ORCID Profile
0000-0002-8283-9015
Current Organisations
King's College London
,
King's College Hospital
,
South London and Maudsley NHS Foundation Trust
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 11-01-2017
DOI: 10.1002/MDC3.12475
Publisher: Elsevier BV
Date: 06-2023
Publisher: Public Library of Science (PLoS)
Date: 18-01-2017
Publisher: BMJ
Date: 28-02-2020
Abstract: 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. A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. Five FND-specific measures were identified—three clinician-rated and two patient-rated—but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost–utility (eg, healthcare resource use and quality-adjusted life years). There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.
Publisher: SAGE Publications
Date: 26-03-2018
Abstract: Medical treatments have limited long-term effect in task-specific dystonia. Whilst evidence supports the use of rehabilitation, no randomised controlled trials have been undertaken. This small-scale study determined the feasibility of implementing and evaluating a mixed sensory–motor task-specific dystonia rehabilitative programme. Participants with writer’s or musician’s dystonia were recruited from a movement disorder and hand therapy clinic. Feasibility measures were recruitment rate, retention, session attendance, adherence to exercises. Self-report measures at 0, 3 and 6 months included: Arm Dystonia Disability Scale (ADDS), Tubiana and Chamagne Scale (TCS), Brief Illness Perception Questionnaire (BIPQ), Health Status (EQ-5D 5L), Clinical Global Impression Scale (CGI). Task performance was video-recorded at baseline and 6 months. At 6 months, interviews explored participant experiences of the intervention. Fifteen patients were recruited over 6 months (rate 2.5/month, musician’s dystonia = 8, writer’s dystonia = 7). Complete data sets were collected for twelve people(80%). The programme comprised a maximum six sessions plus daily home exercises. Nine completed the home programme at ≥75%. No adverse events were reported. Effect sizes at 3 and 6 months, respectively, were ADDS 3-month = 0.28, 6-month = 0.23 TCS 3-month = 0.13, 6-month = 0.53 BIPQ 3-month = 0.38, 6-month = 0.71 EQ-5D-5L 3-month = 0.34, 6-month = 0.59 video analysis at 6 months = 0.78. Eleven (92%) improved on the CGI. Interviews supported acceptability of the intervention. This intervention was feasible to deliver with high retention, adherence and acceptability. Improvements occurred across measures. This informs the development of future randomised controlled trials.
Publisher: American Psychiatric Association Publishing
Date: 10-2019
Publisher: American Psychiatric Association Publishing
Date: 2019
DOI: 10.1176/APPI.NEUROPSYCH.19060128
Abstract: 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 present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.
Publisher: Springer Science and Business Media LLC
Date: 04-01-2015
DOI: 10.1007/S00415-014-7631-1
Abstract: Patients with functional motor disorder (FMD) are commonly seen by physiotherapists and there is growing evidence to support a physical rehabilitation approach. There are, however, few descriptions in the literature of the content of successful physiotherapy treatment. This prospective cohort study reports the practicalities and outcomes of a pilot 5-day physiotherapy programme. Patients were referred from a specialist movement disorders clinic. The treatment consisted of education and movement retraining, with a long-term self-management focus. Education and movement retraining was based on a pathophysiological model for FMD that stresses the importance of self-focussed attention and illness belief. Patients were assessed at baseline, end of treatment and 3-month follow-up. 47 patients completed the programme, mean symptom duration was 5.5 years, 64 % were unemployed due to ill health. At the end of treatment, 65 % rated their symptoms as "very much improved" or "much improved", this reduced to 55 % at 3 months. At follow-up, there was a significant improvement in physical domains of the SF-36, Berg Balance Scale and 10 Metre Timed Walk. Measures of mental health did not change. This prospective cohort study adds to the growing evidence that supports the use of specialist physiotherapy treatment for FMD. Improvements here were made despite the cohort having characteristics associated with poor prognosis. We argue that specific treatment techniques are important and have the potential to improve physical function, quality of life and may prove to be a cost-effective treatment for selected patients with FMD.
Publisher: Royal College of Psychiatrists
Date: 09-2018
DOI: 10.1192/BJO.2018.55
Abstract: Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed. To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses. Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales. Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia. The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia. None.
