Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation

L. S.Merritt Millman; Eleanor Short; Emily Ward; Biba Stanton; Abigail Bradley-Westguard; Laura H. Goldstein; Joel S. Winston; Mitul A. Mehta; Timothy R. Nicholson; Antje A.T.S. Reinders; Anthony S. David; Mark J. Edwards; Trudie Chalder; Matthew Hotopf; Susannah Pick

doi:10.1176/appi.neuropsych.20230103

Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation

L. S.Merritt Millman, Eleanor Short, Emily Ward, Biba Stanton, Abigail Bradley-Westguard, Laura H. Goldstein, Joel S. Winston, Mitul A. Mehta, Timothy R. Nicholson, Antje A.T.S. Reinders, Anthony S. David, Mark J. Edwards, Trudie Chalder, Matthew Hotopf, Susannah Pick

King's College London

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

OBJECTIVE: This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning). METHODS: Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning. RESULTS: Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events. CONCLUSIONS: Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.

Original language	English
Pages (from-to)	350-357
Number of pages	8
Journal	The Journal of neuropsychiatry and clinical neurosciences
Volume	36
Issue number	4
DOIs	https://doi.org/10.1176/appi.neuropsych.20230103
Publication status	Published - 1 Sept 2024

Keywords

Conversion Disorder
Dissociative Seizures
Etiology
Functional Neurological Disorder
Psychogenic Nonepileptic Seizure
Symptom Triggers

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10.1176/appi.neuropsych.20230103

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Millman, L. S. M., Short, E., Ward, E., Stanton, B., Bradley-Westguard, A., Goldstein, L. H., Winston, J. S., Mehta, M. A., Nicholson, T. R., Reinders, A. A. T. S., David, A. S., Edwards, M. J., Chalder, T., Hotopf, M., & Pick, S. (2024). Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation. The Journal of neuropsychiatry and clinical neurosciences, 36(4), 350-357. https://doi.org/10.1176/appi.neuropsych.20230103

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title = "Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation",

abstract = "OBJECTIVE: This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning). METHODS: Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning. RESULTS: Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events. CONCLUSIONS: Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.",

keywords = "Conversion Disorder, Dissociative Seizures, Etiology, Functional Neurological Disorder, Psychogenic Nonepileptic Seizure, Symptom Triggers",

author = "Millman, {L. S.Merritt} and Eleanor Short and Emily Ward and Biba Stanton and Abigail Bradley-Westguard and Goldstein, {Laura H.} and Winston, {Joel S.} and Mehta, {Mitul A.} and Nicholson, {Timothy R.} and Reinders, {Antje A.T.S.} and David, {Anthony S.} and Edwards, {Mark J.} and Trudie Chalder and Matthew Hotopf and Susannah Pick",

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doi = "10.1176/appi.neuropsych.20230103",

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Millman, LSM, Short, E, Ward, E, Stanton, B, Bradley-Westguard, A, Goldstein, LH , Winston, JS , Mehta, MA , Nicholson, TR , Reinders, AATS , David, AS , Edwards, MJ , Chalder, T , Hotopf, M & Pick, S 2024, 'Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation', The Journal of neuropsychiatry and clinical neurosciences, vol. 36, no. 4, pp. 350-357. https://doi.org/10.1176/appi.neuropsych.20230103

TY - JOUR

T1 - Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures

T2 - A Pilot Investigation

AU - Millman, L. S.Merritt

AU - Short, Eleanor

AU - Ward, Emily

AU - Stanton, Biba

AU - Bradley-Westguard, Abigail

AU - Goldstein, Laura H.

AU - Winston, Joel S.

AU - Mehta, Mitul A.

AU - Nicholson, Timothy R.

AU - Reinders, Antje A.T.S.

AU - David, Anthony S.

AU - Edwards, Mark J.

AU - Chalder, Trudie

AU - Hotopf, Matthew

AU - Pick, Susannah

PY - 2024/9/1

Y1 - 2024/9/1

N2 - OBJECTIVE: This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning). METHODS: Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning. RESULTS: Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events. CONCLUSIONS: Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.

AB - OBJECTIVE: This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning). METHODS: Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning. RESULTS: Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events. CONCLUSIONS: Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.

KW - Conversion Disorder

KW - Dissociative Seizures

KW - Etiology

KW - Functional Neurological Disorder

KW - Psychogenic Nonepileptic Seizure

KW - Symptom Triggers

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U2 - 10.1176/appi.neuropsych.20230103

DO - 10.1176/appi.neuropsych.20230103

M3 - Article

C2 - 38481167

AN - SCOPUS:85196837004

SN - 0895-0172

VL - 36

SP - 350

EP - 357

JO - The Journal of neuropsychiatry and clinical neurosciences

JF - The Journal of neuropsychiatry and clinical neurosciences

IS - 4

ER -

Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation

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Keywords

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