Abstract Details

Title Heart Rate Variability and Cortisol Diurnal Profiles in Functional Movement Disorder Patients

Topic Movement Disorders

Presentation(s) P03 - (-)

Poster/Presentation
Number 059

Objective

Background BACKGROUND: FMD patients present with abnormal movements without known neurological cause, often presumed to have a "psychogenic" etiology. The goal of this study was to measure biomarkers of stress in FMD patients. Cortisol is the final effector hormone of the hypothalamic pituitary adrenal (HPA) axis and its secretion has found to be altered in patients with depression, post-traumatic stress disorder and other psychiatric disease. HRV, a measure of beat-to-beat variation in heart rate, is mediated by parasympathetic and sympathetic nervous system input and reduced HRV has been shown in depression and anxiety, associated with increased cardiac morbidity.

Design/Methods DESIGN/METHODS: 15 FMD patients and 15 matched healthy volunteers (HV) without significant medical illness underwent over-night EKG monitoring and salivary cortisol measurements at five times (bedtime, waking, 30 minutes after waking, noon and 3pm).

Results RESULTS: FMD patients were found to have reduced HRV compared to HV (p<0.05) with a decrease in parasympathetic activity (SDNN, standard deviation of NN intervals; NN50, number of interval differences of successive NN intervals greater than 50ms; high frequency power) and an increase in sympathetic nervous system activity (low frequency/high frequency ratio). Salivary cortisol levels were higher in FMD patients at all times of measurements, however not meeting statistical significance. Results were not found to be correlated with depression and SCL-90 scores.

Conclusions CONCLUSIONS: Results from this pilot study demonstrate decreased HRV and a trend towards higher cortisol levels in FMD patients which may represent a mechanism of vulnerability and needs to be explored further in future studies. No correlation with psychometric scores was found, suggesting that findings cannot be attributed to comorbid depression or anxiety disorders.

Authors/Disclosures
Kathrin LaFaver, MD, FAAN PRESENTER	Dr. LaFaver has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. LaFaver has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acorda. Dr. LaFaver has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for WALL, WALL & FRAUENHOFER, LLP. The institution of Dr. LaFaver has received research support from Ayers Foundation. Dr. LaFaver has received publishing royalties from a publication relating to health care. Dr. LaFaver has a non-compensated relationship as a Board Member with FND Society that is relevant to AAN interests or activities. Dr. LaFaver has a non-compensated relationship as a Medical Advisor with FND Hope that is relevant to AAN interests or activities.
	No disclosure on file
Mark Hallett, MD, FAAN (National Institutes of Health)	Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. Dr. Hallett has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainsway. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for VoxNeuro. Dr. Hallett has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for QuantalX. Dr. Hallett has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Hallett has received intellectual property interests from a discovery or technology relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received publishing royalties from a publication relating to health care. Dr. Hallett has received personal compensation in the range of $500-$4,999 for serving as a Speaker with International Parkinson and Movement Disorder Society. Dr. Hallett has a non-compensated relationship as a Past-President with Functional Neurological Disorder Society that is relevant to AAN interests or activities.
Francesco Muntoni, MD (UCL Institute of Child Health)	Dr. Muntoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sarepta. Dr. Muntoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Muntoni has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sarepta. Dr. Muntoni has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Biogen. Dr. Muntoni has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Muntoni has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. The institution of Dr. Muntoni has received research support from European Commission. The institution of Dr. Muntoni has received research support from Medical Research Council. The institution of Dr. Muntoni has received research support from Biogen. The institution of Dr. Muntoni has received research support from Muscular Dystrophy UK. The institution of Dr. Muntoni has received research support from MDA USA. The institution of Dr. Muntoni has received research support from Sarepta. The institution of Dr. Muntoni has received research support from Association Francoise Myopathies. Dr. Muntoni has received personal compensation in the range of $0-$499 for serving as a Clinical expert with UK NICE Committee.

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