Cortical Inhibitory Imbalance in Functional Paralysis

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Abstract

Background: Functional neurological disorders are characterized by neurological symptoms that have no identifiable pathology and little is known about their underlying pathophysiology. Objectives: To analyze motor cortex excitability and intracortical inhibitory and excitatory circuits’ imbalance in patients with flaccid functional weakness. Methods: Twenty-one consecutive patients with acute onset of flaccid functional weakness were recruited. Single and paired-pulse transcranial magnetic stimulation (TMS) protocols were used to analyze resting motor thresholds (RMT) and intracortical inhibitory (short interval intracortical inhibition – SICI) and excitatory (intracortical facilitation – ICF) circuits’ imbalance between the affected and non-affected motor cortices. Results: We observed a significant increase in RMT and SICI in the affected motor cortex (p < 0.001), but not for ICF, compared to the contralateral unaffected side. Conclusion: This study extends current knowledge of functional weakness, arguing for a specific central nervous system abnormality which may be involved in the symptoms’ pathophysiology.

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Benussi, A., Premi, E., Cantoni, V., Compostella, S., Magni, E., Gilberti, N., … Magoni, M. (2020). Cortical Inhibitory Imbalance in Functional Paralysis. Frontiers in Human Neuroscience, 14. https://doi.org/10.3389/fnhum.2020.00153

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