Selma Aybek

Selma Aybek
University of Geneva / InselSpital Bern · Neurosciences (Geneva) / Neurologie Klinik (Bern)

MD

About

96
Publications
36,901
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,597
Citations
Introduction
My current work focusses on Functional Neurological Symptoms ( Conversion Disorder). A four-year research project has been recently funded to study the stress hypothesis in this disorder through brain imaging, genetic testing and clinical assessments.
Additional affiliations
October 2007 - present
Institute of Psychiatry
Position
  • Researcher
October 2001 - October 2013
Lausanne University Hospital
Position
  • Cheffe de clinique
Education
September 1992 - December 1998
University of Lausanne
Field of study
  • Médecine

Publications

Publications (96)
Article
Background: Functional neurological disorders have attracted a lot of attention of the neurological medical community over the last decades as new development in neurosciences has reduced stigma around it by showing brain network dysfunctions. An overlap with other neurological condition such as Multiple sclerosis is well known by clinicians but t...
Poster
Full-text available
Positive signs are the hallmark of functional neurological disorders. Many have been validated in small samples and compared to stroke. More data are required to compare them to a broader range of neurological disorders. We present the preliminary analyses of the Positive Signs Study, which intend to validate the 14 common clinical positive signs f...
Article
Full-text available
Background Patients suffering from functional neurological disorder (FND) experience disabling neurological symptoms not caused by an underlying classical neurological disease (such as stroke or multiple sclerosis). The diagnosis is made based on reliable positive clinical signs, but clinicians often require additional time- and cost consuming medi...
Article
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional n...
Article
Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disab...
Article
Full-text available
Functional neurological disorder (FND) represent a common disorder with significant socio-economic impact. In this context and alongside recent new neuroscientific insights, FND attracts a growing interest both in clinical practice and academic activities. New international recommendation and expert opinions suggest that therapy of FND should be a...
Article
Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions, but their aetiological role is unclear. We conducted a systematic review and quantitative analysis of the type, timing and number of life events preceding the onset of FND in adults...
Article
Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric i...
Article
Background Tourette disorder (TD), hallmarks of which are motor and vocal tics, has been related to functional abnormalities in large-scale brain networks. Using a fully data driven approach in a prospective, case–control study, we tested the hypothesis that functional connectivity of these networks carries a neural signature of TD. Our aim was to...
Article
Full-text available
Background: Theta burst stimulation (TBS) is a non-invasive brain stimulation method. Various stimulation protocols have been proposed, for instance, stimulation at 50 Hz with pattern at 5 Hz, or at 30 Hz with pattern at 6 Hz. To identify better stimulation parameters for behavioral applications, we investigated the effects of 50-Hz continuous TBS...
Article
Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modificati...
Article
Full-text available
Functional neurological (conversion) disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed us...
Article
Full-text available
With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) in 2013, the functional neurological (symptom) disorder diagnostic criteria underwent transformative changes. These included an emphasis on “rule-in” physical examination signs/semiological featu...
Article
The American Neuropsychiatric Association's Committee on Research assigned the task of defining the most helpful clinical factors and tests in establishing the diagnosis of psychogenic nonepileptic seizures (PNES) during a neuropsychiatric assessment. A systematic review of the literature was conducted using three search engines and specified searc...
Article
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of...
Article
Full-text available
The sense of agency (SoA) refers to the perception that an action is the consequence of one’s own intention. Studies exploring the SoA with neuroimaging techniques summarized the available data and confirmed a role of fronto-parietal areas and subcortical structures. However, these studies focused on specific regions of interest. We thus conducted...
Article
Background: The sense of agency is an important aspect of motor control. Impaired sense of agency has been linked to several medical conditions, including schizophrenia and functional neurological disorders. A complex brain network subserves the sense of agency, and the right temporoparietal junction is one of its main nodes. In this paper, we tes...
Article
Full-text available
Objectives We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. Methods A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previou...
Article
The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can prese...
Article
Full-text available
Background: In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder) as a "psychodynamic" lesion. Numerous advances in neuroimaging have permitted identification of the neural underpinnings of this disorder. Case presentation: Herein we describe a case of functional neurologi...
Article
A dualistic mind-body understanding of functional neurological disorders (FNDs), also known as conversion disorders, has led to the view that the cause of the symptom should be either psychological (psychogenic) or physical (neurogenic-“organic”). One of the most influential psychological approaches is the Freudian model of conversion, which sugges...
Article
Objective: A growing interest in functional neurological disorders (FND) has led to the development of specialized clinics. This study aimed to better understand the structure and role of such clinics. Methods: Data were retrospectively collected from clinical records at three national referral centers, two specifically for motor FND and one for...
Article
