应重视功能性神经系统疾病诊断与治疗

doi:10.3969/j.issn.1672-6731.2023.01.010

摘要/Abstract

摘要： 功能性神经系统疾病（以下简称功能性神经疾病）是一类具有明确临床症状的自主运动或感觉系统疾病，因发病广泛和疾病负担沉重日益受到社会的高度重视。我国功能性神经疾病研究起步较晚，临床医师、患者及其家属对疾病认识不足、概念不清。本文拟对我国功能性神经疾病诊断与治疗现状进行分析，并就出台相关措施以提高我国诊断与治疗水平、加强相关研究提出建议。

关键词: 转换障碍, 多学科诊疗模式（非MeSH词）, 教育, 医学, 继续, 综述

Abstract: Functional neurological disorder (FND) is a kind of autonomic motor or sensory system disease with well-defined clinical symptoms. It has attracted the attention of many scientists due to its high incidence and heavy social burden, and many studies have promoted the development of FND. However, due to the late start of related research in China, clinicians, patients and their families have relatively weak understanding of the concept of FND and related knowledge. This article analyzes the current status of FND diagnosis and treatment in China, proposed the suggestions to improve the level of diagnosis and treatment for FND in details and enhance related study.

Key words: Conversion disorder, Multi-disciplinary team (not in MeSH), Education, medical, continuing, Review

王金涛, 林国珍, 王刚. 应重视功能性神经系统疾病诊断与治疗[J]. 中国现代神经疾病杂志, 2023, 23(1): 53-57.

WANG Jin-tao, LIN Guo-zhen, WANG Gang. Attention should be emphasized to the diagnosis and treatment of functional neurological disorder[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(1): 53-57.

