Understanding foreign accent syndrome

ObjectiveForeign accent syndrome (FAS) is widely understood as an unusual consequence of structural neurological damage, but may sometimes represent a functional neurological disorder. This observational study aimed to assess the prevalence and utility of positive features of functional FAS in a large group of individuals reporting FAS.MethodsParticipants self-reporting FAS recruited from informal unmoderated online support forums and via professional networks completed an online survey. Speech samples were analysed in a subgroup.ResultsForty-nine respondents (24 UK, 23 North America, 2 Australia) reported FAS of mean duration 3 years (range 2 months to 18 years). Common triggers were: migraine/severe headache (15), stroke (12), surgery or injury to mouth or face (6) and seizure (5, including 3 non-epileptic). High levels of comorbidity included migraine (33), irritable bowel syndrome (17), functional neurological disorder (12) and chronic pain (12). Five reported structural lesions on imaging. Author consensus on aetiology divided into, ‘probably functional (n=35.71%), ‘possibly structural’ (n=4.8%) and ‘probably structural’ (n=10.20%), but positive features of functional FAS were present in all groups. Blinded analysis of speech recordings supplied by 13 respondents correctly categorised 11 (85%) on the basis of probable aetiology (functional vs structural) in agreement with case history assignment.ConclusionsThis largest case series to date details the experience of individuals with self-reported FAS. Although conclusions are limited by the recruitment methods, high levels of functional disorder comorbidity, symptom variability and additional linguistic and behavioural features suggest that chronic FAS may in some cases represent a functional neurological disorder, even when a structural lesion is present.

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20 International online survey of 1162 individuals with functional neurological disorder: demographics, symptom comorbidities, self- management strategies, and illness beliefs

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-bnpa.37 ◽

2020 ◽

Vol 91 (8) ◽

pp. e16.1-e16

Author(s):

Matthew Butler ◽

Mathieu Seynaeve ◽

Susannah Pick ◽

James Rucker ◽

Timothy Nicholson

Keyword(s):

Neurological Disorder ◽

Online Survey ◽

Management Strategies ◽

Self Management ◽

Patient Questionnaire ◽

Symptom Duration ◽

Illness Beliefs ◽

Alternative Treatments ◽

Wide Range ◽

Functional Neurological Disorder

AimsFunctional neurological disorder (FND) is common and often severe. It is poorly understood, and there have been no international large-scale studies of self- management and illness beliefs in FND. We created a patient questionnaire to assess FND demographics, symptom comorbidity, self-management strategies (particularly in relation to prohibited substances), views on novel treatments, and illness beliefs.MethodsThe questionnaire was shared open access over a three-week period.Participants were recruited internationally through social media and patient groups. RESULTS: In total, 1162 respondents from 16 countries took the survey. Of these, 98% reported a formal diagnosis of FND from a consultant neurologist or other suitably trained clinician. Females constituted 86% of respondents, with an average age of 41.7 years (SD=12.50). Mean symptom duration was 7.69 years (SD=9.37) and average time from diagnosis was 2.24 years (SD=3.35), indicating a diagnostic lag of over 5 years. Symptom comorbidity was very high, with respondents reporting current: seizures (50%), gait disturbance (76%), loss of balance (77%), tremors (61%), muscle jerks/spasms (65%), altered sensations (79%), speech difficulties (65%), memory problems (80%), fatigue (93%), and headache (70%). Current psychiatric comorbidities – depression (43%), anxiety (51%), panic (20%), and PTSD (22%) - were also common. Illness beliefs varied, with respondents agreeing most strongly that FND is a combination of physical and stress/trauma-related factors. Respondents rated FND as having a severe effect on their life, with little control felt over their symptoms. Respondents had received a wide range of medical interventions, and many had tried alternative treatments. Prohibited substances such as cannabis, ketamine, and psychedelics had been used by 15% of respondents, with the majority experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents reported that they would be willing to try medically supervised psychedelic therapy if it was found to be safe and effective.ConclusionsThis large international online survey of FND patients indicated a striking co-occurrence of multiple symptoms. As expected, respondents reported that FND severely impacted on their lives, and many had lived with symptoms, which are not well managed by current medical therapies, for years. There was interest in novel putative treatments, such as medically supervised psychedelic therapies, which indicates a strong need to investigate alternative treatments for this poorly served patient group.

