Eric Morel, Antonia Klein, Adrian Scutelnic, Janine Bühler, Selma Aybek, Christoph Schankin
{"title":"功能性神经障碍阳性症状与头痛严重程度的相关性:一项前瞻性横断面研究。","authors":"Eric Morel, Antonia Klein, Adrian Scutelnic, Janine Bühler, Selma Aybek, Christoph Schankin","doi":"10.1176/appi.neuropsych.20250004","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Positive signs are clinical signs that are not explained by a structural neurological lesion and are considered the hallmark of functional neurological disorder (FND). In the literature and in clinical experience, positive signs are observed among patients without FND. The aim of the study was to examine the significance of positive signs among headache patients.</p><p><strong>Methods: </strong>The authors of this prospective study recruited patients in headache consultation at the University Hospital Inselspital, Bern, Switzerland. Inclusion criteria were headache or facial pain in the past 3 months and age ≥18 years. The exclusion criterion was a known diagnosis of FND. All patients were examined for 14 validated positive signs: give-way weakness, co-contraction, sternocleidomastoid sign, trapezius elevation test, head flexion test, drift without pronation, Hoover I and II, spinal injury test, arm drop test, lip-pulling sign, midline splitting, splitting of vibration sign at the front, and expressive behavior sign.</p><p><strong>Results: </strong>In total, 101 patients were recruited (69% female; mean±SD age=40.8±16.3 years), of whom 43% showed positive signs. Splitting of vibration was the most common sign (27%); the other signs were less frequent (≤10%). Patients with positive signs were older than patients without such signs and had more monthly headache days and exacerbations as well as more intense headache at examination. Multivariable logistic regression revealed a significant association between positive signs and exacerbation days per month (OR=1.08, 95% CI=1.01-1.14, per exacerbation day; p=0.019).</p><p><strong>Conclusions: </strong>Positive signs are frequent among headache patients and point toward a more severe headache condition. This finding suggests overlapping mechanisms in headache and FND.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"appineuropsych20250004"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Correlation of Positive Signs of Functional Neurological Disorder With Headache Severity: A Prospective Cross-Sectional Study.\",\"authors\":\"Eric Morel, Antonia Klein, Adrian Scutelnic, Janine Bühler, Selma Aybek, Christoph Schankin\",\"doi\":\"10.1176/appi.neuropsych.20250004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Positive signs are clinical signs that are not explained by a structural neurological lesion and are considered the hallmark of functional neurological disorder (FND). In the literature and in clinical experience, positive signs are observed among patients without FND. The aim of the study was to examine the significance of positive signs among headache patients.</p><p><strong>Methods: </strong>The authors of this prospective study recruited patients in headache consultation at the University Hospital Inselspital, Bern, Switzerland. Inclusion criteria were headache or facial pain in the past 3 months and age ≥18 years. The exclusion criterion was a known diagnosis of FND. All patients were examined for 14 validated positive signs: give-way weakness, co-contraction, sternocleidomastoid sign, trapezius elevation test, head flexion test, drift without pronation, Hoover I and II, spinal injury test, arm drop test, lip-pulling sign, midline splitting, splitting of vibration sign at the front, and expressive behavior sign.</p><p><strong>Results: </strong>In total, 101 patients were recruited (69% female; mean±SD age=40.8±16.3 years), of whom 43% showed positive signs. Splitting of vibration was the most common sign (27%); the other signs were less frequent (≤10%). Patients with positive signs were older than patients without such signs and had more monthly headache days and exacerbations as well as more intense headache at examination. Multivariable logistic regression revealed a significant association between positive signs and exacerbation days per month (OR=1.08, 95% CI=1.01-1.14, per exacerbation day; p=0.019).</p><p><strong>Conclusions: </strong>Positive signs are frequent among headache patients and point toward a more severe headache condition. This finding suggests overlapping mechanisms in headache and FND.</p>\",\"PeriodicalId\":16559,\"journal\":{\"name\":\"Journal of Neuropsychiatry and Clinical Neurosciences\",\"volume\":\" \",\"pages\":\"appineuropsych20250004\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuropsychiatry and Clinical Neurosciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1176/appi.neuropsych.20250004\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuropsychiatry and Clinical Neurosciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1176/appi.neuropsych.20250004","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Correlation of Positive Signs of Functional Neurological Disorder With Headache Severity: A Prospective Cross-Sectional Study.
Objective: Positive signs are clinical signs that are not explained by a structural neurological lesion and are considered the hallmark of functional neurological disorder (FND). In the literature and in clinical experience, positive signs are observed among patients without FND. The aim of the study was to examine the significance of positive signs among headache patients.
Methods: The authors of this prospective study recruited patients in headache consultation at the University Hospital Inselspital, Bern, Switzerland. Inclusion criteria were headache or facial pain in the past 3 months and age ≥18 years. The exclusion criterion was a known diagnosis of FND. All patients were examined for 14 validated positive signs: give-way weakness, co-contraction, sternocleidomastoid sign, trapezius elevation test, head flexion test, drift without pronation, Hoover I and II, spinal injury test, arm drop test, lip-pulling sign, midline splitting, splitting of vibration sign at the front, and expressive behavior sign.
Results: In total, 101 patients were recruited (69% female; mean±SD age=40.8±16.3 years), of whom 43% showed positive signs. Splitting of vibration was the most common sign (27%); the other signs were less frequent (≤10%). Patients with positive signs were older than patients without such signs and had more monthly headache days and exacerbations as well as more intense headache at examination. Multivariable logistic regression revealed a significant association between positive signs and exacerbation days per month (OR=1.08, 95% CI=1.01-1.14, per exacerbation day; p=0.019).
Conclusions: Positive signs are frequent among headache patients and point toward a more severe headache condition. This finding suggests overlapping mechanisms in headache and FND.
期刊介绍:
As the official Journal of the American Neuropsychiatric Association, the premier North American organization of clinicians, scientists, and educators specializing in behavioral neurology & neuropsychiatry, neuropsychology, and the clinical neurosciences, the Journal of Neuropsychiatry and Clinical Neurosciences (JNCN) aims to publish works that advance the science of brain-behavior relationships, the care of persons and families affected by neurodevelopmental, acquired neurological, and neurodegenerative conditions, and education and training in behavioral neurology & neuropsychiatry. JNCN publishes peer-reviewed articles on the cognitive, emotional, and behavioral manifestations of neurological conditions, the structural and functional neuroanatomy of idiopathic psychiatric disorders, and the clinical and educational applications and public health implications of scientific advances in these areas. The Journal features systematic reviews and meta-analyses, narrative reviews, original research articles, scholarly considerations of treatment and educational challenges in behavioral neurology & neuropsychiatry, analyses and commentaries on advances and emerging trends in the field, international perspectives on neuropsychiatry, opinions and introspections, case reports that inform on the structural and functional bases of neuropsychiatric conditions, and classic pieces from the field’s rich history.