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L'hypothèse du stress dans le Trouble de Conversion

English title The stress hypothesis in Conversion Disorder
Applicant Aybek Rusca Selma
Number 147997
Funding scheme Ambizione
Research institution Unité de Neuroradiologie Service de Radiologie Hôpital Cantonal - HUG
Institution of higher education University of Geneva - GE
Main discipline Neurology, Psychiatry
Start/End 01.09.2014 - 30.06.2018
Approved amount 592'800.00
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Keywords (6)

childhood adversity; structural MRI; amygdala; Conversion disorder; functional MRI; stress

Lay Summary (French)

Lead
Le trouble de Conversion (TC) - connu historiquement sous le terme d'Hystérie - est une maladie neuropsychiatrique actuellement toujours bien présente et fréquente, qui reste particulièrement déconcertante et présente plusieurs défis scientifiques. Les patients présentent des symptômes allant de la brusque perte de connaissance (mimant de l’épilepsie) à des paralysies des membres (mimant des attaques cérébrale) pour lesquels aucun maladie reconnue n’est trouvée - même après des examens médicaux approfondis.Ces troubles ont alors, depuis l’époque de Sigmund Freud il y a plus d’un siècle, été attribués a des facteurs psychologiques et classés dans les maladies dites « psychosomatiques ». Le contexte actuel médical et scientifique disposant de moyens modernes et de techniques d’explorations du fonctionnement cérébral permet d’aborder cette question sous un nouvel angle et notamment de mieux explorer le rôle de ces potentiels stresseurs psychologiques dans cette maladie
Lay summary

Le projet combinera des techniques cliniques, biologiques, génétiques et de neuroimagerie afin d’explorer le rôle du stress dans le TC.

En particulier, une étude par imagerie par résonance magnétique fonctionnelle (fMRI) explorera les régions cérébrales activées lors d’une émotion stressante chez des patients souffrant de TC en comparaison à des sujets contrôles. De plus, seront évalués dans les deux groupes, les hormones de stress (cortisol) et les profils génétiques concernant la régulation émotionnelle (gènes impliqués dans l’axe du stress hypothalamo-pituitaire). Les données cliniques concernant les facteurs de stress (traumatisme dans l’enfance, événements de vie difficiles récents) seront systématiquement évaluées. Toutes ces données seront mis en lien avec les symptômes physiques des patients.

Dans son ensemble ce projet permettra de mieux comprendre les mécanismes cérébraux impliqués dans cette maladie. 