Publisher: American Psychiatric Association Publishing
Date: 2019
DOI: 10.1176/APPI.NEUROPSYCH.19040083
Abstract: 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. Data were retrospectively collected from clinical records at three national referral centers, two specifically for motor FND and one for FND in general. Data were for 492 consecutive patients referred over a 9- to 15-month period: 100 from the United Kingdom clinic, 302 from the Swiss clinic, and 90 from the Canadian clinic. Data included symptom subtype and duration, comorbid pain and fatigue, disability, and treatment recommendations. The mean age of the 492 patients was 44 years, and most (73%) were female. Most had a prolonged motor FND (mean symptom duration of 6 years) 35% were not working because of ill health, 26% received disability benefits, and up to 38% required a care giver for personal care. In the Swiss cohort, 39% were given a diagnosis of another somatic symptom disorder rather than an FND diagnosis. Pain was common in the United Kingdom (79%) and Canada (56%), as was fatigue (48% and 47%, respectively). Most patients (61%) were offered physiotherapy referral to neuropsychiatry or psychology differed across centers (32%-100%). FND specialty clinics have an important role in ensuring correct diagnosis and appropriate treatment. Most patients with motor FND require specialized neurophysiotherapy. Patients readily accepted an integrated neuropsychiatric approach. Close collaboration between FND clinics and acute neurology facilities might improve early detection of FND and could improve outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-12-2017
DOI: 10.1212/WNL.0000000000004830
Abstract: To determine whether sensorimotor beta-frequency oscillatory power is raised during motor preparation in patients with functional movement disorders (FMD) and could therefore be a marker of abnormal “body-focused” attention. We analyzed motor performance and beta-frequency cortical oscillations during a precued choice reaction time (RT) task with varying cue validity (50% or 95% congruence between preparation and go cues). We compared 21 patients with FMD with 13 healthy controls (HCs). In HCs, highly predictive cues were associated with faster RT and beta desynchronization in the contralateral hemisphere (contralateral slope −0.045 [95% confidence interval (CI) −0.057 to −0.033] vs ipsilateral −0.033 [95% CI −0.046 to −0.021], p 0.001) and with a tendency for reaching lower contralateral end-of-preparation beta power (contralateral −0.482 [95% CI −0.827 to −0.137] vs ipsilateral −0.328 [95% CI −0.673 to 0.016], p = 0.069). In contrast, patients with FMD had no improvement in RTs with highly predictive cues and showed an impairment of beta desynchronization and lateralization before movement. Persistent beta synchronization during motor preparation could reflect abnormal explicit control of movement in FMD. Excessive attention to movement itself rather than the goal might maintain beta synchronization and impair performance.
Publisher: BMJ
Date: 11-04-2012
Abstract: Functional (psychogenic) motor symptoms are commonly encountered in clinical neurology. Physiotherapy has face validity as a treatment for such symptoms and, anecdotally, referral of patients with functional motor symptoms (FMS) to physiotherapy services is common practice by neurologists. Here the authors sought to explore exposure to and attitudes towards patients with FMS among neurophysiotherapists. The authors used an internet survey to gather information on the knowledge and attitudes of patients with FMS among 1402 members of a UK neurophysiotherapy organisation. The response rate was 61%. Most physiotherapists saw patients with FMS, and for 25% of respondents these patients made up over 10% of their workload. Respondents were moderately interested in treating these patients (ranking them sixth out of 10 neurological conditions), but had low self-judged knowledge. Most respondents felt physiotherapy had more to offer patients with FMS, but felt poorly supported by referring neurologists and by inadequate service structures. Neurologists frequently refer patients with FMS to neurophysiotherapy services. Physiotherapists in general are interested in treating such patients and feel physiotherapy to be an appropriate treatment. However, inadequate service structures, knowledge and support from non-physiotherapy colleagues are judged to be barriers to provision of care.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JPSYCHORES.2013.05.006
Abstract: Functional (psychogenic) motor symptoms (FMS), also called motor conversion disorder or non-organic motor symptoms are a common cause of disability and distress among patients attending neurology and neurorehabilitation services. Patients with FMS are often referred for physiotherapy but it is not clear whether this is effective. Here we aim to systematically review the literature regarding physiotherapy interventions for patients with functional motor symptoms. Systematic review of databases with reference search for period 1950 to September 2012. There was only one controlled intervention study with a historical control group and 28 case series or reports describing interventions. The total number of patients in all studies was 373. Physiotherapy most commonly occurred in the context of multidisciplinary treatment and involved a motor learning approach. Novel approaches included the use of distraction techniques and transcutaneous electrical nerve stimulation (TENS) machine. Deceptive behavioural techniques have also been described. Most studies reported benefit from physical treatment, including some studies with long-term follow up. Patients with FMS are commonly encountered in neurological practice and are often referred for physiotherapy. The existing data to guide physiotherapy treatment for FMS is of low quality and limited in scope. However, it suggests potential positive effects and provides a useful resource for developing and testing physiotherapy interventions in future studies.
Publisher: American Medical Association (AMA)
Date: 09-2018
Publisher: Springer Science and Business Media LLC
Date: 21-10-2019
DOI: 10.1186/S12883-019-1461-9
Abstract: Patients with functional motor disorder (FMD) experience persistent and disabling neurological symptoms such as weakness, tremor, dystonia and disordered gait. Physiotherapy is usually considered an important part of treatment however, sufficiently-powered controlled studies are lacking. Here we present the protocol of a randomised controlled trial (RCT) that aims to evaluate the clinical and cost effectiveness of a specialist physiotherapy programme for FMD. The trial is a pragmatic, multicentre, single blind parallel arm randomised controlled trial (RCT). 264 Adults with a clinically definite diagnosis of FMD will be recruited from neurology clinics and randomised to receive either the trial intervention (a specialist physiotherapy protocol) or treatment as usual control (referral to a community physiotherapy service suitable for people with neurological symptoms). Participants will be followed up at 6 and 12 months. The primary outcome is the Physical Function domain of the Short Form 36 questionnaire at 12 months. Secondary domains of measurement will include participant perception of change, mobility, health-related quality of life, health service utilisation, anxiety and depression. Health economic analysis will evaluate the cost impact of trial and control interventions from a health and social care perspective as well as societal perspective. This trial will be the first adequately-powered RCT of physical-based rehabilitation for FMD. International Standard Randomised Controlled Trials Number ISRCTN56136713 . Registered 27 March 2018.
