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Neuroimaging Biomarkers of Prognosis in Motor Functional Neurological Disorders

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ClinicalTrials.gov Identifier: NCT03398070
Recruitment Status : Recruiting
First Posted : January 12, 2018
Last Update Posted : March 11, 2019
Sponsor:
Information provided by (Responsible Party):
David Lewis Perez, Massachusetts General Hospital

Brief Summary:
Functional Neurological Disorder (FND/ Conversion Disorder) is a highly prevalent and disabling neuropsychiatric condition. Motor FND symptoms include Nonepileptic Seizures, Functional Movement Disorders and Functional Weakness. Clinical research across these motor FND subtypes, including research studies from the candidate's laboratory, suggest that these populations share many clinical and phenotypic similarities that warrant increased research integration. Furthermore, despite the prevalence of motor FND, little is known about the underlying neuropathophysiology of this condition, which is a prerequisite for the development of biologically informed prognostic and treatment response biomarkers. Across 3 published neurobiologically focused articles, the candidate proposed a framework through which to conceptualize motor FND. It is suggested that motor FND develops in the context of structural and functional alterations in neurocircuits mediating emotion awareness/expression, bodily awareness, viscerosomatic processing and behavioral regulation. The overall goal of this project is to comprehensively investigate structural and functional magnetic resonance imaging (MRI) biomarkers of prognosis across motor FND. Multimodal structural and functional MRI techniques (including voxel-based morphometry, cortical thickness, resting-state functional connectivity and diffusion tensor imaging tractography) will be used to systemically probe brain-prognosis relationships. Novel aspects of this proposal include the study of the full spectrum of motor FND, consistent with a trans-diagnostic approach.

Condition or disease Intervention/treatment
Conversion Disorder Other: Standard of Care

Detailed Description:

Functional Neurological Disorder (FND) (Conversion Disorder) is a poorly understood and prevalent somatoform disorder, making up 16% of outpatient neurology referrals. Patients with motor FND (mFND) are difficult to treat, result in major morbidity, and are costly to the US. An estimated $256 billion is spent annually treating this population. mFND includes Nonepileptic Seizures (NES), Functional Movement Disorders (FMD) and Functional Weakness (FW). An impediment to managing mFND is the lack of a neurobiological understanding for this disorder. The diagnosis of mFND is currently based on qualitative aspects of behaviors, which may be difficult to interpret, and the absence of findings characteristic of other neuropsychiatric disorders on laboratory studies such as electroencephalography (EEG) and magnetic resonance imaging (MRI).

A major step forward would be the identification of neuroimaging biomarkers for mFND. mFND is understudied compared to other disorders, but recent studies point to distributed neurocircuit alterations associated with mFND. This project aims to advance our biological understanding of mFND by investigating neuroimaging biomarkers linked to prognosis. An improved understanding of the neuropathophysiology of mFND will provide a critical step in elucidating diagnostic, prognostic and treatment response biomarkers.

Aim:

Identify structural and functional biomarkers of prognosis at 6-months in patients with motor functional neurological disorders receiving an updated standard of care.

H1: Favorable mFND prognosis at 6 months post initial evaluation will be predicted by the degree of preserved baseline gray matter in limbic-paralimbic regions, particularly those part of the salience network.

H2: Favorable mFND prognosis at 6 months post initial evaluation will be predicted by the degree of preserved baseline resting-state functional connectivity in limbic/paralimbic areas, particularly those part of the salience network.

H3: Favorable mFND prognosis at 6 months will correlate with the degree of preserved baseline cingulum bundle and cingulo-insular tract integrity.

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Study Type : Observational
Estimated Enrollment : 49 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Neuroimaging Biomarkers of Prognosis in Motor Functional Neurological Disorders
Actual Study Start Date : September 1, 2017
Estimated Primary Completion Date : August 31, 2022
Estimated Study Completion Date : August 31, 2022

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Motor Functional Neurological Disorder.

