Functional neurological movement disorders: Neuroimaging findings and methods of treatment

Results of neuroimaging can provide information concerning the cause of functional motor disorders. In this paper, we review the most important of these neuroimaging investigations indicating changes in activation patterns in several brain regions relevant to motor control. A new combined treatment approach has demonstrated more promising results than previous attempts where either psychological or physiotherapeutic interventions have been used. When physiotherapy focusing on relearning appropriate movement patterns is combined with psychodynamic psychotherapy, including personally adapted psychoeducation, the results are convincing and most often long-lasting. Few cases with relapse show remission after undergoing only a few additional sessions of this new treatment modality. Three cases presented in this paper illustrate such courses post-treatment, lending credence to the potential existence of a dialectic interaction between mind and brain processes. The cases underline the importance of a therapeutic alliance and the ability of the therapist to let painful emotional material emerge and be understood, all based on confidence between the patient and the treating team.