Direct link to Lay Summary Last update: 02.09.2014

Responsible applicant and co-applicants

Employees

Publications

Publication
Biological and perceived stress in motor functional neurological disorders.
Apazoglou K Mazzola V Wegrzyk J Polara GF Aybek S (2017), Biological and perceived stress in motor functional neurological disorders., in Psychoneuroendocrinology, 85, 142-150.
Increased methylation of the oxytocin receptor gene in motor functional neurological disorder: a preliminary study.
Apazoglou K Adouan W Aubry JM Dayer A Aybek S. (2017), Increased methylation of the oxytocin receptor gene in motor functional neurological disorder: a preliminary study., in J Neurol Neurosurg Psychiatry, online.
Functional movement disorders
Barbey A Aybek S (2017), Functional movement disorders, in Current Opinion in Neurology, 4, 427-434.
Testing head rotation and flexion is useful in Functional Limb Weakness
Horn D Galli S Berney A Vingerhoets F Aybek S (2017), Testing head rotation and flexion is useful in Functional Limb Weakness, in Movement disorders Clinical Practice, online.
Aversive stimuli exacerbate defensive motor behaviour in motor conversion disorder.
Blakemore RL Sinanaj I Galli S Aybek S Vuilleumier P. (2016), Aversive stimuli exacerbate defensive motor behaviour in motor conversion disorder., in Neuropsychologia, 93(A), 229-241.
Functional limb weakness and paralysis.
Stone J Aybek S (2016), Functional limb weakness and paralysis., Elsevier, London.
Imaging studies of functional neurological disorders / Hanbook of Clinical Neurology
Aybek S Vuilleumier P. (2016), Imaging studies of functional neurological disorders / Hanbook of Clinical Neurology, Elsevier, London.
Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.
Hubschmid M Aybek S Maccaferri GE Chocron O Gholamrezaee MM Rossetti AO Vingerhoets F Berney (2015), Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks., in Gen Hosp Psychiatry, 37(5), 448-455.
Self-awareness in Conversion Disorder/The Neurology of Consciousness
Aybek S Vuilleumier P (2015), Self-awareness in Conversion Disorder/The Neurology of Consciousness, Elsevier, London.
Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.
Daum Gheorghita Spatola Stojanova Medlin Vingerhoets Berney Gholam Aybek (2015), Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study., in J Neurol Neurosurg Psychiatry, 86(4), 425-430.
Functional Paralysis/ Brain Mapping : An Encyclopedic Reference
Aybek S (2015), Functional Paralysis/ Brain Mapping : An Encyclopedic Reference, Elsevier, London.
Troubles dissociatifs (de conversion): les intuitions freudiennes revisitées par la neuroimagerie.
A. Berney S Aybek (2015), Troubles dissociatifs (de conversion): les intuitions freudiennes revisitées par la neuroimagerie., in Psychothérapies, 35, 53-58.
Les mouvements anormaux fonctionnels (anciennement psychogènes)
S. Galli P. Pollak S. Aybek (2014), Les mouvements anormaux fonctionnels (anciennement psychogènes), in CMA Mouvements Neurosciences cliniques , 2014, 5-14.
Validity of the clinical examination in the diagnosis of Functional Neurological Symptoms (Conversion Disorder)
D. Pothalil S. Aybek (2014), Validity of the clinical examination in the diagnosis of Functional Neurological Symptoms (Conversion Disorder), in Schweizerzeitschrift fur Neurologie & Psychiatrie, 20-25.
Resting State fMRI as a potential biomarker for Functional neurological disorders
Wegzyrk j Kebets V Ricchiardi J Van de Ville D Aybek S, Resting State fMRI as a potential biomarker for Functional neurological disorders, in Neuroimage Clinical, in press.

