Metropolitan Rehabilitation Hospital, Sydney, Australia.
Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, Australia.
Med Hypotheses. 2018 Feb;111:41-48. doi: 10.1016/j.mehy.2017.12.010. Epub 2017 Dec 9.
Functional Neurological Symptom Disorder (FND) is a relatively common neurological condition, accounting for approximately 3-6% of neurologist referrals. FND is considered a transient disorder of neuronal function, sometimes linked to physical trauma and psychological stress. Despite this, chronic disability is common, for example, around 40% of adults with motor FND have permanent disability. Building on current theoretical models, this paper proposes that microglial dysfunction could perpetuate functional changes within acute motor FND, thus providing a pathophysiological mechanism underlying the chronic stage of the motor FND phenotypes seen clinically. Core to our argument is microglia's dual role in modulating neuroimmunity and their control of synaptic plasticity, which places them at a pathophysiological nexus wherein coincident physical trauma and psychological stress could cause long-term change in neuronal networks without producing macroscopic structural abnormality. This model proposes a range of hypotheses that are testable with current technologies.
功能性神经症状障碍（FND）是一种相对常见的神经系统疾病，约占神经科转介的 3-6%。FND 被认为是神经元功能的短暂障碍，有时与身体创伤和心理压力有关。尽管如此，慢性残疾很常见，例如，大约 40%的运动 FND 成年人有永久性残疾。基于当前的理论模型，本文提出小胶质细胞功能障碍可能使急性运动 FND 中的功能性变化持续存在，从而为临床所见运动 FND 表型的慢性阶段提供了一个病理生理学机制。我们的观点的核心是小胶质细胞在调节神经免疫和控制突触可塑性方面的双重作用，这使它们处于病理生理学的枢纽位置，在这个位置上，同时发生的身体创伤和心理压力可能会导致神经元网络的长期变化，而不会产生宏观结构异常。该模型提出了一系列假设，这些假设可以用当前的技术进行测试。
