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Sense of Agency and Stress in Functional Neurological Disorders

English title Sense of Agency and Stress in Functional Neurological Disorders
Applicant Aybek Rusca Selma
Number 176985
Funding scheme SNSF Professorships
Research institution Universitätsklinik für Neurologie Inselspital Universität Bern
Institution of higher education University of Berne - BE
Main discipline Neurology, Psychiatry
Start/End 01.11.2018 - 31.10.2022
Approved amount 1'583'722.00
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All Disciplines (2)

Discipline
Neurology, Psychiatry
Neurophysiology and Brain Research

Keywords (7)

Conversion Disorder; Agency; functional MRI; Mindfulness Meditation; Transcranial magnetic stimulation; Functional Neurological disorder; Stress

Lay Summary (French)

Lead
Ce projet propose de mieux comprendre le mécanisme responsable d’une maladie neurologique fréquente mais mal connue du grand publique et négligée par la recherche scientifique : les troubles neurologiques fonctionnels.
Lay summary

Contenu et objectif du travail de recherche

Ces troubles se manifestent par des : 1. pertes de force (bras, jambe, visage), 2. Mouvements incontrôlables (tremblement, crampes, secousses) 3. Malaises avec parfois perte de connaissance. Un point commun à ces troubles et que les patients perdent le contrôle volontaire de leur corps (ou le sens d’être les agents de leurs actions: sens de l’agencement)

Le sens de l’agencement est lié au bon fonctionnement d’une région du cerveau en particulier (la jonction temporo-pariétale droite : JTP).

Ce projet va étudier s’il est possible de modifier le fonctionnement de la JTP au moyen de la neuromodulation (application d’un champ électrique sur le crâne).

De plus ce projet va étudier si le stress influence cette région et si on peut améliorer les symptômes par un programme de réduction du stress (méditation sur 8 semaines).

 

Contexte scientifique et social du projet de recherche

Ce projet relève de la recherche fondamentale puisqu’il va étudier les mécanismes cérébraux responsable de cette maladie mais aussi de la recherche clinique car il va tester l’effet d’une méthode (réduction du stress) sur les symptômes. Il fera donc avancer les connaissances dans le but d’amener un meilleur soin aux patients à l’avenir. 

Mots-clés

Trouble neurologique fonctionnel – Neurologie – Psychiatrie – Stress – IRM fonctionnelle – Neuromodulation – Biomarqueurs

Direct link to Lay Summary Last update: 03.10.2018

Responsible applicant and co-applicants

Employees

Associated projects

Number Title Start Funding scheme
147997 L'hypothèse du stress dans le Trouble de Conversion 01.09.2014 Ambizione

Abstract

Background and rationale: Functional neurological disorder (FND) (formerly Hysteria/Conversion disorder) is a disabling and frequent disorder. This field of medicine suffers from a lack of research and no targeted treatment option is available. A better understanding of the mechanisms is needed. Evidence for abnormal sensori-motor processing (agency) and stress dysregulation exists. The link between the two has never been studied.Overall objective: Explore the links betweens abnormal agency and stress in FND.Specific Aims: 1) study the neural correlates of agency with neuroimaging (fMRI)2) study their correlation with biological stress parameters (cortisol and amylase)3) study the effect of transcranial magnetic stimulation (rTMS) on agency by targeting a key node of the network; the right temporo-parietal junction (rTPJ)4) study the effect of mindfulness-based stress reduction (MBSR) therapy on agency, stress and clinical outcome.Methods: Two main prospective studies over the 4 years will address these 4 aims. STUDY A will include 60 FND patients and 40 healthy controls in an fMRI agency task. Subjects will be randomized in a single-blind design to receive real or sham TMS on the rTPJ before repeating the same fMRI agency task. Cortisol and amylase will be analysed in saliva samples. STUDY B will include 80 FND patients in a randomized trial to receive either 8-week MBSR or treatment as usual. The agency task, stress and clinical measures will be collected before and after the intervention. A 6 months follow-up will look at clinical outcome. Expected results: We hypothesize that 1) the agency network is abnormal in FND and that TMS can change this network, when applied over the rTPJ, 2) the agency performance and related brain activations are correlated with stress parameters (the higher the stress, the poorer the agency) 3) MBSR reduces stress and improves clinical outcome and this is mediated by improvement in agency.Impact for the field: This project will contribute to the understanding of FND by bridging two current lines of research investigating HOW the symptoms are produced (agency) and WHY (stress risk factors). It will test two mechanisms by which clinical outcome could be improved; neuromodulation and stress reduction therapy, which will open new lines of research on targeted treatments.
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