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Predictors of success of low-intensity specific physiotherapy in functional movement disorders
Chmelíková, Petra ; Serranová, Tereza (advisor) ; Vogner, Martin (referee)
Introduction: Functional movement disorders are a nosological entity falling within the group of functional neurological disorders. Despite their relatively common occurrence, this area at the intersection of neurology and psychiatry is clinically and research-wise overlooked. However, they typically manifest as chronic conditions causing significant disability to patients. Specific physiotherapy is considered the first-line treatment for most patients; however, indicators of its effectiveness are currently lacking. Objective: The aim of this study is to investigate whether selected variables - the number of hours of completed physiotherapy, duration of the illness, and expression of a fibromyalgia- like pattern - can serve as suitable predictors of the success of physiotherapy in functional movement disorders. Methods: This is a retrospective study conducted on a sample of patients with functional movement disorders (n=18). Before the intervention, patients completed questionnaires assessing fibromyalgia-like patterns - the Widespread Pain Index and Symptom Severity Index. Subsequently, they underwent specific physiotherapy sessions, with variations in the number and time period of therapy sessions among patients. During the final physiotherapy session, improvement in symptoms over the...
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Functional movement disorders: phenotypes, neurobiological markers, pathophysiological mechanisms
Forejtová, Zuzana ; Serranová, Tereza (advisor) ; Kališová, Lucie (referee) ; Bočková, Martina (referee)
Functional Movement Disorders (FMD), also known as conversion, psychogenic, or dissociative motor disorders, are complex and clinically heterogeneous group of diseases. In addition to motor symptoms, FMD are manifested by a number of comorbid non-motor symptoms. Despite the potential reversibility, these disorders still have an unfavourable prognosis and are associated with a low quality of life. Regardless of the growing interest of both clinical and research communities over the last two decades, this issue remains insufficiently understood in many aspects. The aim of the presented studies was to fill some gaps in the knowledge of neurophysiological and clinical correlates in FMD. The first of the presented studies explored the robust neurophysiological phenomenon of prepulse inhibition (PPI) in FMD. The alteration in PPI, along with previous findings of a reduced PPI in other functional syndromes, supported a possible unified pathophysiology across functional neurological and somatic syndromes with implications for diagnostic classification and development of novel biomarkers and treatments. These results are in line with the differentiation FMD from feigned or malingered phenomena. The aim of the second study was to explore the relationship between common motor, non-motor symptoms and...
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Functional movement disorders: pathophysiological mechanisms, diagnostic neurophysiological markers, and new therapeutic approaches
Slovák, Matěj ; Serranová, Tereza (advisor) ; Vevera, Jan (referee) ; Rusina, Robert (referee)
Functional movement disorders (FMD), previously referred as psychogenic, are characterized by inconsistency and incogruence with organic neurological disorders. The original psychological models of FMD were replaced by a neurobiological model of the disease. The identification of neurophysiological correlates of FMD and their comorbidities may add to the so far limited knowledge of the pathophysiology of these disorders. This Thesis focuses on three thematic areas of FMD: 1. assessment of prevalence of comorbid restless legs syndrome (RLS) and periodic limb movements (PLM) as an objective marker of RLS using actigraphy; 2. analysis of reflexive and volitional eye movements using videooculography (VOG); 3. evaluation of emotional arousal objectively by pupillometry and subjectively using affective ratings of emotional pictures. In total, 115 FMD patients and 76 age- and matched healthy controls participated in the studies. 1. FMD patients (N=96) presented with signficantly higher prevalence of RLS (43,8 % vs. 7,9 %, p<0,001) and clinically relevant PLM (20,8 % vs. 2,6 %, p=0,0002) compared to controls. The association of RLS/PLM with FMD raises the possibility of common pathophysiological mechanisms of these conditions and has clinical implications in management of FMD. 2. VOG analyses showed normal...
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The effects of deep brain stimulation of the subthalamic nucleus on emotional and motivational processing in Parkinson's disease patients
Serranová, Tereza ; Růžička, Evžen (advisor) ; Horáček, Jiří (referee) ; Mareš, Jan (referee)
Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral...
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The effects of deep brain stimulation of the subthalamic nucleus on emotional and motivational processing in Parkinson's disease patients
Serranová, Tereza ; Růžička, Evžen (advisor) ; Horáček, Jiří (referee) ; Mareš, Jan (referee)
Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral...
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