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Cortical Inhibitory Imbalance in Functional Paralysis.

Alberto Benussi1, Enrico Premi2, Valentina Cantoni1

  • 1Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Frontiers in Human Neuroscience
|May 28, 2020
PubMed
Summary

Functional neurological disorders show increased motor cortex excitability and intracortical inhibition in affected limbs. This suggests a central nervous system abnormality underlies flaccid functional weakness symptoms.

Keywords:
functional neurological disordersfunctional paralysismotor thresholdshort interval intracortical inhibitiontranscranial magnetic stimulation

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Area of Science:

  • Neuroscience
  • Neurology
  • Clinical Neurophysiology

Background:

  • Functional neurological disorders present neurological symptoms without identifiable pathology.
  • The pathophysiology of these disorders remains poorly understood.

Purpose of the Study:

  • To investigate motor cortex excitability and the balance of intracortical inhibitory and excitatory circuits in patients with flaccid functional weakness.
  • To identify potential central nervous system abnormalities contributing to functional weakness.

Main Methods:

  • Utilized transcranial magnetic stimulation (TMS) protocols in 21 patients with acute flaccid functional weakness.
  • Analyzed resting motor thresholds (RMT), short interval intracortical inhibition (SICI), and intracortical facilitation (ICF) in affected versus unaffected motor cortices.

Main Results:

  • Observed a significant increase in RMT and SICI in the affected motor cortex compared to the unaffected side (p < 0.001).
  • No significant difference in ICF was found between the affected and unaffected motor cortices.

Conclusions:

  • Findings suggest a specific central nervous system abnormality in functional weakness.
  • Increased RMT and SICI point to altered motor cortex excitability and inhibition as potential pathophysiological mechanisms.