Functional movement disorders (FMD) represent a complex and disabling entity characterized by a broad range of clinical symptoms not explained by a classical neurological disease. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) added a clinical criterion based on incongruence and inconsistency, supported by recent literat...
Article
Background: Patients affected by functional (psychogenic) movement disorders (FMD) have abnormal processing of stress responses. However, little is known about the influence of this abnormal stress processing on automatic motor defense behavior, such as freeze response. Our aim was thus to investigate stress-induced postural motor responses in FMD...
Article
Full-text available
Importance Functional neurological disorders (FND) are common sources of disability in medicine. Patients have often been misdiagnosed, correctly diagnosed after lengthy delays, and/or subjected to poorly delivered diagnoses that prevent diagnostic understanding and lead to inappropriate treatments, iatrogenic harm, unnecessary and costly evaluatio...
Article
Background: Functional parkinsonism (FP) is considered rare but no studies have looked at its frequency. Case series have described high rates of comorbidity with Parkinson's disease (PD), suggesting a possible association between these conditions. Objectives: To study the prevalence, epidemiology and clinical features of FP and its association...
Article
Motor conversion disorder (CD) entails genuine disturbances in the subjective experience of patients who maintain they are unable to perform a motor function, despite lack of apparent neurological damage. Abilities by which individuals assess their own capacities during performance in a task are called metacognitive, and distinctive impairment of s...
Article
Background: Stressful life events and maltreatment have traditionally been considered crucial in the development of conversion (functional neurological) disorder, but the evidence underpinning this association is not clear. We aimed to assess the association between stressors and functional neurological disorder. Methods: We systematically revie...
Chapter
Since its initial description in 1851, Munchausen syndrome has been widely used interchangeably with factitious disorder. Nevertheless, this syndrome is only one form of factitious disorder that is both severe and chronic. The syndrome was named after Karl Friedrich Hieronymus, Baron von Münchhausen (1720-1797), a German nobleman who became famous...
Chapter
This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or...
Article
Full-text available
Background Motor functional neurological disorder (mFND) is a clinical diagnosis with reliable features; however, patients are reluctant to accept the diagnosis and physicians themselves bear doubts on potential misdiagnoses. The identification of a positive biomarker could help limiting unnecessary costs of multiple referrals and investigations, t...
Article
Background: Current models explaining motor functional neurological disorders (FND) integrate both the neurobiological mechanisms underlying symptoms production and the role of psychosocial stressors. Imaging studies have suggested abnormal motor control linked to impaired emotional and stress regulation. However, little is known on the biological...
Article
Purpose of review: The review highlights the clinical presentation of functional movement disorders (FMDs) and presents current evidence on bedside signs and paraclinical tests to differentiate them from other neurological disorders. Recent findings: FMDs are diagnosed by the presence of positive clinical signs as emphasized in the new Diagnosti...
Article
Background Functional (psychogenic) neurological disorders (FNDs) are common and should be diagnosed using positive diagnostic features of internal inconsistency. However, there is a lack of objective data regarding motor signs and a lack of signs relating to motor disorders that affect the upper body and neck. The objective of this study was to pr...
Article
Full-text available
Background: Psychological models of conversion disorder (CD) traditionally assume that psychosocial stressors are identifiable around symptom onset. In the face of limited supportive evidence such models are being challenged. Method: Forty-three motor CD patients, 28 depression patients and 28 healthy controls were assessed using the Life Events...
Chapter
Brain imaging techniques provide unprecedented opportunities to study the neural mechanisms underlying functional neurologic disorder (FND, or conversion disorder), which have long remained a mystery and clinical challenge for physicians, as they arise with no apparent underlying organic disease. One of the first questions addressed by imaging stud...
Chapter
Functional (psychogenic) limb weakness describes genuinely experienced limb power or paralysis in the absence of neurologic disease. The hallmark of functional limb weakness is the presence of internal inconsistency revealing a pattern of symptoms governed by abnormally focused attention. In this chapter we review the history and epidemiology of th...
Article
Functional paralysis – formerly called hysterical paralysis – represents a major neurological burden, as symptoms are often chronic and treatments limited. It is part of a broader category of neurological functional symptoms also called conversion disorder that ranges from weakness to sensory symptoms, abnormal movements, and nonepileptic seizures....
Article
Purpose: To compare the clinical and demographic characteristics of adult patients with nonorganic or medically unexplained visual loss (MUVL) to those with other common conditions presenting to a neuro-ophthalmology clinic. Methods: Case-control design: a retrospective review of medical notes on a consecutive case series of 49 patients assessed...
Conference Paper
Dr Selma Aybek completed her Medical training and Neurology residency in Lausanne, Switzerland. After she received her specialist title in 2007, she did a 3-year fellowship at the Institute of Psychiatry in London (King's College University) where she trained in Neuroimaging and in Cognitive Neuropsychiatry with Professor Anthony David. Her main re...
Article
The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receivi...
Article
Full-text available
Objectives: To evaluate the neural correlates of implicit processing of negative emotions in motor conversion disorder (CD) patients. Methods: An event related fMRI task was completed by 12 motor CD patients and 14 matched healthy controls using standardised stimuli of faces with fearful and sad emotional expressions in comparison to faces with...
Article
