Objective: Identify where the attentional focus naturally lies in functional movement disorders and evaluate which abnormal attentional foci contribute to symptom generation. The ultimate aim is to thereby improve treatment approaches.

Background: The most characteristic, yet intriguing feature of functional movement disorders is that they typically manifest with attention to the affected limb, and improve or even disappear with distraction [1]. It is unknown which aspect of attention is involved.

Method: The effect of different attentional foci on the performance of a reaching movement are analysed: attention onto the movement; onto the accuracy of the movement; onto the target; onto distraction tasks; onto somatosensory feedback; and attention away from visual feedback. The study involves twenty functional tremor patients, and two control groups (20 organic tremor patients and 20 healthy controls).

Results: Movement performance (straightness of the reaching trajectory) worsens with indirect, compared to direct visual feedback; with explicit attention to the movement; with slower movements; and when trying to make the movement as accurate as possible. Improvements on the other hand are found without visual feedback; with very fast movements; when the movement is performed without attributing any importance to it (“just move to the starting point in order to get ready”); and when simultaneously performing an auditory distraction task.

Conclusion: An unhelpful strategy for functional tremor patients is to focus on their movement, move slowly and try hard to be as accurate as possible. A better strategy is not to look at the limb while moving, perform it at a good speed, not give it any importance or distract oneself away from it. Simply telling our patients to “just ignore your movements” is certainly correct, but very difficult to implement. It is akin to the famous “Don ́t think of a pink elephant”. A more useful advice is to focus not on the intermediate, but on the ultimate result of the movement. A similar abstract was/will be presented at the Association of British Neurologists annual meeting, Birmingham September 2018 and Edinburgh May 2019, where as a one of their research fellows I am obliged to present my work.

References: [1] Edwards MJ, et al. Curr Opin Neurol. 2013; 26(4):442-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-role-of-attention-in-functional-movement-disorders/