Functional Neurological Disorders（FND）に臨床神経生理検査をどう役立てるか
Functional neurological disorders（FND）での臨床神経生理検査の有用性を運動症状が主体の病態を中心に概説した．表面筋電図，体性感覚誘発電位（somatosensory evoked potential，以下SEPと略記），単発磁気刺激（transcranial magnetic stimulation，以下TMSと略記）などがあるが，これらは器質的疾患の除外のために行われる場合と，FNDを積極的に証明するために行われる場合がある．以下に各検査の有用性について解説する．表面筋電図：運動症状を客観的に示すために必須の検査であり・器質的疾患の除外にもFNDでの陽性所...
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| Published in | 臨床神経学 Vol. 65; no. 1; pp. 1 - 7 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-002050 |
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| Abstract | Functional neurological disorders（FND）での臨床神経生理検査の有用性を運動症状が主体の病態を中心に概説した．表面筋電図，体性感覚誘発電位（somatosensory evoked potential，以下SEPと略記），単発磁気刺激（transcranial magnetic stimulation，以下TMSと略記）などがあるが，これらは器質的疾患の除外のために行われる場合と，FNDを積極的に証明するために行われる場合がある．以下に各検査の有用性について解説する．表面筋電図：運動症状を客観的に示すために必須の検査であり・器質的疾患の除外にもFNDでの陽性所見の検出にも有用である．さらにPower spectral analysisにより情報が増える．SEP：Giant SEPは器質的疾患の除外に重要である．単発TMS：機能性麻痺患者では陽性所見として役立つとともに，器質性疾患の除外という意味で有用である．Jerk-locked back averaging（JLA），bereitschaftspotential（BP），event related desynchronization（ERD）：様々な検査があるが，FNDでの診断的意義は確立されていない． |
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| AbstractList | Functional neurological disorders（FND）での臨床神経生理検査の有用性を運動症状が主体の病態を中心に概説した．表面筋電図，体性感覚誘発電位（somatosensory evoked potential，以下SEPと略記），単発磁気刺激（transcranial magnetic stimulation，以下TMSと略記）などがあるが，これらは器質的疾患の除外のために行われる場合と，FNDを積極的に証明するために行われる場合がある．以下に各検査の有用性について解説する．表面筋電図：運動症状を客観的に示すために必須の検査であり・器質的疾患の除外にもFNDでの陽性所見の検出にも有用である．さらにPower spectral analysisにより情報が増える．SEP：Giant SEPは器質的疾患の除外に重要である．単発TMS：機能性麻痺患者では陽性所見として役立つとともに，器質性疾患の除外という意味で有用である．Jerk-locked back averaging（JLA），bereitschaftspotential（BP），event related desynchronization（ERD）：様々な検査があるが，FNDでの診断的意義は確立されていない． |
| Author | 宇川, 義一 |
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| References | 12) Schwingenschuh P, Saifee TA, Katschnig-Winter P, et al. Validation of “Laboratory-Supported” criteria for functional (psychogenic) tremor. Mov Disord 2016;31:555-562. 17) Beudel M, Zutt R, Meppeling AM, et al. Improving neurophysiological biomarkers for functional myoclonic movements. Park Relat Disord 2018;51:3-8. 7) Baizabal-Carvallo JF, Hallett M, Jankovica J. Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiol Dis 2019;127:32-44. 10) Matsumoto H, Ugawa Y. Central and peripheral motor conduction studies by single-pulse magnetic stimulation: a review. J Clin Neurol 2024;20:241-255. 15) Shibasaki H, Sasaki T, Nishimura Y, et al. Involuntary movements in chorea-acanthocytosis: a comparison with Huntington’s chorea. Ann Neurol 1982;12:311-314. 8) Grippe T, Chen R. Utility of Neurophysiological evaluation in movement disorders clinical practice. Mov Disord Clin Pract 2023;10:1599-1610. 21) Quartarone A, Rizzo V, Terranova C, et al. Abnormal sensorimotor plasticity in organic but not in psychogenic dystonia. Brain. 2009;132:2871-2877. 6) Roelofs JJ, Teodoro T, Edwards MJ. Neuroimaging in functional movement disorders. Curr Neurol Neurosci Rep 2019;19:12. 22) Kamble N, Pal PM. Electrophysiology in functional movement disorders: an update. tremor and other hyperkinetic movements. Tremor Other Hyperkinet Mov (N Y) 2023;13:49. 16) 園生雅弘，宇川義一，作田学．準備電位を伴った片側アテトーゼ様不随意運動の一例．臨床神経 1989;29:343-348. 4) LaFaver K. Treatment of functional movement disorders. Neurol Clin 2020;38:469-480. 2) 園生雅弘．精神科との境界領域について：機能性神経障害を中心に．臨床神経 2023;63:135-144. 19) Huang YZ, Edwards MJ, Rounis E, et al. Theta burst stimulation of the human motor cortex. Neuron 2005;45:201-206. 23) van der Stouwe AM, Elting JW, van der Hoeven JH, et al. How typical are ‘typical’ tremor characteristics? Sensitivity and specificity of five tremor phenomena. Parkinsonism Relat Disord 2016;30:23-28. 14) Van der Salm SMA, Erro R, Cordivari C, et al. Propriospinal myoclonus: clinical reappraisal and review of literature. Neurology 2014;83:1862-1870. 1) Hallett M, Aybek S, Dwretzky BA, et al. Functional neurological disorder: new phenotypes, common mechanisms. Lancet Neurol 2022;21:537-550. 13) Deuschl G, Koster B, Ludking C, et al. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord 1998;13:294-320. 11) Hallett M. Physiology of psychogenic movement disorders. J Clini Neurosci 2010;17:959-965. 20) Hamada M, Terao Y, Hanajima R, et al. Bidirectional long-term motor cortical plasticity and metaplasticity induced by quadripulse transcranial magnetic stimulation. J Physiol 2008;586:3927-3947. 3) Ricciardi L, Edwards MJ. Treatment of functional (psychogenic) movement disorders. Neurotherapeutics 2014;11:201-207. 18) Sakai K, Kojima E, Suzuki M, et al. Primary motor cortex isolation: complete paralysis with preserved primary motor cortex. J Neurol Sci 1998:115:115-116. 5) Goldstein LH, Gelauff J, Stone J. Prognosis of functional neurologic disorders. Functional Neurologic Disorders. Handbook of Clinical Neurology, Vol. 139 (3rd series). 9) 宇川義一．Functional movement disorderは電気生理学的に診断できるか．Noの立場から．MDSJ letters 2021;14:1-3. |
