Failure of explicit movement control in patients with functional motor symptoms


  • Founding agencies: M.J.E. and T.A. are funded by the National Institute for Health Research (NIHR). A.S. is funded by the Guarantors of Brain. This work was undertaken at the University College London Hospitals/University College London, who received a proportion of funding from the Department of Health's NIHR Biomedical Research Center funding scheme.

  • Relevant conflicts of interest/financial disclosures: Dr Mark Edwards is funded by National Institute for Health Research (6187).

  • Full financial disclosures and author roles may be found in the online version of this article.

Correspondence to: Dr. Mark J. Edwards, Sobell Department, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom. E-mail:


Functional neurological symptoms are one of the most common conditions observed in neurological practice, but understanding of their underlying neurobiology is poor. Historic psychological models, based on the concept of conversion of emotional trauma into physical symptoms, have not been implemented neurobiologically, and are not generally supported by epidemiological studies. In contrast, there are robust clinical procedures that positively distinguish between organic and functional motor signs that rely primarily on distracting attention away from movement or accessing it covertly. We aimed to investigate the neurobiological principles underpinning these techniques and implications for understanding functional symptoms. We assessed 11 patients with functional motor symptoms and 11 healthy controls in three experimental set-ups, where voluntary movements were made either with full explicit control or could additionally be influenced automatically by factors of which participants were much less aware (one-back reaching, visuomotor transformation, and precued reaction time with variable predictive value of the precue). Patients specifically failed in those tasks where preplanning of movement could occur and under conditions of increasing certainty regarding the movement to be performed. However, they implicitly learned to adapt to a visuomotor transformation as well as healthy controls. We propose that when the movement to be performed can be preplanned or is highly predicted, patients with functional motor symptoms shift to an explicit attentive mode of processing that impairs kinematics of movement control, but movement becomes normal when such processes cannot be employed (e.g., during unexpected movement or implicit motor adaptation). © 2013 Movement Disorder Society