Joint meeting with the British Psychological Society’s Division of Neuropsychology, the UK Functional Symptoms Research Group in collaboration with the ABN Cognitive Special Interest Group
This was my first time at the BNPA AGM, and I was attracted this year by their collaboration with the recently formed ABN Cognitive SIG. Getting to the heart of London was not as easy as I thought, especially on the second day when there was a bus strike in the capital! However, my efforts negotiating the jammed London transport system were rewarded by the sessions and lectures
As one might expect for such a meeting, there was a lot of material on functional neurology, an area with much crossover and interdisciplinary collaboration between psychiatrists, neurologists and neuropsychologists. The sessions were kicked off by Jon Stone, one of the few Neurologists who has taken on functional neurology as a bona fide and worthwhile subject for Neurologists, given how prevalent and disabling it is, and how little Neurologists have been interested in this area until recently. He spoke on functional cognitive symptoms and how to approach them.
Continuing on the theme, we heard Tony David give a very honest tour of recent fMRI experiments in functional conditions, which suffer the same limitations as most imaging correlations in neuroscience. I found one of his conclusions quite elegant: for a patient with functional loss – I say “I cannot”, it looks like “I will not”, it is “I cannot will”.
I thoroughly enjoyed the video sessions illustrating both functional disorders and not: dissociative seizure, fixed dystonia, Latah; but also paroxysmal kinesogenic dystonia and Pantothenate kinase 2 mutation.
Another towering figure in the neurology of functional (movement) disorders is Mark Edwards and he spoke on a Bayesian approach to describe how these phenomena can arise in the brain, i.e. how (false) expectations can drive and distort predictions and therefore perceptions, whilst inward attention would affect the sense of agency.
Marina de Koning-Tijsen gave an excellent talk on movement disorders and how to differentiate tics, myoclonus and functional jerks.
I thought the best session in the theme of functional disorders was by Glenn Nielsen on physiotherapy of such patients, which involved a lot of (re-)education, both cognitive and physical, resulting in astonishing results. It was both elating (because we can effectively treat even the most difficult cases) and depressing at the same time, because his sort of expertise is not widely available in all neurophysiotherapy departments in the country.
Another important theme, as would be expected, was memory. Here we heard from Adam Zeman on new theories of memory, and the zeitgeist shift from centres of memory (or any higher cortical domain) to networks. This immediately makes dementias into network disorders. In particular, for too long has early Alzheimer’s disease been studied as a pure hippocampal lesion study, while we are finally coming round to the realisation of it being better described by damage across selective networks e.g. the circuit of Papez and the default network.
Markus Reuber spoke on intrusive memories, such as flashbacks, deja vu and deja vecu, while Torsten Bartsch spoke on Transient Global Amnesia (TGA), which was first described by Charles Miller Fisher and Raymond Adams but later on by John Hodges. John Hodges was also an honoured speaker on the day, giving a tour de force on another condition which has consumed the latter part of his research career – Frontotemporal dementia (FTD) – where he spoke on the imperfect match between pathology, clinical phenotype and genetics of FTD. He focused on his recent work on behavioural variant FTD and FTD-MND, but also spoke on the language variants of semantic dementia and progressive non fluent aphasia.
The next big theme was on body image. Michael Trimble lectured on a conceptual history of the body image and the self, starting from the Discobolos and Narcissus in Ancient Greece, to Penfields’s homonculus, Macdonald Critchley’s corporeal awareness and the modern “selfie” as evidence of the dominance of narcissism in the modern world. Through this thesis, conditions such as schizophrenia, anorexia, hallucinations, heautoscopy, phantom limb phenomena, anosognosia, body image distortions in epilepsy and migraine and hysteria with regard to agency and body image can all be better conceptualised.
Peter Brugger spoke as an expert phantomologist, on phantom limb phenomena in amputees but also on a rare condition called xenophilia or apotemnophilia where people wish for a limb to be amputated.
James Rowe spoke on the pathognomonic and rare alien limb phenomenon in corticobasal degeneration, suggesting it arises, at least in part, by disinhibition, but also with loss of intention, to move the limb.
Giuseppe Valar spoke on neglect and its various manifestations, in particular of a form called somatoparaphrenia, where patients, usually with a right parietal lesion, develop a belief that their limb is not their own, but belongs to someone else.
The most inspired lecture of the conference, in my opinion, was by Katerina Fotopoulou, who spoke on her studies on disorders of body image and especially on successful therapeutic approaches of anosognosia and somatoparaphrenia using videos, mirrors and the “rubber hand illusion” with very encouraging results.
Finally, I must say I really enjoyed the “diagnostic masterclass” session where interesting cases were shared and discussed. I found the mixed audience discussions, where Neurologists and Psychiatrists came to different diagnostic conclusions after seeing videos of patients being assessed with various neurological conditions, most illuminating. The whole conference seemed dedicated to expounding the common substrate of both Neurologists and Psychiatrists and hence making a case for the two specialties to work in a more integrated way. Both sides increasingly see patients that would benefit from the specialist input of the other: Greater knowledge and communication between the two specialities provides our patients with the best chance of getting the correct diagnosis and optimal treatment.
ACNR 2015;15(2):30. Online 23/06/15