TY - JOUR
T1 - The auditory startle response in relation to outcome in functional movement disorders
AU - Dreissen, Y. E. M.
AU - Koelman, J. H. T. M.
AU - Tijssen, M. A. J.
N1 - Funding Information: This study was funded by Prinses Beatrix fund and Ipsen® . The funders (Prinses Beatrix Fund, Ipsen®) were not involved in the study design, data collection, data analysis, data interpretation or writing of the manuscript. Funding Information: This study was part of a larger study project which was funded by the Prinses Beatrix Fund. Dr Koelman reports educational grants from Ipsen, Allergan and Merz, outside the submitted work. Prof Tijssen reports grants from the Netherlands Organisation for Health Research and Development ZonMW Topsubsidie (91218013), the European Fund for Regional Development from the European Union (01492947) and the province of Friesland, Dystonia Medical Research Foundation, from Stichting Wetenschapsfonds Dystonie Vereniging, from Fonds Psychische Gezondheid, from Phelps Stichting, and an unrestricted grant from Actelion and from AOP Orphan Pharmaceuticals AG for a lecture. Dr Dijk reports grants from rom ZonMw (The Netherlands Organisation for Health Research and Development) and Medtronic, outside the submitted work. All other authors have nothing to disclose. Funding Information: This study was funded by Prinses Beatrix fund and Ipsen?. The funders (Prinses Beatrix Fund, Ipsen?) were not involved in the study design, data collection, data analysis, data interpretation or writing of the manuscript. Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: The auditory startle reflex (ASR) is enlarged in patients with functional movement disorders (FMD). Objectives: To study whether the ASR relates to symptom reduction in FMD patients, who participated in a placebo controlled double blind treatment trial with Botulinum Neurotoxin (BoNT). Methods: Response to treatment in the BoNT study was assessed using the Clinical Global Impression – Improvement scale (CGI-I). The electromyography (EMG) muscle activity of 7 muscles following 110 dB tones was measured in 14 FMD patients before and after one-year treatment and compared to 11 matched controls. The early and a late (behaviorally affected) component of the ASR and the sympathetic skin response (SSR) were assessed. Results: 10 of 14 patients (71.4%) showed symptom improvement, which was believed to be mainly caused by placebo effects. The early total response probability of the ASR at baseline tended to be larger in patients compared to controls (p = 0.08), but normalized at follow-up (p = 0.84). The late total response probability was larger in patients vs. controls at baseline (p < 0.05), a trend that still was present at follow-up (p = 0.08). The SSR was higher in patients vs. controls at baseline (p < 0.01), and normalized at follow-up (p = 0.71). Conclusions: On a group level 71.4% of the patients showed clinical symptom improvement after treatment. The early part of the ASR, most likely reflecting anxiety and hyperarousal, normalized in line with the clinical improvement. Interestingly, the augmented late component of the ASR remained enlarged suggesting persistent altered behavioral processing in functional patients despite motor improvement.
AB - Background: The auditory startle reflex (ASR) is enlarged in patients with functional movement disorders (FMD). Objectives: To study whether the ASR relates to symptom reduction in FMD patients, who participated in a placebo controlled double blind treatment trial with Botulinum Neurotoxin (BoNT). Methods: Response to treatment in the BoNT study was assessed using the Clinical Global Impression – Improvement scale (CGI-I). The electromyography (EMG) muscle activity of 7 muscles following 110 dB tones was measured in 14 FMD patients before and after one-year treatment and compared to 11 matched controls. The early and a late (behaviorally affected) component of the ASR and the sympathetic skin response (SSR) were assessed. Results: 10 of 14 patients (71.4%) showed symptom improvement, which was believed to be mainly caused by placebo effects. The early total response probability of the ASR at baseline tended to be larger in patients compared to controls (p = 0.08), but normalized at follow-up (p = 0.84). The late total response probability was larger in patients vs. controls at baseline (p < 0.05), a trend that still was present at follow-up (p = 0.08). The SSR was higher in patients vs. controls at baseline (p < 0.01), and normalized at follow-up (p = 0.71). Conclusions: On a group level 71.4% of the patients showed clinical symptom improvement after treatment. The early part of the ASR, most likely reflecting anxiety and hyperarousal, normalized in line with the clinical improvement. Interestingly, the augmented late component of the ASR remained enlarged suggesting persistent altered behavioral processing in functional patients despite motor improvement.
KW - Auditory startle response
KW - BoNT
KW - Functional movement disorders
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85110198746&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.parkreldis.2021.07.012
DO - https://doi.org/10.1016/j.parkreldis.2021.07.012
M3 - Article
C2 - 34274620
SN - 1353-8020
VL - 89
SP - 113
EP - 117
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
ER -