Publisher: Informa UK Limited
Date: 22-01-2019
Publisher: American Society for Clinical Investigation
Date: 05-2008
DOI: 10.1172/JCI34438
Publisher: BMJ
Date: 30-09-2016
Abstract: To determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS). A randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months. 60 in iduals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46-0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087. This feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed. NCT02275000 Results.
Publisher: Wiley
Date: 26-12-2013
DOI: 10.1002/MDS.25791
Abstract: Musician's dystonia (MD) affects 1% to 2% of professional musicians and frequently terminates performance careers. It is characterized by loss of voluntary motor control when playing the instrument. Little is known about genetic risk factors, although MD or writer's dystonia (WD) occurs in relatives of 20% of MD patients. We conducted a 2-stage genome-wide association study in whites. Genotypes at 557,620 single-nucleotide polymorphisms (SNPs) passed stringent quality control for 127 patients and 984 controls. Ten SNPs revealed P < 10(-5) and entered the replication phase including 116 MD patients and 125 healthy musicians. A genome-wide significant SNP (P < 5 × 10(-8) ) was also genotyped in 208 German or Dutch WD patients, 1,969 Caucasian, Spanish, and Japanese patients with other forms of focal or segmental dystonia as well as in 2,233 ethnically matched controls. Genome-wide significance with MD was observed for an intronic variant in the arylsulfatase G (ARSG) gene (rs11655081 P = 3.95 × 10(-9) odds ratio [OR], 4.33 95% confidence interval [CI], 2.66-7.05). rs11655081 was also associated with WD (P = 2.78 × 10(-2) ) but not with any other focal or segmental dystonia. The allele frequency of rs11655081 varies substantially between different populations. The population stratification in our s le was modest (λ = 1.07), but the effect size may be overestimated. Using a small but homogenous patient s le, we provide data for a possible association of ARSG with MD. The variant may also contribute to the risk of WD, a form of dystonia that is often found in relatives of MD patients.
Publisher: Proceedings of the National Academy of Sciences
Date: 24-04-2017
Abstract: Infection with Leishmania ( Viannia ) parasites can have different manifestations, ranging from localized cutaneous to disseminated and mucocutaneous leishmaniasis, that are prone to relapse after the healing. We previously described the association of the endosymbiont Leishmania RNA virus 1 (LRV1) with increased disease severity. Here, we showed that coinfection with the lymphocytic choriomeningitis virus (LCMV) or Toscana virus exacerbated the outcome of Leishmania guyanensis -induced murine leishmaniasis, favoring parasite persistence and dissemination resulting in metastasis. Both endogenous and exogenous coinfections were dependent upon type I interferon responses. Strikingly, LCMV coinfection after the healing of leishmaniasis induced disease reactivation, overriding the protective adaptive immune response. Thus, viral infections may be a significant risk factor contributing to the pathological spectrum of human leishmaniasis.
Publisher: Wiley
Date: 10-05-2014
DOI: 10.1111/EJN.12613
Abstract: Surround inhibition (SI) is a neural process that has been extensively investigated in the sensory system and has been recently probed in the motor system. Muscle-specific modulation of corticospinal excitability at the onset of an isolated finger movement has been assumed to reflect the presence of SI in the motor system. This study attempted to characterise this phenomenon in a large cohort of normal volunteers and investigate its relationship with muscle activity in the hand. Corticospinal excitability of the pathways projecting to three hand muscles [first dorsal interosseus (FDI), abductor pollicis brevis (APB) and abductor digiti minimi (ADM)] and electromyographic (EMG) activity of the same muscles were assessed in 31 healthy volunteers during an isolated index finger movement. In the agonist FDI muscle both corticospinal excitability and EMG activity were found to be increased at the onset of the movement (P < 0.001 and P < 0.001, respectively). On the contrary, in the surround ADM, there was dissociation between the corticospinal excitability (decreased: P < 0.001) and EMG activity (increased: P < 0.001). Cross-correlation analysis of the EMG activity showed that neuronal signals driving the agonist and surround muscles are not synchronised when SI is present. The results suggest a distinctive origin of the neuronal signals driving the agonist and surround muscles. In addition, they indicate that cortical output might be simultaneously modulated by voluntary and non-voluntary activity, generated in cortical and subcortical structures, respectively.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: No location found
No related grants have been discovered for Mark Edwards.