http://journal11.magtechjournal.com/cjcnn/CN/Y2023/V23/I1/53

参考文献

[1] Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder:new subtypes and shared mechanisms[J]. Lancet Neurol, 2022, 21:537-550.
[2] Stone J, Burton C, Carson A. Recognising and explaining functional neurological disorder[J]. BMJ, 2020, 371:m3745.
[3] Hallett M. Psychogenic movement disorders:a crisis for neurology[J]. Curr Neurol Neurosci Rep, 2006, 6:269-271.
[4] Asadi-Pooya AA, Bahrami Z. Auras in psychogenic nonepileptic seizures[J]. Seizure, 2019, 69:215-217.
[5] Asadi-Pooya AA, Farazdaghi M. Aura:epilepsy vs. functional (psychogenic) seizures[J]. Seizure, 2021, 88:53-55.
[6] Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, LaFaver K, LaFrance WC Jr, Lang AE, Nicholson T, Nielsen G, Reuber M, Voon V, Stone J, Morgante F. Current concepts in diagnosis and treatment of functional neurological disorders[J]. JAMA Neurol, 2018, 75:1132-1141.
[7] Aybek S, Perez DL. Diagnosis and management of functional neurological disorder[J]. BMJ, 2022, 376:o64.
[8] Carson A, Lehn A. Epidemiology[J]. Handb Clin Neurol, 2016, 139:47-60.
[9] Stone J, Warlow C, Sharpe M. The symptom of functional weakness:a controlled study of 107 patients[J]. Brain, 2010, 133(Pt 5):1537-1551.
[10] Duan YQ, Wang G. A case of cardiac tremor in children[J]. Chongqing Yi Ke Da Xue Xue Bao, 2012, 37:471-472. 段月琴, 王刚. 儿童心因性震颤1例[J]. 重庆医科大学学报, 2012, 37:471-472.
[11] Tang YN, Wei L. Clinical analysis of 3 cases of functional dyskinesia induced by examination stress[J]. Zhongguo Sheng Yu Jian Kang Za Zhi, 2022, 33:179-182. 汤亚南, 魏玲. 考试压力诱发功能性运动障碍3例临床分析[J]. 中国生育健康杂志, 2022, 33:179-182.
[12] Chouksey A, Pandey S. Functional movement disorders in children[J]. Front Neurol, 2020, 11:570151.
[13] Baizabal-Carvallo JF, Jankovic J. Gender differences in functional movement disorders[J]. Mov Disord Clin Pract, 2019, 7:182-187.
[14] Stephen CD, Fung V, Lungu CI, Espay AJ. Assessment of emergency department and inpatient use and costs in adult and pediatric functional neurological disorders[J]. JAMA Neurol, 2021, 78:88-101.
[15] Lidstone SC, Costa-Parke M, Robinson EJ, Ercoli T, Stone J; FMD GAP Study Group. Functional movement disorder gender, age and phenotype study:a systematic review and individual patient meta-analysis of 4905 cases[J]. J Neurol Neurosurg Psychiatry, 2022, 93:609-616.
[16] Gendre T, Carle G, Mesrati F, Hubsch C, Mauras T, Roze E, Houot M, Degos B, Garcin B. Quality of life in functional movement disorders is as altered as in organic movement disorders[J]. J Psychosom Res, 2019, 116:10-16.
[17] Fahn S, Williams DT. Psychogenic dystonia[J]. Adv Neurol, 1988, 50:431-455.
[18] Shill H, Gerber P. Evaluation of clinical diagnostic criteria for psychogenic movement disorders[J]. Mov Disord, 2006, 21:1163-1168.
[19] Gupta A, Lang AE. Psychogenic movement disorders[J]. Curr Opin Neurol, 2009, 22:430-436.
[20] Espay AJ, Lang AE. Phenotype-specific diagnosis of functional (psychogenic) movement disorders[J]. Curr Neurol Neurosci Rep, 2015, 15:32.
[21] LaFrance WC Jr, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures:a staged approach. A report from the International League Against Epilepsy Nonepileptic Seizures Task Force[J]. Epilepsia, 2013, 54:2005-2018.
[22] Nass RD, Sassen R, Elger CE, Surges R. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures[J]. Seizure, 2017, 47:51-65.
[23] Wang YQ, Wen Y, Wang MM, Zhang YW, Fang ZX. Prolactin levels as a criterion to differentiate between psychogenic non-epileptic seizures and epileptic seizures:a systematic review[J]. Epilepsy Res, 2021, 169:106508.
[24] Hallett M. Psychogenic movement disorders and other conversion disorders (second edition)[M]. Wang G, trans. Shanghai:Shanghai Jiaotong University Press, 2020:210-215. Hallet M. 心因性运动障碍和其他转换障碍(第2版)[M]. 王刚, 译. 上海:上海交通大学出版社, 2020:210-215.
[25] Xie XY, Lin GZ, Huang Q, Li CB, Hallett M, Voon V, Ren RJ, Chen SD, Wang G. Opinions and clinical practice of functional movement disorders:a nationwide survey of clinicians in China[J]. BMC Neurol, 2021, 21:435.
