Pathophysiologie funktioneller Bewegungsstörungen

ZUSAMMENFASSUNG

Die Ursache funktioneller neurologischer Bewegungsstörungen ist multifaktoriell. Es ist denkbar, dass es eine genetische Prädisposition gibt, die zu einer verminderten Belastbarkeit und Verarbeitungsfähigkeit externer Stressoren führt. Zu den Risikofaktoren zählen Traumata in der Kindheit; insbesondere eine psychische Vernachlässigung (Neglect), innerfamiliäre Schwierigkeiten, Mobbing, erhöhter sozialer Druck und sexueller Missbrauch. Dazu passt, dass ein hoher Prozentsatz betroffener Patienten an psychiatrischen Komorbiditäten wie Depressionen, Angststörungen oder posttraumatischen Belastungsstörungen leidet. Oftmals gehen der Erstmanifestation andere organische Erkrankungen, Operationen oder Unfälle voraus. Es gibt zahlreiche neurophysiologische und bildgebende Untersuchungen, die ein zugrunde liegendes gestörtes Handlungsbewusstsein nahelegen. Hierbei ist insbesondere die Wahrnehmung der Kontrolle eigener Handlungen und deren Konsequenzen gestört. Verortet wird das Handlungsbewusstsein im temporo-parietalen Knotenpunkt, der eine reduzierte Aktivierung bei Patienten mit einem funktionellen Tremor zeigt. Zudem wurde eine verminderte funktionelle Konnektivität zwischen rechtem temporo-parietalem Übergang und bilateralen sensomotorischen Regionen beschrieben. Das beeinträchtigte Handlungsbewusstsein ist vermutlich Folge einer fehlerhaften Integration motorischer Feedforward- und sensorischer Feedback-Mechanismen. In dieser Übersichtsarbeit werden wir diese Aspekte beleuchten, um anschließend ein pathophysiologisches Modell zu erstellen.

ABSTRACT

Functional movement disorders are multifactorial in their origin. It is conceivable that there is a genetic predisposition with an impaired ability to manage lifetime stressors. Additional environmental determents may occur and lead to a functional movement disorder. Risk factors include childhood trauma such as emotional neglect or problematic family structures with sexual abuse or intimidation. Further predisposing factors comprise psychiatric co-morbidities. Some patients might have had organic diseases such as trauma, surgery, or neurological illnesses. Several neurophysiological and neuroimaging studies have been published in the past years. They point to an abnormal sense of agency that has been associated with hypofunction in the right temporo-parietal junction. Functional magnetic resonance imaging studies revealed reduced functional connectivity from that junction to sensorimotor and limbic regions. Impaired sense of agency has also been attributed to disturbed integration of motor feedforward and sensory feedback mechanisms. In this review article we will illustrate the different pathophysiological aspects and provide a model to integrate those aspects.

Schlüsselwörter

Funktionelle Bewegungsstörungen - prädisponierende Faktoren - funktionelle und strukturelle Bildgebung - elektrophysiologische Kriterien - Handlungsbewusstsein

Key words

Functional movement disorders - predisposing factors - functional and structural imaging - electrophysiological criteria - sense of agency

Publikationsverlauf

Artikel online veröffentlicht:
02. August 2023

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