Division of Neurology, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
Morton and Gloria Shulman Movement Disorder Unit and E.J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN, University of Toronto, Ontario M5G 2C4, Canada.
Brain. 2021 Sep 4;144(8):2278-2283. doi: 10.1093/brain/awab131.
Neuroimaging has been pivotal in identifying and reframing our understanding of functional movement disorders. If accessible, it compensates for the limitations of the clinical exam and is especially useful where there is overlap of functional symptoms with classical presentations of disease. Imaging in functional movement disorders has increasingly identified structural and functional abnormalities that implicate hypoactivation of the cortical and subcortical motor pathways and increased modulation by the limbic system. Neurobiological theories suggest an impaired sense of agency, faulty top-down regulation of motor movement and abnormal emotional processing in these individuals. This framework challenges our traditional understanding of functional movement disorders as distinct from the deceptive term of 'organic' diseases and proposes that these conditions are not considered as mutually exclusive. This update summarizes the literature to date and explores the role of imaging in the diagnosis of functional movement disorders and in detecting its underlying molecular network.
神经影像学在识别和重新构建我们对功能性运动障碍的理解方面发挥了关键作用。如果可行，它可以弥补临床检查的局限性，特别是在功能性症状与疾病的经典表现重叠时非常有用。在功能性运动障碍中，影像学越来越多地发现了结构和功能异常，这些异常提示皮质和皮质下运动通路的活动不足，以及边缘系统的调节增加。神经生物学理论表明，这些个体存在感知能力受损、运动控制的自上而下调节失灵以及情绪处理异常。这个框架挑战了我们对功能性运动障碍的传统理解，即与“器质性”疾病这一有欺骗性的术语不同，并提出这些疾病不应被视为相互排斥。本更新总结了迄今为止的文献，并探讨了影像学在功能性运动障碍诊断中的作用，以及在检测其潜在分子网络中的作用。