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EMDR to Treat Functional Neurological Disorder: A Review

Journal of EMDR Practice and Research ◽

10.1891/1933-3196.12.3.118 ◽

2018 ◽

Vol 12 (3) ◽

pp. 118-132 ◽

Cited By ~ 3

Author(s):

Sarah R. Cope ◽

Lucy Mountford ◽

Jared G. Smith ◽

Niruj Agrawal

Keyword(s):

Neurological Disorder ◽

Web Of Science ◽

Case Series ◽

Cochrane Library ◽

Functional Movement ◽

Treatment Pathway ◽

Prisma Statement ◽

Meta Analyses ◽

Emdr Therapy ◽

Functional Neurological Disorder

Eye movement desensitization and reprocessing (EMDR) therapy is an established treatment for posttraumatic stress disorder (PTSD), but there is increasing evidence for its use beyond PTSD. EMDR can be effective at treating distressing memories not associated with PTSD, as well as somatic symptoms (like chronic pain), and as such could potentially be used as a treatment for patients with functional neurological disorder (FND). Searches were conducted for published peer-reviewed articles on the use of EMDR for FND. The databases selected and searched were Medline, Embase, Cochrane Library, CINAHL Plus, Web of Science, PsychINFO, PubMed, and Francine Shapiro Library. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three relevant articles were found. The studies included are one case series and two case studies. Of the five participants included in the studies, four experienced functional non-epileptic attacks; and one experienced functional movement disorder. Four out of the five patients were successfully treated with EMDR. EMDR is potentially a useful treatment of FND, but further research, including controlled trials, is required. The authors propose that EMDR could be useful in treating patients with FND and comorbid PTSD, as well as patients without comorbid PTSD. We discuss the clinical implications and propose how EMDR could fit into the FND treatment pathway.

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International online survey of 1048 individuals with functional neurological disorder

European Journal of Neurology ◽

10.1111/ene.15018 ◽

2021 ◽

Author(s):

Matthew Butler ◽

Oliver Shipston‐Sharman ◽

Mathieu Seynaeve ◽

Jianan Bao ◽

Susannah Pick ◽

...

Keyword(s):

Neurological Disorder ◽

Online Survey ◽

Functional Neurological Disorder

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Psychogenic non-epileptic seizures among patients with functional neurological disorder: A case series from a Tanzanian referral hospital and literature review

Epilepsia Open ◽

10.1002/epi4.12096 ◽

2018 ◽

Vol 3 (1) ◽

pp. 66-72 ◽

Cited By ~ 5

Author(s):

Marieke C. J. Dekker ◽

Sarah J. Urasa ◽

Marissa Kellogg ◽

William P. Howlett

Keyword(s):

Literature Review ◽

Neurological Disorder ◽

Case Series ◽

Epileptic Seizures ◽

Referral Hospital ◽

Functional Neurological Disorder

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Foreign accent syndrome: a case report with multiple accents

10.26226/morressier.5b68175db56e9b005965c4fb ◽

2018 ◽

Author(s):

Sermin Karaman

Keyword(s):

Case Report ◽

Foreign Accent ◽

Foreign Accent Syndrome

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Faculty Opinions recommendation of Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735118803.793558383 ◽

2019 ◽

Author(s):

Jon Stone

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Neurological Disorder ◽

Case Control Study ◽

Case Control ◽

Control Study ◽

Functional Neurological Disorder

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Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

Palliative Medicine ◽

10.1177/02692163211019885 ◽

2021 ◽

pp. 026921632110198

Author(s):

Catriona R Mayland ◽

Rosemary Hughes ◽

Steven Lane ◽

Tamsin McGlinchey ◽

Warren Donnellan ◽

...

Keyword(s):

Public Health ◽

Family Support ◽

Online Survey ◽

Free Text ◽

Professional Networks ◽

Dying Patients ◽

The Face ◽

Individualised Care ◽

The Impact ◽

Informative Communication

Background: COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. Aim: To explore bereaved relatives’ experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. Design: A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June–September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Participants: Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. Results: Respondents ( n = 278, mean 53.4 years) tended to be female ( n = 216, 78%); over half were ‘son/daughter’ (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their ‘usual place of care’ ( n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of ‘not knowing’; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. Conclusion: Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.

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Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case–control study – CORRIGENDUM

Psychological Medicine ◽

10.1017/s0033291721002658 ◽

2021 ◽

pp. 1-1

Author(s):

N. O'Connell ◽

T. R. Nicholson ◽

S. Wessely ◽

A. S. David

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Neurological Disorder ◽

Case Control Study ◽

Case Control ◽

Control Study ◽

Functional Neurological Disorder

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The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study

Australasian Psychiatry ◽

10.1177/10398562211009247 ◽

2021 ◽

pp. 103985622110092

Author(s):

Shimaa K. Morsy ◽

Daniela Huepe-Artigas ◽

Ahmed M. Kamal ◽

Maha Ali Hassan ◽

Nashaat Adel Abdel-Fadeel ◽

...

Keyword(s):

Neurological Disorder ◽

Conversion Disorder ◽

Cross Sectional Study ◽

Cross Sectional ◽

Trauma Symptom ◽

Functional Symptoms ◽

Neurology Clinic ◽

The Relationship ◽

Trauma Type ◽

Functional Neurological Disorder

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. Methods: We retrospectively reviewed the medical records of patients attending Australia’s first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms ( p = .036), for example, while expressive speech problems more commonly followed relationship difficulties ( p = .021). Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

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