title: Abnormal brain activation during movement observation in patients with conversion paralysis.
abstract: Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis.
authors.affiliation: Department of Psychosomatics and Psychotherapy, University of Münster, Domagkstr. 22, D-48149 Münster, Germany. burgmem@mednet.uni-muenster.de
authors.forename: Markus
authors.initials: M
authors.lastname: Burgmer
authors.forename: Carsten
authors.initials: C
authors.lastname: Konrad
authors.forename: Andreas
authors.initials: A
authors.lastname: Jansen
authors.forename: Harald
authors.initials: H
authors.lastname: Kugel
authors.forename: Jens
authors.initials: J
authors.lastname: Sommer
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: Erich B
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: Gereon
authors.initials: G
authors.lastname: Heuft
authors.forename: Stefan
authors.initials: S
authors.lastname: Knecht
mesh_terms: D000328:Adult; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D003291:Conversion Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D004213:Dissociative Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006225:Hand / Q000294:innervation*; D006429:Hemiplegia / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007092:Imagination / Q000502:physiology; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology; D009474:Neurons / Q000502:physiology; D012016:Reference Values