Dissociative disorders as defined in the international classification of diseases (ICD-10) belong to the category of functional disorders which still remains a great enigma for medicine. We will focus here on the neurobiological correlates of motor dissociative disorders such as revealed by novel functional neuroimaging techniques. There have been...
Article
Dissociative disorders (of conversion): freudian intuitions revisited by neuro-imagery Dissociative disorders as defined in the international classification of diseases (ICD-10) belong to the category of functional disorders which still remains a great enigma for medicine. We will focus here on the neurobiological correlates of motor dissociative d...
Chapter
Conversion hysteria refers to neurological disorders at the borderline between neurology and psychiatry, characterized by impaired awareness of bodily or cognitive function (such as paralysis, anesthesia, blindness, or amnesia) in the absence of apparent organic lesion in the nervous system. Although it is assumed that conversion hysteria may resul...
Article
Full-text available
Background Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of ‘positive signs’ on neurological examination. Only few signs have been validated, and little is known about their reliability. Objective The aim was to examine the clinical value of bedside positive signs in the diagnosis of...
Article
Full-text available
Importance Freud argued that in conversion disorder (CD) the affect attached to stressful memories is “repressed” and “converted” into physical symptoms, although this has never been subject to scientific study to our knowledge.Objective To examine the neural correlates of recall of life events judged to be of causal significance in CD.Design, Se...
Article
BACKGROUND: Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE: The aim was to examine the clinical value of bedside positive signs in the diagnosis...
Article
Full-text available
To investigate potential abnormalities in subcortical brain structures in conversion disorder (CD) compared with controls using a region of interest (ROI) approach. Fourteen patients with motor CD were compared with 31 healthy controls using high-resolution MRI scans with an ROI approach focusing on the basal ganglia, thalamus and amygdala. Brain v...
Article
Full-text available
Freud proposed that in Conversion disorder (CD), the affect attached to stressful memories is "repressed" and "converted" into physical symptoms. Contemporary neuroscience has shown that the neural correlates for "repression" or memory suppression include dorsolateral prefrontal (DLPFC) cortex activation and hippocampal deactivation. Our objectives...
Article
Conversion disorder (CD) is a condition where neurological symptoms, such as weakness or sensory disturbance, are unexplained by neurological disease and are presumed to be of psychological origin. Contemporary theories of the disorder generally propose dysfunctional frontal control of the motor or sensory systems. Classical (Freudian) psychodynami...
Article
Full-text available
Background Conversion disorder (CD) is a psychiatric disorder, yet the diagnosis cannot be established without the expertise of a neurologist, as distinguishing a functional from an organic symptom relies on careful bedside examination. Joseph Babinski considered the absence of pronator drift as a ‘positive sign’ for hysterical paresis but the vali...
Article
Full-text available
Experts in the field of conversion disorder have suggested for the upcoming DSM-V edition to put less weight on the associated psychological factors and to emphasise the role of clinical findings. Indeed, a critical step in reaching a diagnosis of conversion disorder is careful bedside neurological examination, aimed at excluding organic signs and...
Article
To evaluate the efficacy of an early multidisciplinary (neurology and psychiatry) intervention for conversion disorder (CD). Consecutive patients newly diagnosed with CD from 2005 to 2007 were compared to a control group of newly diagnosed CD patients receiving usual care. At 3 years, a questionnaire evaluated self-rated subjective outcome, symptom...
Article
Full-text available
Objective: To detect anatomical differences in areas related to motor processing between patients with motor conversion disorder (CD) and controls. Methods: T1-weighted 3T brain MRI data of 15 patients suffering from motor CD (nine with hemiparesis and six with paraparesis) and 25 age- and gender-matched healthy volunteers were compared using vo...
Article
Objective Conversion disorder is the presence of neurological symptoms that are not due to neurological disease and are thought to be psychological in origin. It is assumed that patients have normal brain anatomy; structural brain abnormalities of potential aetiological relevance generally preclude the diagnosis. However, it remains possible there...
Article
Psychogenic neurologic disorders are common in clinical practice, but their underlying mechanisms are largely unknown. These disorders represent “functional” neurologic deficits, such as amnesia, paralysis, or somatosensory losses that are not explained by organic lesions in the nervous system but arise in the context of “psychogenic” stress or emo...
Article
Objective: Motor changes in major depression (MD) may represent potential markers of treatment response. Physiological rhythms (heart rate/gait cycle/hand movements) have been recently shown to be neither random nor regular but to display a fractal temporal organisation, possibly reflecting a unique central "internal clock" control. Sleep and mood...
Article
Aims Classical models of Conversion Disorder (CD) hypothesise that specific stressful experiences are “converted” into symptoms to relieve psychological pressure, and would suggest those experiences should be of a nature that allowed the “escape” from an unwelcome situation and would also tend to be underreported by patients. We sought to compare t...
Article
Conversion disorder presents a problem for the revisions of DSM-IV and ICD-10, for reasons that are informative about the difficulties of psychiatric classification more generally. Giving up criteria based on psychological aetiology may be a painful sacrifice but it is still the right thing to do.
Article
Positive occipital sharp transient of the sleep (POSTS) are considered a normal variant of non-REM sleep EEG. We describe a small series of patients with asymmetric POSTS and ipsilateral abnormal EEG findings. Over a period of 30 weeks, we prospectively observed five consecutive subjects with strictly unilateral POSTS associated with ispilateral el...