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Misdirected attentional focus in functional tremor.

Anne-Catherine M L Huys1, Patrick Haggard2, Kailash P Bhatia1

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In functional neurological disorder, attention to visual feedback worsens movement. Distraction, however, improves motor performance in functional tremor patients, suggesting altered attentional focus contributes to the condition.

Keywords:
attentionfunctional movement disorderfunctional neurological disordertreatmentvisual feedback

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Area of Science:

  • Neurology
  • Movement Disorders
  • Cognitive Neuroscience

Background:

  • Functional neurological disorder (FND) symptoms often correlate with attention levels.
  • Attentional phenomena are implicated in FND, but their specific role in functional tremor remains unclear.
  • Understanding attentional focus in functional tremor is crucial for developing effective interventions.

Purpose of the Study:

  • To investigate if attentional focus is misdirected in functional tremor.
  • To determine if this misdirection is detrimental or compensatory.
  • To compare attentional strategies in functional tremor, organic tremor, and healthy controls.

Main Methods:

  • Compared attentional focus during reaching movements in 17-28 participants with functional tremor, organic tremor, and healthy controls.
  • Assessed motor performance under varying attentional conditions (visual feedback, no feedback, speed, accuracy).
  • Measured trajectory length and movement duration as indicators of motor performance.

Main Results:

  • Functional tremor patients disproportionately focused on visual feedback, unlike controls.
  • Motor performance deteriorated across all groups with attention to visual feedback, accuracy, or slow movements.
  • Motor performance improved in functional tremor patients when movement was unimportant or performed quickly, and in all groups without visual feedback.

Conclusions:

  • Altered attentional allocation, specifically excessive focus on visual feedback, is characteristic of functional tremor.
  • This altered focus may contribute to tremor by interfering with automatic movement processes.
  • Distraction can improve motor performance in functional tremor, highlighting a potential therapeutic avenue.