Brain Activity in People With Functional Movement Disorders
Condition: Functional Movement Disorders
MeSH terms: Movement Disorders; Conversion Disorder; Hysteria
Study type: Observational

Summary: 
      This study will use functional MRI (fMRI, a technique that shows what areas of the brain are
      active when performing different mental tasks), to examine how the brain in people with
      functional movement disorders (FMD) may differ from that in people without FMDs. People with
      FMD have movement symptoms they feel they cannot control and that are not due to a known
      medical disorder. Previous studies looking at the brain activity of FMD patients have found
      areas in the frontal lobe of the brain that appeared overactive. These overactive areas may
      make it difficult to perform complex mental tasks. Studying the brain during performance of
      these tasks may enhance knowledge about FMD.

      Patients 18 years of age or older with an FMD and healthy normal volunteers may be eligible
      for this study. Participants have two visits to the NIH Clinical Center for the following
      procedures:

      First visit (screening):

        -  Medical history and neurological examination.

        -  Urine drug screen for illicit drugs.

        -  Psychological testing, including an interview and questionnaires.

      Second visit:

        -  Brain MRI (if one has not been done at NIH within the past 12 months): MRI uses a
           magnetic field and radio waves to produce images of body tissues and organs. The subject
           lies on a table that can slide in and out of the scanner (a narrow cylinder), wearing
           earplugs to muffle loud noises that occur during the scanning process. The procedure
           lasts about 2 hours, during which time the patient is asked to lie still for up to 30
           minutes at a time.

        -  Brain fMRI: While in the MRI scanner, subjects read questions and answer them yes or no
           by pushing buttons. They are asked to answer questions about their health, their
           movement symptoms and unrelated topics (like personal preferences and current events).
           The questions vary in difficulty. Sometimes subjects are instructed to answer correctly;
           other times they are asked to answer incorrectly. A strap is placed around the subject's
           chest and two wires are taped to the fingers to monitor heart rate, breathing rate and
           sweat response during the scan. The scan takes about 2 hours.
    

Detailed description: 
      OBJECTIVE

      The purpose of this study is to utilize functional MRI (fMRI) to identify structural brain
      regions and activation patterns involved in deception in order to determine whether illness
      deception can be differentiated from involuntary conversion disorders. We intend to compare
      the brain activations of functional movement disorder (FMD) patients against those of healthy
      volunteers in order to determine whether various aspects of the disorder are under volitional
      control, suggesting a component of illness deception, or are involuntary as hypothesized in
      conversion disorders.

      STUDY POPULATION

      We intend to use up to 35 right-hand dominant adult healthy volunteers (the first five
      subjects will be used to develop this method) and 30 functional movement disorder patients.

      DESIGN

      Using a slow event-related design, we will scan subjects using a 3T fMRI scanner while they
      are visually presented with survey-based stimuli which require a yes/no response using a key
      press. Information used to create the stimuli will be pseudo-randomly derived from one of two
      databases. The first database will be created from the information garnered in the survey
      subjects will complete during their screening visit (i.e. subjects eye color or height). The
      second database will be a collection of non-specific information (i.e. current year, season,
      etc.) that intentionally does not apply to the subjects. For each question displayed,
      subjects will receive a visual instruction to respond either truthfully or deceptively.
      Correct answers to responses will be evaluated based upon the survey the subjects completed.
      In addition to the BOLD data collected, we plan to calculate reaction times and acquire
      autonomic data in order to identify possible correlates with the brain responses.

      OUTCOME MEASURES

      The primary outcome measure is the BOLD-fMRI data collected from subjects while answering
      yes-no type questions. Secondary outcome measures will include reaction times and autonomic
      data that will be collected simultaneously with the fMRI data. Standard univariate general
      linear model analysis will be performed on the fMRI data as well as the use of multivariate
      methods, including support vector machine learning. Subgroup analyses will be conducted to
      characterize the correlation between reaction times, autonomic data, and fMRI results as well
      as potential differences in activation patterns for subject-referenced questions and
      questions which are unrelated to the subject.
    

Keywords: Psychogenic Movement Disorders; Volition; fMRI; Functional MRI; Functional Movement Disorder; Healthy Volunteer; HV