[26] LaFaver K, Lang AE, Stone J, Morgante F, Edwards M, Lidstone S, Maurer CW, Hallett M, Dwivedi AK, Espay AJ. Opinions and clinical practices related to diagnosing and managing functional (psychogenic) movement disorders:changes in the last decade[J]. Eur J Neurol, 2020, 27:975-984.
[27] Yin D, Wang H, Zhang YH, Ni Z, Chen Y, Chen XW, Dou RH, Hong Z, Kuang WH, Lin GZ, Wang YK, Wang HL, Xue Z, Xu SL, Chen W, Chen HB, Chen SD, Li CB, Wang G. Chinese expert consensus on the diagnosis and treatment of functional movement disorders[J]. Chongqing Yi Ke Da Xue Xue Bao, 2021, 46:732-736. 尹豆, 王含, 张玉虎, 倪臻, 陈燕, 陈先文, 窦荣花, 洪桢, 况伟宏, 林国珍, 王玉凯, 王华龙, 薛峥, 许顺良, 陈伟, 陈海波, 陈生弟, 李春波, 王刚. 功能性运动障碍的诊断与治疗中国专家共识[J]. 重庆医科大学学报, 2021, 46:732-736.
[28] Hao SS, Xiao L, Wang HL, Liu ZC, Wang GH. Survey on the non-psychiatric physician's ability of diagnosis and treatment of depression/anxiety disorders in general hospital[J]. Zhonghua Xing Wei Yi Xue Yu Nao Ke Xue Za Zhi, 2015, 24:1037-1040. 郝世胜, 肖玲, 王惠玲, 刘忠纯, 王高华. 综合医院非精神科临床医师对抑郁焦虑障碍诊疗服务能力现状调查[J]. 中华行为医学与脑科学杂志, 2015, 24:1037-1040.
[29] National Health Comission. Notice of the General Office of the National Health Commission on printing and distributing the standards for the accreditation of standardized training bases for residents (Trial) and the content and standards of standardized training for residents (Trial)[EB/OL]. (2014-08-22)[2022-03-05]. http://www.nhc.gov.cn/qjjys/s3593/201408/946b17f463fa4e5dbcfb4f7c68834c41.shtml. 国家卫生计生委. 国家卫生计生委办公厅关于印发住院医师规范化培训基地认定标准(试行)和住院医师规范化培训内容与标准(试行)的通知[EB/OL]. (2014-08-22)[2022-03-05]. http://www.nhc.gov.cn/qjjys/s3593/201408/946b17f463fa4e5dbcfb4f7c68834c41.shtml.
[30] Frucht L, Perez DL, Callahan J, MacLean J, Song PC, Sharma N, Stephen CD. Functional dystonia:differentiation from primary dystonia and multidisciplinary treatments[J]. Front Neurol, 2021, 11:605262.
[31] Kotwas I, Arthuis M, Cermolacce M, Bartolomei F, McGonigal A. Psychogenic non-epileptic seizures:chronology of multidisciplinary team approach to diagnosis and management[J]. Rev Neurol (Paris), 2022, 178:692-702.
[32] Duncan R, Horwood J, Razvi S, Mulhern S. Psychogenic nonepileptic seizures that remit when the diagnosis is given:just good luck[J]? Epilepsy Behav, 2020, 102:106667.
[33] Taib S, Ory-Magne F, Brefel-Courbon C, Moreau Y, Thalamas C, Arbus C, Simonetta-Moreau M. Repetitive transcranial magnetic stimulation for functional tremor:a randomized, double-blind, controlled study[J]. Mov Disord, 2019, 34:1210-1219.
[34] Minghetti S, Lenge M, Pisano T, Gori S, Mongardi L, Sestini S, Cavallo MA, Genitori L, Giordano F. Deep brain stimulation of subgenual cingulate region for treatment of an early-onset conversion disorder with psychogenic non-epileptic seizures and prolonged catatonia:preliminary results in one patient[J]. Stereotact Funct Neurosurg, 2021, 99:363-365.
[35] Gilmour GS, Nielsen G, Teodoro T, Yogarajah M, Coebergh JA, Dilley MD, Martino D, Edwards MJ. Management of functional neurological disorder[J]. J Neurol, 2020, 267:2164-2172.
[36] LaFaver K. Treatment of functional movement disorders[J]. Neurol Clin, 2020, 38:469-480.
[37] Cope SR, Smith JG, Edwards MJ, Holt K, Agrawal N. Enhancing the communication of functional neurological disorder diagnosis:a multidisciplinary education session[J]. Eur J Neurol, 2021, 28:40-47.
[38] Chen DK, Maheshwari A, Franks R, Trolley GC, Robinson JS, Hrachovy RA. Brief group psychoeducation for psychogenic nonepileptic seizures:a neurologist-initiated program in an epilepsy center[J]. Epilepsia, 2014, 55:156-166.
[39] Keynejad RC, Frodl T, Kanaan R, Pariante C, Reuber M, Nicholson TR. Stress and functional neurological disorders:mechanistic insights[J]. J Neurol Neurosurg Psychiatry, 2019, 90:813-821.
[40] Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorder:a review, biopsychosocial model and research agenda[J]. J Neurol Neurosurg Psychiatry, 2019, 90:704-711.

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