Avicenne Hospital (French: Hôpital Avicenne) is a Islamic hospital in Bobigny, Seine-Saint-Denis, in the northern suburbs of Paris. Opened in 1935 as the Franco-Muslim Hospital (Hôpital franco-musulman de Paris), it was built specifically to cater for North-African immigrants who had flocked to the Paris area. Renamed Avicenne in 1978, in memory of the Persian physician Avicenna, it is now a university hospital catering for the local population..
OBJECTIVES:Using network analysis, which takes a holistic approach to health systems, we aimed to identify which psychosocial burden dimensions are the most central and, thus, critical to prioritising to improve the overall health of people with type 1 diabetes (PwT1D). DESIGN:A cross-sectional network analysis. SETTING:We used data from participants attending 44 diabetes centres in France, who were enrolled in the SFDT1 cohort study between June 2020 and February 2024. PARTICIPANTS:We included 1430 PwT1D (52% women, median age (IQR) 41 (31-52.8) years) who had completed questionnaires on diabetes burden. OUTCOME MEASURES:The items from questionnaires on diabetes distress, fear of hypoglycaemia, quality of life, treatment burden and the impact of diabetes on education and work. RESULTS:The network was highly stable (correlation stability coefficient=0.75). We observed nine domains within the network; 'Loneliness, Worrying & Burnout' was the most influential. We further grouped the domains into three distinct syndromes labelled 'Diabetes Distress', 'Treatment Burden' and 'Impact of Diabetes on Life'. These syndromes reflect the most relevant pillars of the psychosocial burden in PwT1D. CONCLUSIONS:We observed that 'Loneliness, Worrying & Burnout' is the most influential psychosocial burden network domain to prioritise for type 1 diabetes care. This new network-based approach opens the path to defining personalised interventions targeting the most critical burden parameters to expect the most significant overall beneficial impact on PwT1D's health. TRIAL REGISTRATION NUMBER:NCT04657783.
Background: Functional neurological disorders (FNDs) are characterised by the presence of motor, sensory, or cognitive neurological symptoms not explained by a recognised neurological disorder. Chronic pain is not part of the diagnostic criteria for FND, but these two conditions frequently coexist. Our objective was to evaluate the frequency and mechanism-based characteristics of chronic pain symptoms in a single-center cohort of patients with FND. Methods: Data were collected prospectively using a standardised questionnaire and a face-to-face interview. Results: In this study, 63 consecutive patients with FND were interviewed, 54 (86%) of whom reported chronic pain. The onset of pain was associated with a traumatic event in 41% of patients. Pain was described as permanent in 65% of patients, primarily localised to the lower limbs (83%), but actually affecting several other body regions in the vast majority of cases (89%). Pain intensity averaged 5 to 6 out of 10, and its impact on daily activities was rated at 5.5 out of 10 on the Brief Pain Inventory. The description of pain symptoms was more consistent with neuropathic pain or cognitive symptoms of central sensitization than with nociceptive pain or emotional symptoms of central sensitization. Conclusion: Chronic pain is the most frequently reported symptom by patients, even more than other clinical symptoms specific to FND. This pain has a significant impact on the daily lives of patients. Significance: Chronic pain is very common in patients with functional neurological disorders and is characterised by highly varied pathophysiological mechanisms. Given its frequency, heterogeneity, and potential impact on other aspects of the functional neurological disorder and on its prognosis, improved management of chronic pain is needed in these patients, particularly through the optimisation of symptomatic treatment strategies.
PURPOSE OF REVIEW:Functional movement disorders (FMD) are common and potentially reversible causes of movement disorders, yet they remain under-recognized and frequently misdiagnosed. RECENT FINDINGS:Diagnosis has shifted from an exclusion-based model to a positive rule-in approach grounded in positive clinical signs such as inconsistency (distractibility and variability), with electrophysiology providing useful support in selected cases. Current pathophysiological models suggest that FMD arise from interacting abnormalities in predictive coding, sensorimotor integration, altered sense of agency, maladaptive attentional focus, and disrupted limbic-motor network connectivity. These mechanisms may contribute both to symptom generation and maintenance. Prognosis is variable and often guarded, highlighting the importance of early diagnosis and timely intervention. Management should rely on a clear and validating explanation of the diagnosis, individualized rehabilitation focused on movement retraining, and tailored psychotherapy addressing perpetuating cognitive, behavioral, and emotional factors. Pharmacological treatment has a mainly an adjunctive role, particularly for comorbid psychiatric symptoms, pain, and sleep disturbances. SUMMARY:FMD require an integrated, multidisciplinary, and patient-centered approach to optimize functional recovery and long-term outcomes.