Collaboration

Group / person Country
Types of collaboration
P.Vuilleumier/ Brain and Behaviour Laboratory - Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
T.Moulin/Université de Franche-Comté, Besançon France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
D.VandeVille/Medical Image Processing Lab, UNIGE, EPFL Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
A.Dayer/Dpt of Psychiatry and Neuroscience, Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
K.Aminian/Laboratory of Movement Analysis and Measurments (LMAM) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Exchange of personnel
F.Vingerhoets /Centre Hospitalier Universitaire Vaudois - Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Annual Meeting of the Swiss Neurological Society Poster Testing Head Rotation and Flexion is useful in Functional limb weakness 28.09.2017 Interlaken, Switzerland Aybek Rusca Selma;
3rd International Conference on Functional Neurological Disorders Talk given at a conference Eraly Life experiences and Life events in FND 06.09.2017 Edimbourg, Great Britain and Northern Ireland Aybek Rusca Selma;
International congress of Parkinson's disease and Movement disorders Poster Neurological examination of motor FND: an evidence-based review towards development of consensus guidelines from the Committe on Rsearch of the ANPA 04.06.2017 Vancouver, Canada Aybek Rusca Selma;
26th European Stroke Conference Talk given at a conference Functional Neurological disorders 25.05.2017 Berlin, Germany Aybek Rusca Selma;
Congrès des 30 ans du Club des Mouvements Anormaux Talk given at a conference Mouvements anormaux psychogènes: De Blanche Wittmann à l'imagerie 24.05.2017 Paris, France Aybek Rusca Selma;
69th Annual meeting of the American Academy of Neurology (AAN) 2017 Poster Objective biomarkers of Stress in Motor Functional Neurologial (Conversion) Disorder 22.04.2017 Boston, United States of America Apazoglou Kalliopi;
Annual meeting of the American Neuropsychiatric Associaton (ANPA) 2017 Poster Dysregulation of the Stress system in Conversion Disorder 08.03.2017 Atlanta, United States of America Apazoglou Kalliopi;
Annual meeting of the American Neuropsychiatric Associaton (ANPA) 2017 Talk given at a conference Functional Movement disorders and Functional Weakness: Towards Guidelines Development 08.03.2017 Atlanta, United States of America Aybek Rusca Selma;
UK- FNS Researcg Group Talk given at a conference Can resting state fMRI be used as a diagnositc tool in Functional Neurological Disorders? 08.09.2016 London, Great Britain and Northern Ireland Aybek Rusca Selma;
Human Brain Mapping 2016 Poster Aberrant resting state functional connectivity in Functional Neurological Disorders 26.06.2016 Geneva, Switzerland Aybek Rusca Selma;
25th European Stroke Conference Talk given at a conference Functional Stroke Mimics 13.04.2016 Venice, Italy Aybek Rusca Selma;
Annual meeting of the British Neuropsychiatric Association (BNPA) Talk given at a conference THE ROLE OF STRESS, CHILDHOOD TRAUMA AND PERSONALITY IN THE DEVELOPMENT OF FUNCTIONAL NEUROLOGICAL SYMPTOMS 04.02.2015 Londres, Great Britain and Northern Ireland Aybek Rusca Selma;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Informations en français pour les patients http://www.neurosymptoms.org/ International 2014

Awards

Title Year
Prix de la Faculté de Médecine de Lausanne pour la thèse de Dimitri Horn 2018
Best Paper award, from the Swiss Movement Disorder Society 2014

Associated projects

Number Title Start Funding scheme
176985 Sense of Agency and Stress in Functional Neurological Disorders 01.11.2018 SNSF Professorships

Abstract

Conversion Disorder (CD) - formerly called Hysteria - is a disabling and frequent neuropsychiatric disease. Patients present with diverse neurological symptoms such as paralysis, involuntary movements (tremor) gait disorders or non-epileptic convulsions but the symptoms are ‘medically unexplained’, as no neurological disease is found. Since the end of the 19th Century at the time of Charcot and Freud, it’s been hypothesized that psychiatric stressors played a causal role but little research has been conducted in that field. With recent developments in neuroscience rendering research techniques available, we are now in a favourable position to study the underlying aetiological mechanisms of Conversion Disorder. Moreover, clinical care of CD patients is difficult because establishing the diagnosis can still be problematic - and could benefit from objective markers - and because no reliable prognostic factors can be used to guide treatment. This project proposes to 1) explore the stress hypothesis in CD, as these patients are known to suffer from childhood adversities as well as negative triggering life events prior to their symptoms, 2) identify objective markers of the disease (both clinical and through neuroimaging) and 3) identify prognostic factors. The method will combine clinical, biological, genetic and neuroimaging techniques. A functional magnetic resonance imaging (fMRI) paradigm will explore affective response in patients compared to controls and test whether neural correlates of the freeze response (periaqueducal grey area) are involved. Stress hormones (cortisol) will be tested and genetic profiles, focussing on candidates genes implicated in the stress axes (hypothalamo-pituitary axis) and in childhood adversities will be looked for. Objective movements measurement and advanced structural MRI will be used to look for biomarkers of the disease. A longitudinal follow-up of patients over 9 months will allow defining prognostic factors. Patients suffering from CD will be compared to a group of healthy volunteers as well as to a group of subjects suffering from similar symptoms but due to a known organic neurological condition.Overall, this project will bring light to the etiological mechanisms of the disease and will identify biomarkers and prognostic factors, all essential in order to improve medical care of CD patients in the future.
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