Biological and perceived stress in motor functional neurological disorders.

Apazoglou, Kalliopi; Mazzola, Viridiana; Wegrzyk, Jennifer; Polara, Giulia Frasca; Aybek, Selma (2017). Biological and perceived stress in motor functional neurological disorders. Psychoneuroendocrinology, 85, pp. 142-150. Elsevier 10.1016/j.psyneuen.2017.08.023

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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 stress regulation in FND. Our aim was to study the biological and perceived response to stress in patients with motor FND. METHODS Sixteen patients with motor FND (DSM-5 criteria) and fifteen healthy controls underwent the Trier Social Stress Test. Hypothalamo-pituitary-adrenal axis (HPA) response was evaluated with salivary cortisol and autonomous sympathetic response with salivary alpha-amylase. Area under the curve was computed to reflect background levels (AUCg) and change over time (AUCi). Life adversities and perceived subjective stress on a visual analog scale (VAS) were correlated with biological responses. RESULTS FND patients had significantly higher background levels (AUCg) of both stress markers (cortisol and amylase) than controls. The biological response (AUCi) to stress did not differ between groups for both markers but the subjective response showed an interaction effect with patients reporting higher levels of stress than controls. After stress, controls showed a strong correlation between subjective and objective sympathetic values (amylase) but not patients. The number and subjective impact of adverse life events correlated with cortisol AUCg in patients only. CONCLUSION This study confirms a baseline HPA-axis and sympathetic hyperarousal state in motor FND related to life adversities. During a social stress, dissociation between perceived stress and biological markers was observed in patients only, reflecting a dysregulation of interoception capacity, which might represent an endophenotype of this disorder.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Aybek, Selma


600 Technology > 610 Medicine & health








Stefanie Hetzenecker

Date Deposited:

12 Oct 2017 11:06

Last Modified:

12 Oct 2017 11:06

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Amylase Conversion disorder Cortisol Functional neurological disorder Stress Trier social stress test




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