Pathophysiology of Involuntary Movements and Volitional Disorders

心因性运动障碍(PMD)的病理生理学还知之甚少。这些疾病在人群中很常见，诊断困难，治疗通常无效。我们正在使用认知任务、神经生理学测试、精神病学测量和功能成像来研究这些障碍的潜在机制。一项功能成像研究是对震颤患者的功能磁共振成像进行比较，初步结果显示前额叶背外侧皮质异常激活。我们还想寻找与探测情绪表达和运动抑制等功能的任务相关的异常激活。我们还将调查这些患者在功能磁共振研究中的代理感，类似于我们研究正常受试者的方式。 另一个主要问题是转换和伪装的区别。对于这一重要的区别，目前还没有可用的临床方法。我们将尝试使用功能磁共振成像来实现这一点。 使用主观经验计时的Libet时钟方法，可以确定愿意运动的感觉的时间。有可能的是，意志感扭曲的患者在运动本身的时机方面会有意愿的异常时机。在这方面的初步研究正在精神分裂症和抽动症抽动中进行。 抽搐的起源通常是未知的，我们一直在以几种方式接近生理学。抽动症患者报告“先兆性冲动”和其他与抽搐相关的感觉异常。我们一直在用功能神经成像和EEG研究抽动的发生，并打算进行一系列研究，着眼于感觉冲动的生理学。 多年来，我们一直在收集患有特发性震颤的家系，寻找可能的基因异常，并在几个家系中发现了6号和11号染色体上的基因连锁区域。这项工作是与列夫·戈德法布博士合作完成的。

The pathophysiology of psychogenic movement disorders (PMD) is very poorly understood. These disorders are common in the population, diagnosis is difficult and treatment typically ineffective. We are studying the mechanisms underlying these disorders using cognitive tasks, neurophysiological testing, psychiatric measures, and functional imaging. One functional imaging study is an fMRI comparison of patients with tremor, and preliminary results show abnormal activation in dorsolateral prefrontal cortex. We also want to look for abnormal activations related to tasks that probe functions such as emotional expression and movement inhibition. We will also investigate these patients for their sense of agency during fMRI studies, similar to the way we have studied normal subjects. Another major problem is the differentiation of conversion from malingering. There are no clinical methods available for this important distinction. We will be attempting to do this with fMRI. Using the Libet clock method of timing of subjective experience, it is possible to determine the time of the sense of willing a movement. It is possible that patients with distorted sense of volition will have abnormal timing of the sense of willing with respect to the timing of the movement itself. Initial studies in this regard are being undertaken in schizophrenia and for the tics in Tourette Syndrome. The origin of tics is generally unknown, and we have been approaching physiology in several ways. Tourette syndrome patients report "premonitory urge" and other sensory abnormalities associated with the presence of tics. We have been studying tic genesis with functional neuroimaging and EEG, and intend a series of studies looking at the physiology of the sensory urge. For many years, we have been collecting families with essential tremor looking for possible genetic abnormalities, and in several families found an area suggestive of genetic linkage on chromosome 6 and 11. This work is being done in conjunction with Dr. Lev Goldfarb.