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Alberto J. Espay

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3 papers
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3

YNICL Journal 2024 Journal Article

Response to the Letter Concerning the Publication: Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Perez DL et al. Neuroimage Clin. 2021;30:102623

  • David L. Perez
  • Timothy R. Nicholson
  • Ali A. Asadi-Pooya
  • Matthew Butler
  • Alan J. Carson
  • Anthony S. David
  • Quinton Deeley
  • Ibai Diez

In their letter, Tuller and colleagues raise concerns regarding the following introductory phrase and the linked Stone et al (2010) reference: "this renewed interest parallels recognition that FND [functional neurological disorder] is the 2nd most common outpatient neurologic diagnosis."While we appreciate there is complexity to epidemiological considerations in FND, we do not agree with the concerns raised.We share our perspective on this matter with the following four points:

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YNICL Journal 2021 Journal Article

Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda

  • David L. Perez
  • Timothy R. Nicholson
  • Ali A. Asadi-Pooya
  • Indrit Bègue
  • Matthew Butler
  • Alan J. Carson
  • Anthony S. David
  • Quinton Deeley

Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.

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YNICL Journal 2018 Journal Article

Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study

  • Alberto J. Espay
  • Thomas Maloney
  • Jennifer Vannest
  • Matthew M. Norris
  • James C. Eliassen
  • Erin Neefus
  • Jane B. Allendorfer
  • Anthony E. Lang

BACKGROUND: Despite its high prevalence and associated disability, the neural correlates of emotion processing in patients with functional (psychogenic) tremor (FT), the most common functional movement disorder, remain poorly understood. METHODS: In this cross sectional functional magnetic resonance imaging (fMRI) study at 4T, 27 subjects with FT, 16 with essential tremor (ET), and 25 healthy controls (HCs) underwent a finger-tapping motor task, a basic-emotion task, and an intense-emotion task to probe motor and emotion circuitries. Anatomical and functional MRI data were processed with FSL (FMRIB Software Library) and AFNI (Analysis of Functional Neuroimages), followed by seed-to-seed connectivity analyses using anatomical regions defined from the Harvard-Oxford subcortical atlas; all analyses were corrected for multiple comparisons. RESULTS: After controlling for depression scores and correcting for multiple comparisons, the FT group showed increased activation in the right cerebellum compared to ET during the motor task; and increased activation in the paracingulate gyrus and left Heschl's gyrus compared with HC with decreased activation in the right precentral gyrus compared with ET during the basic-emotion task. No significant differences were found after adjusting for multiple comparisons during the intense-emotion task but increase in connectivity between the left amygdala and left middle frontal gyrus survived corrections in the FT subjects during this task, compared to HC. CONCLUSIONS: In response to emotional stimuli, functional tremor is associated with alterations in activation and functional connectivity in networks involved in emotion processing and theory of mind. These findings may be relevant to the pathophysiology of functional movement disorders.

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