Page 97 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Functional neurological movement disorders

memory of unpleasant events and functional symptoms. 13,16 We conducted a special kind of treatment
However, even in apparently resting conditions, fMR may consisting of a combined approach of physiotherapy
reveal right temporoparietal hypoactivity. Furthermore, in warm water swimming pools and training on the
fMR shows decreased functional connectivity between floor, and psychodynamic psychotherapy (including
the right temporoparietal junction and right sensorimotor psychoeducation) in 42 consecutive patients. This
32
cortex, bilateral SMA, vermis, and right insula indicating treatment was carried out as inpatient treatment for several
impaired self-agency. 17,18 weeks and in some cases, patients received psychotherapy
Very few studies have investigated the brain activation as an outpatient regime.
patterns following successful treatment. Some did find The patients were examined by neurologists to disclose
normalization of changes primarily prefrontally, 19,20 other possible neurological and medical disorders and
whereas others found normalization of brain activity in evaluate paraclinical findings, which can be quite extensive
other important brain regions controlling motor function, for patients who had previously consulted multiple doctors.
along with improvement of symptoms. 21,22 There may be The diagnosis obtained was not the result of exclusions
several explanations for changes in brain activation and but was based on positive criteria, which are explained
connectivity in patients with FMD. Mental overloads to the patient as part of general clinical information
increase the activity in the limbic system, which in turn and psychoeducation. The patients were informed that
may lead to inhibition of normal activation of prefrontal symptoms are considered a result of the accumulation of
areas, thereby interfering with the planning and execution different psychological burdens that disturb important
of motor function. The inhibition may, however, take brain motor programs and that we previously had
11
place at lower levels in certain brain parts such as the seen similar cases and most often observed substantial
basal ganglia, cerebellum, thalamus, or hippocampus. improvement following treatment. To maximize the
On the other hand, the limbic system may not directly treatment effects, patients were recommended to be
be responsible for the inhibition of the motor system but hospitalized in our department so that they could at
instead, the reduction of the activity of the motor response least distance themselves from the routine interpersonal
may be attributed to changes within different prefrontal patterns in the outside world, which might be involved
and frontal motor areas. 9 in the production and maintenance of their symptoms.
Several studies on this topic present a range of To ensure mutual understanding and confirmation, there
methodological limitations: (1) the study groups are small exists a collaboration between patients and the treating
or inhomogeneous; (2) the nomenclature used is often team.
varying; (3) some patients are on psychoactive drugs which Regarding physiotherapy, physiotherapeutic evaluation
may influence the brain activation patterns; and (4) many was conducted based on an analysis of physical functions
studies lack control groups. combined with observations of movement patterns in

The objective of the present study was to deepen our the warm water swimming pool. The complexity and
understanding of the mechanism of functional neurological challenges of the physical exercises are gradually increased
symptoms. In this study, we collected relevant studies of during training to keep the progress at an appropriate
neuroimaging and interpreted the findings obtained against pace. The training revolves around relearning appropriate
the psychological hypothesis. The combined treatment of movement patterns in the water, followed by training on
physiotherapy and personally adapted psychodynamic the floor. The self-confidence and belief in one’s movement
psychoeducation was also found to show positive results. abilities are strengthened during physiotherapy, leading
The sole focus of this work was on FMD, without covering to gradual improvement in the ability to carry out daily
psychogenic non-epileptic seizures, a much more activities. Thus, it can be said that physiotherapy is a method
pathologically complex disease than FMD. set to improve patients’ balance rather than address or
resolve their symptoms. Trust and emotionally responsive
2. Methods of treatment presence are keywords and crucial for a successful result.
In the past, FMD was often associated with a bad Regarding the psychological method, the intervention
32
prognosis. 23,24 In recent decades, however, a growing is conceptually a psychodynamic mode of treatment,
number of publications have shown successful treatment based on the assumption that functional motor
outcomes among FMD patients in outpatient 25,26 or disturbances are pathogenetically linked with memorized
inpatient settings. 27-31 All these studies reported treatment and present mental strains, burdens, and/or conflicts.
regimes comprising physiotherapy in combination with The emergence of physical symptoms may, in the
psychoeducation (Table 1). patient’s mind, subjectively be connected with social or

Volume 3 Issue 1 (2025) 91 doi: 10.36922/jcbp.4369