de la sphère exécutivo-attentionnelle. Le quatrième patient présente des symptômes cognitifs inhérents à un syndrome anxiodépressif dont le bilan neuropsychologique met aussi en évidence une atteinte de la sphère exécutivo-attentionnelle. Le cinquième patient des difficultés cognitives normales faisant l’objet d’un focus attentionnel important entraînant de l’anxiété et le bilan neuropsychologique est normal.
Ces cas cliniques montrent que la classification de Stone et al. (2015) regroupe sous une même catégorie des patients présentant des symptômes différents. Nous distinguons les patients présentant un tableau d’inconsistances au sein même du bilan neuropsychologique de ceux présentant un syndrome dysexécutif ou des performances normales et nous proposons que le TCF désigne avant tout un tableau d’inconsistance.
Une meilleure spécification des TCF et de leur présentation permettrait certainement de discriminer le TCF d’autres affections, comme par exemple les troubles cognitifs inhérents aux troubles de l’humeur.
The diagnosis of functional dystonia is challenging because it is difficult to distinguish functional dystonia from other types of dystonia. After diagnostic explanation, multidisciplinary care is ...recommended, but some patients are resistant to treatments. We used motor blocks in three patients with severe resistant functional dystonia of the upper limbs to test (i) whether joint contracture was present and (ii) whether motor blocks have a therapeutic effect on functional dystonia. Patient 1 showed a good and sustained therapeutic response, Patient 2 experienced a resolution of the dystonic posture that lasted for 10 days, and Patient 3 experienced no effect. Motor blocks may be a useful therapeutic option in chronic treatment‐resistant functional dystonia. The treatment effect might be achieved through the experience of normal positioning and functioning of the limb.
Functional motor disorders (FMD) are common and disabling. They are known to predominantly affect women and young to middle-aged patients, although they also occur during childhood or in the elderly. ...Demographic and clinical characteristics of patients with FMD are poorly known, since large series of consecutive patients are scarce.
In a chart review study, we retrospectively abstracted data from consecutive FMD patients who were referred to the Neurophysiology Department of the Salpêtrière University Hospital between 2008 and 2016 for treatment with repeated transcranial magnetic stimulation.
482 patients were included. Most patients were women (73.7%). Median age at symptoms onset was 35.5 years and symptoms were mostly characterized by acute (47.3%) or subacute (46%) onset. Only 23% of patients were active workers, while 58.3% were unemployed because of FMD. Half of the patients had functional motor weakness (n = 241) whereas the other half had movement disorders (n = 241), mainly with tremor (21.1%) or dystonia (20.5%). Among all patients, 66.4% had psychiatric comorbidity and 82.6% reported a history of trauma in the 6 months before symptoms onset. No difference was found in age or gender according to clinical phenotypes.
This large series will contribute to better characterize FMDs.
•We report 482 patients with functional motor disorders, median age was 40 years old.•Half had weakness and half had movement disorders, mainly tremor and dystonia.•No difference was found in age or gender regarding the clinical phenotype.•58% of the patients were unemployed because of the functional movement disorder.
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