Selma Aybek

• MD
• Researcher at University of Geneva / InselSpital Bern

Background Functional neurological disorder (FND) is linked to functional changes in brain networks without an underlying brain lesion. However, the dichotomy between functional and structural changes has been challenged by research suggesting that not only functional but also anatomical alterations in the gray and white matter may underlie a subs...

Background Functional cognitive disorder (FCD) poses a diagnostic challenge due to its resemblance to other neurocognitive disorders and limited biomarker accuracy. We aimed to develop a new diagnostic checklist to identify FCD versus other neurocognitive disorders. Methods The clinical checklist was developed through mixed methods: (1) a literatu...

Individuals diagnosed with functional neurological disorder experience abnormal movement, gait, sensory processing or functional seizures, for which research into the pathophysiology identified psychosocial contributing factors as well as promising biomarkers. Recent pilot studies suggested that (epi-)genetic variants may act as vulnerability facto...

Background Current models on functional neurological disorders (FND) propose a multifactorial origin. Recent studies identified potential biological vulnerability factors such as a reduced limbic volume or an altered stress response. These findings highlight the need to investigate a potential genetic contribution to the biological vulnerability to...

Objective Dissociative seizures are paroxysmal disruptions of awareness and behavioral control in the context of affective arousal. Alterations in stress‐related endocrine function have been demonstrated, but the timescale of dissociation suggests that the central locus coeruleus (LC) noradrenergic system is likely pivotal. Here, we investigate whe...

Background Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited. Objective Our aim was to provide an expert overview of the state of affairs of FND practice across Eu...

Objective. Dissociative seizures are paroxysmal disruptions of awareness and behavioural control in the context of affective arousal. Alterations in stress-related endocrine function have been demonstrated, but the timescale of dissociation suggests that the central locus coeruleus (LC) noradrenergic system is likely pivotal. Here, we investigate w...

Background Functional neurological disorder (FND) is a common neuropsychiatric condition with established diagnostic criteria and effective treatments but for which the underlying neuropathophysiological mechanisms remain incompletely understood. Recent neuroimaging studies have revealed FND as a multi-network brain disorder, unveiling alterations...

Background Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. Methods International experts in cognitive disorders were invited to assess s...

Functional neurological disorders’ (FND) neuropathophysiology has been described as multi-network disturbances including aberrancies in the agency network highlighting the role of the right temporo-parietal junction (rTPJ). Refining the relevance of the rTPJ. we applied a co-activation pattern (CAP) based approach using the rTPJ as seed in 58 patie...

Background Functional neurological disorders were historically regarded as the manifestation of a dynamic brain lesion which might be linked to trauma or stress, although this association has not yet been directly tested yet. Analysing large-scale brain network dynamics at rest in relation to stress biomarkers assessed by salivary cortisol and amyl...

Background The hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are connective tissue disorders characterized by generalized joint hypermobility, associated with chronic pain and several symptoms, such as fatigue, dysautonomia, as well as psychiatric co‐morbidities. Clinical observations of unusual manifestations...

Background Disrupted sense of agency (SoA)—the sense of being the agent of one’s own actions—has been demonstrated in patients with functional neurological disorder (FND), and a key area of the corresponding neuronal network is the right temporoparietal junction (rTPJ). Several functional MRI (fMRI) studies have found hypoactivation as well as hype...

Background and purpose Female gender, younger age and stressful life events are known predisposing factors for functional neurological disorders (FNDs). Employment in a healthcare profession has also been suggested to be a predisposing factor. We set out to conduct a large‐scale case–control study to estimate the rate employment in a healthcare pro...

After more than twenty years of academic research on functional neurological disorders (FND) throughout the world, a standardized care management strategy has emerged to allow a more adapted care offer to patients with FND, as close as possible to their experience and their needs. With regard to this special issue on FND in collaboration with L'Enc...

Objectives: To develop individual and effective treatment plans for patients with chronic pain, we aimed to replicate Grolimund et al's (2017) empirical categorization of chronic pain patients on a new and larger sample. Moreover, this work aimed to extend previous knowledge by considering various treatment outcomes and exploratorily analyzing whi...

As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary mu...

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people wit...

We set out to replicate findings of significant (a) reductions in pain, psychological distress, and motivational incongruence (i.e., insufficient motive satisfaction) after interdisciplinary multimodal pain treatment and (b) associations between reductions in motivational incongruence (i.e., improved motive satisfaction) and decreases in psychologi...

Stress is a well-known risk factor to develop a functional neurological disorder, a frequent neuropsychiatric medical condition in which patients experience a variety of disabling neurological symptoms. Only little is known about biological stress regulation, and how it interacts with predisposing biological and psychosocial risk factors. Dysregula...

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...

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...

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...

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...

Functional limb weakness often has an acute or subacute onset and tends to happen more often in females with a peak of onset during mid to late thirties. Making an early accurate diagnosis is important to avoid unnecessary tests or interventions and allow specific therapy to start. The diagnosis requires a thorough clinical examination looking for...

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...

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...

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...

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...

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...

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 (...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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....

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...