功能紊乱
神经学
神经系统疾病
转换障碍
认知
心理学
神经科学
医学
物理医学与康复
精神科
中枢神经系统疾病
作者
Mark Hallett,Selma Aybek,Barbara A. Dworetzky,Lara McWhirter,Jeffrey P. Staab,Jon Stone
标识
DOI:10.1016/s1474-4422(21)00422-1
摘要
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Four entities-functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder-show similarities in aetiology and pathophysiology and are variants of a disorder at the interface between neurology and psychiatry. All four entities have distinctive features and can be diagnosed with the support of clinical neurophysiological studies and other biomarkers. The pathophysiology of functional neurological disorder includes overactivity of the limbic system, the development of an internal symptom model as part of a predictive coding framework, and dysfunction of brain networks that gives movement the sense of voluntariness. Evidence supports tailored multidisciplinary treatment that can involve physical and psychological therapy approaches.
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