| References_xml | – reference: 11) Hallett M. Physiology of psychogenic movement disorders. J Clini Neurosci 2010;17:959-965. – reference: 17) Beudel M, Zutt R, Meppeling AM, et al. Improving neurophysiological biomarkers for functional myoclonic movements. Park Relat Disord 2018;51:3-8. – reference: 18) Sakai K, Kojima E, Suzuki M, et al. Primary motor cortex isolation: complete paralysis with preserved primary motor cortex. J Neurol Sci 1998:115:115-116. – reference: 9) 宇川義一．Functional movement disorderは電気生理学的に診断できるか．Noの立場から．MDSJ letters 2021;14:1-3. – reference: 23) van der Stouwe AM, Elting JW, van der Hoeven JH, et al. How typical are ‘typical’ tremor characteristics? Sensitivity and specificity of five tremor phenomena. Parkinsonism Relat Disord 2016;30:23-28. – reference: 12) Schwingenschuh P, Saifee TA, Katschnig-Winter P, et al. Validation of “Laboratory-Supported” criteria for functional (psychogenic) tremor. Mov Disord 2016;31:555-562. – reference: 22) Kamble N, Pal PM. Electrophysiology in functional movement disorders: an update. tremor and other hyperkinetic movements. Tremor Other Hyperkinet Mov (N Y) 2023;13:49. – reference: 6) Roelofs JJ, Teodoro T, Edwards MJ. Neuroimaging in functional movement disorders. Curr Neurol Neurosci Rep 2019;19:12. – reference: 15) Shibasaki H, Sasaki T, Nishimura Y, et al. Involuntary movements in chorea-acanthocytosis: a comparison with Huntington’s chorea. Ann Neurol 1982;12:311-314. – reference: 4) LaFaver K. Treatment of functional movement disorders. Neurol Clin 2020;38:469-480. – reference: 5) Goldstein LH, Gelauff J, Stone J. Prognosis of functional neurologic disorders. Functional Neurologic Disorders. Handbook of Clinical Neurology, Vol. 139 (3rd series). – reference: 21) Quartarone A, Rizzo V, Terranova C, et al. Abnormal sensorimotor plasticity in organic but not in psychogenic dystonia. Brain. 2009;132:2871-2877. – reference: 10) Matsumoto H, Ugawa Y. Central and peripheral motor conduction studies by single-pulse magnetic stimulation: a review. J Clin Neurol 2024;20:241-255. – reference: 2) 園生雅弘．精神科との境界領域について：機能性神経障害を中心に．臨床神経 2023;63:135-144. – reference: 19) Huang YZ, Edwards MJ, Rounis E, et al. Theta burst stimulation of the human motor cortex. Neuron 2005;45:201-206. – reference: 20) Hamada M, Terao Y, Hanajima R, et al. Bidirectional long-term motor cortical plasticity and metaplasticity induced by quadripulse transcranial magnetic stimulation. J Physiol 2008;586:3927-3947. – reference: 3) Ricciardi L, Edwards MJ. Treatment of functional (psychogenic) movement disorders. Neurotherapeutics 2014;11:201-207. – reference: 8) Grippe T, Chen R. Utility of Neurophysiological evaluation in movement disorders clinical practice. Mov Disord Clin Pract 2023;10:1599-1610. – reference: 13) Deuschl G, Koster B, Ludking C, et al. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord 1998;13:294-320. – reference: 1) Hallett M, Aybek S, Dwretzky BA, et al. Functional neurological disorder: new phenotypes, common mechanisms. Lancet Neurol 2022;21:537-550. – reference: 14) Van der Salm SMA, Erro R, Cordivari C, et al. Propriospinal myoclonus: clinical reappraisal and review of literature. Neurology 2014;83:1862-1870. – reference: 7) Baizabal-Carvallo JF, Hallett M, Jankovica J. Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiol Dis 2019;127:32-44. – reference: 16) 園生雅弘，宇川義一，作田学．準備電位を伴った片側アテトーゼ様不随意運動の一例．臨床神経 1989;29:343-348. |
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| Snippet | Functional neurological disorders（FND）での臨床神経生理検査の有用性を運動症状が主体の病態を中心に概説した．表面筋電図，体性感覚誘発電位（somatosensory evoked potential，以下SEPと略記），単発磁気刺激（transcranial magnetic... |
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| SubjectTerms | ミオクローヌス 振戦 機能性神経疾患 表面筋電図 運動準備電位 |
| Title | Functional Neurological Disorders（FND）に臨床神経生理検査をどう役立てるか |
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