Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder

Voon, Valerie; Brezing, Christina; Gallea, Cecile; Hallett, Mark

doi:10.1002/mds.23890

Cited by 237Psychosomatic Disorders and Their TreatmentsNeurological disorders and treatmentsPain Management and Placebo Effect

Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder

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Voon, Valerie, Brezing, Christina, Gallea, Cecile, Hallett, Mark·2011·Movement Disorders

DOI 10.1002/mds.23890PMC PMC4162742

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Abstract

Conversion disorder (CD) is characterized by unexplained neurological symptoms presumed related to psychological issues. The main hypotheses to explain conversion paralysis, characterized by a lack of movement, include impairments in either motor intention or disruption of motor execution, and further, that hyperactive self‐monitoring, limbic processing or top‐down regulation from higher order frontal regions may interfere with motor execution. We have recently shown that CD with positive abnormal or excessive motor symptoms was associated with greater amygdala activity to arousing stimuli along with greater functional connectivity between the amygdala and supplementary motor area. Here we studied patients with such symptoms focusing on motor initiation. Subjects performed either an internally or externally generated 2‐button action selection task in a functional MRI study. Eleven CD patients without major depression and 11 age‐ and gender‐matched normal volunteers were assessed. During both internally and externally generated movement, conversion disorder patients relative to normal volunteers had lower left supplementary motor area (SMA) (implicated in motor initiation) and higher right amygdala, left anterior insula, and bilateral posterior cingulate activity (implicated in assigning emotional salience). These findings were confirmed in a subgroup analysis of patients with tremor symptoms. During internally versus externally generated action in CD patients, the left SMA had lower functional connectivity with bilateral dorsolateral prefrontal cortices. We propose a theory in which previously mapped conversion motor representations may in an arousing context hijack the voluntary action selection system, which is both hypoactive and functionally disconnected from prefrontal top‐down regulation. © 2011 Movement Disorder Society

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[40]Voon V Gallea C Hattori N Bruno M Ekanayake V Hallett M The involuntary nature of conversion disorder Neurology 2010 74 223 228 20083798 PMC2809033
[41]Voon V Brezing C Gallea C Emotional stimuli and motor conversion disorder Brain 2010 133 1526 1536 20371508 PMC2859149

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Authors: Voon, V., Brezing, C., Gallea, C., & Hallett, M.
Affiliations: University of Cambridge (GB)
National Institutes of Health (US)
Corresponding author: Voon, Valerie
ORCID: Voon, Valerie
Brezing, Christina
Hallett, Mark
Venue: Movement Disorders
Publisher: Wiley
Published: 2011-09-20
Volume: 26
Issue: 13
Pages: 2396-2403
ISSN: 0885-3185 (ISSN-L)
1531-8257
DOI: 10.1002/mds.23890
PMC: PMC4162742
OpenAlex: W2153113149
Cited by: 237
References: 40
Citations by year: 2026: 9 · 2025: 16 · 2024: 16 · 2023: 10 · 2022: 19 · 2021: 10 · 2020: 24 · 2019: 19 · 2018: 18 · 2017: 18 · 2016: 15 · 2015: 14 · 2014: 15 · 2013: 21 · 2012: 12
FWCI: 10.50
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Movement Disorders (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health
National Institute of Neurological Disorders and Stroke (Z01NS002667)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Neurology › Neurological disorders and treatments
Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
Keywords: conversion disorder, supplementary motor area, amygdala, anterior insula, posterior cingulate cortex, motor preparation, action selection, motor initiation, dorsolateral prefrontal cortex, functional connectivity, limbic system, emotional salience, top-down control
MeSH terms: Conversion Disorder, Female, Humans, Limbic System, Magnetic Resonance Imaging, Male, Middle Aged, Motor Activity, Motor Cortex, Movement Disorders, Neuropsychological Tests

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Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder

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