Impaired awareness of motor intention in functional neurological disorder: implications for voluntary and functional movement.
Impaired awareness of motor intention in functional neurological disorder: implications for voluntary and functional movement.
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DOI：
10.1017/s0033291717000071
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发表时间：
2017-07
影响因子：
6.9
通讯作者：
Voon V
中科院分区：
文献类型：
--
作者：
Baek K;Doñamayor N;Morris LS;Strelchuk D;Mitchell S;Mikheenko Y;Yeoh SY;Phillips W;Zandi M;Jenaway A;Walsh C;Voon V
功能性神经障碍（FNDs），也称为转换障碍，是与神经系统病因无关的无法解释的神经系统症状。这种疾病很常见，但人们对其了解甚少。这些症状是不自觉的，但与自愿过程有相似之处。本文研究了FND中的意向意识。共有26名FND患者和25名健康志愿者使用Libet时钟参与了这项功能磁共振研究。FND的特点是相对于运动本身，延迟意识到运动的意图。对意图的报告更加精确，这表明这些发现是可靠的，与非特异性注意力缺陷无关。这些发现在异常的阳性功能运动症状中比阴性症状更为突出，这可能与抑制性否决过程的时间障碍有关。相对于运动，对意图的注意与FND右下顶叶皮层的活动有关，该区域是意图加工的早期区域。休息时，观察到右侧顶叶下皮层和其他运动意向区功能连接异常。结果与观察到的低下顶叶活动相一致，比较了FND的非自愿运动和自愿运动，强调了意图的核心缺陷。这种受损意图的高度精确与贝叶斯理论一致，即自上而下的先验受损可能会影响不自主感。自发性运动意向在早期加工阶段的原发性损伤可能解释了临床观察中出现的努力性自发性运动减慢、自我导向注意力增强和潜在的功能性运动。这些发现进一步提出了新的治疗靶点。
Functional neurological disorders (FNDs), also known as conversion disorder, are unexplained neurological symptoms unrelated to a neurological cause. The disorder is common, yet poorly understood. The symptoms are experienced as involuntary but have similarities to voluntary processes. Here we studied intention awareness in FND. A total of 26 FND patients and 25 healthy volunteers participated in this functional magnetic resonance study using Libet's clock. FND is characterized by delayed awareness of the intention to move relative to the movement itself. The reporting of intention was more precise, suggesting that these findings are reliable and unrelated to non-specific attentional deficits. That these findings were more prominent with aberrant positive functional movement symptoms rather than negative symptoms may be relevant to impairments in timing for an inhibitory veto process. Attention towards intention relative to movement was associated with lower right inferior parietal cortex activity in FND, a region early in the processing of intention. During rest, aberrant functional connectivity was observed with the right inferior parietal cortex and other motor intention regions. The results converge with observations of low inferior parietal activity comparing involuntary with voluntary movement in FND, emphasizing core deficiencies in intention. Heightened precision of this impaired intention is consistent with Bayesian theories of impaired top-down priors that might influence the sense of involuntariness. A primary impairment in voluntary motor intention at an early processing stage might explain clinical observations of slowed effortful voluntary movement, heightened self-directed attention and underlie functional movements. These findings further suggest novel therapeutic targets.