The cohort will consist of patients with clinically established motor functional neurological disorder, which includes individuals with functional movement disorders, psychogenic nonepileptic seizures and functional limb weakness.

Patients will be receiving the standard of care within the Massachusetts General Hospital (MGH) Functional Neurological Disorders Clinic.

The updated standard of care that patient's receive in the MGH Functional Neurological Disorders Clinic includes the following:

  1. Delivery of a positive "rule-in" diagnosis of functional neurological disorder
  2. Individuals are provided with educational materials on functional neurological disorders
  3. Referred to physical therapy and/or occupational therapy as clinically indicated
  4. FND related cognitive behavioral therapy (CBT) referral when appropriate
  5. Psychotropic medication management based on standard psychiatric care
Other: Standard of Care

The standard of care interventions for Functional Neurological Disorders (FND) include:

  1. delivery of a rule-in diagnosis
  2. providing educational materials
  3. referring to physical therapy (PT) and/or occupational therapy (OT) as clinically indicated
  4. referring to FND-related cognitive behavioral therapy (CBT)
  5. psychotropic medication management based on standard psychiatric care




Primary Outcome Measures :
  1. Gray Matter Volume Biomarkers of 6 Month Prognosis as measured by Voxel Based Morphometry [ Time Frame: 2-4 years ]
    Correcting for multiple comparisons in structural analyses, baseline structural grey matter volumes in limbic/paralimbic regions (particularly those affiliated with the salience network), would be predictive of clinical outcome in individuals receiving the standard of care at 6 months.

  2. Resting State Functional Connectivity Strength Biomarkers of 6 Month Prognosis [ Time Frame: 3-5 years ]
    Correcting for multiple comparisons in resting state connectivity analyses, baseline functional connectivity strength (Pearson correlation coefficients) across limbic/paralimbic regions (particularly those affiliated with the salience network), would be predictive of clinical outcome in individuals receiving the standard of care at 6 months.

  3. The integrity of specific white matter tracts (fractional anisotropy) as measured by diffusion tensor imaging (DTI) tractography will relate to 6-month prognosis [ Time Frame: 3-5 years ]
    Baseline integrity of the cingulum bundle and cingulate-insular tracts, as measured by fractional anisotropy, would be predictive of 6 month prognosis in patients with Functional Neurological Disorders (FND) receiving the standard of care.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Recruitment will occur from patients receiving care in the Massachusetts General Hospital (MGH) Functional Neurological Disorders Clinic
Criteria

Inclusion Criteria:

  • clinically established motor functional neurological disorder, including individuals with functional movement disorders, functional limb weakness and psychogenic nonepileptic seizures

Exclusion Criteria:

  • active suicidality
  • major medical/neurological comorbidities with known central nervous system (CNS) consequences
  • active drug use or alcohol dependence
  • known history of a primary psychotic disorder

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03398070


Contacts
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Contact: David L Perez, MD, MMSc 617-724-7243 dlperez@partners.org

Locations
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United States, Massachusetts
Massachusetts General Hospital Recruiting
Boston, Massachusetts, United States, 02114
Contact: David L Perez, MD, MMSc    617-724-7243    dlperez@partners.org   
Sponsors and Collaborators
Massachusetts General Hospital
  Study Documents (Full-Text)

Documents provided by David Lewis Perez, Massachusetts General Hospital:

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Responsible Party: David Lewis Perez, Principal Investigator, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT03398070    
Other Study ID Numbers: 1K23MH111983-01A1 ( U.S. NIH Grant/Contract )
First Posted: January 12, 2018    Key Record Dates
Last Update Posted: March 11, 2019
Last Verified: March 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by David Lewis Perez, Massachusetts General Hospital:
Functional Neurological Disorder
Functional Movement Disorder
Psychogenic Nonepileptic Seizures
Functional Limb Weakness
Additional relevant MeSH terms:
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Disease
Conversion Disorder
Hysteria
Dissociative Disorders
Nervous System Diseases
Pathologic Processes
Somatoform Disorders
Mental Disorders
Histrionic Personality Disorder
Personality Disorders