The purpose of this K23 Career Development Award application is to build the foundations for a successful pursuit of an independent clinical research career on psychogenic movement disorders (PMD). PMD are collectively the largest proportion of misdiagnosed, undertreated, and highly disabling entities seen at specialized movement disorders neurology clinics. There is little understanding of their pathophysiology and no universally accepted therapies. The candidate is seeking to capitalize on earlier work that concentrated on the electrophysiology of psychogenic dystonia, one of the common manifestations of PMD, which demonstrated for the first time abnormalities in inhibitory circuits until then believed to be only present in organic forms of the disorder. This proposed study will utilize functional magnetic resonance imaging (fMRI) to uncover specific abnormalities in emotional circuitry in patients with psychogenic tremor (PT), the most common forms of PMD; and will examine the therapeutic value of cognitive behavioral therapy (CBT) and its associated effects on neuronal circuitry. The data generated during the K23 effort will serve to gain educational and first-hand experience in fMRI/CBT and gather the preliminary data required for a competitive R01 application. The proposed work for the K23 application meets both a public health need (PMD are among the most expensive and least effectively managed neurological disorders) as well as an academic need by affording the candidate an unique and well-integrated combination of environmental and educational experiences: (1) an established fMRI center, the University of Cincinnati Center for Imaging Research (CIR); (2) the mentorship with successful fMRI researchers, Dr. Jerzy Szaflarski, who is also an expert in psychogenic non-epileptic seizures (PNES), a disorder related to PMD, and Dr Stephen Strakowski, Professor & Chair of Psychiatry, Professor of Psychology and Biomedical Engineering and Director of the CIR at the University of Cincinnati College of Medicine; (3) mentorship of Dr. Anthony Lang, a world expert in PMD; (4) mentorship of Dr. Curt LaFrance, a neuropsychiatrist who has successfully applied CBT to psychogenic populations, including NES and CBT; (5) the collaboration of Dr. Lawson Wulsin, a local expert in CBT; and (6) an educational program for the K23 tailored to allow the candidate to develop expertise in CBT technique and fMRI methodology, to which the candidate had no prior exposure during his fellowship or MSc training. Ultimately, the candidate will be equipped to become a successful independent investigator, advancing the knowledge and management of a largely neglected but promising group of disorders.

Public Health Relevance

Psychogenic tremor belongs to a group of conditions caused by psychological stress factors, known as psychogenic movement disorders. This study seeks to understand what changes occur in the activity of the brain of people with psychogenic tremor, which may explain how their tremor is different from other forms of tremor and from people without tremor. Also this study will appraise how cognitive behavioral therapy, a form of psychological therapy, may help the tremor and overall psychological make up of people with psychogenic tremor.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH092735-05
Application #
8843038
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
Chavez, Mark
Project Start
2011-07-15
Project End
2017-04-30
Budget Start
2015-05-01
Budget End
2017-04-30
Support Year
5
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Cincinnati
Department
Neurology
Type
Schools of Medicine
DUNS #
041064767
City
Cincinnati
State
OH
Country
United States
Zip Code
45221
Espay, Alberto J; Guskey, Michael T; Norton, James C et al. (2018) Pimavanserin for Parkinson's Disease psychosis: Effects stratified by baseline cognition and use of cognitive-enhancing medications. Mov Disord 33:1769-1776
Espay, Alberto J; Maloney, Thomas; Vannest, Jennifer et al. (2018) Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study. Neuroimage Clin 17:179-187
Espay, Alberto J; Maloney, Thomas; Vannest, Jennifer et al. (2018) Dysfunction in emotion processing underlies functional (psychogenic) dystonia. Mov Disord 33:136-145
Espay, Alberto J; Lang, Anthony E; Erro, Roberto et al. (2017) Essential pitfalls in ""essential"" tremor. Mov Disord 32:325-331
LaFaver, Kathrin; Espay, Alberto J (2017) Diagnosis and Treatment of Functional (Psychogenic) Parkinsonism. Semin Neurol 37:228-232
Merola, Aristide; Duker, Andrew P; Mandybur, George et al. (2017) Thalamic deep brain stimulation and gait in orthostatic tremor. Mov Disord 32:937-938
Merola, Aristide; Espay, Alberto J; Zibetti, Maurizio et al. (2017) Pure autonomic failure versus prodromal dysautonomia in Parkinson’s disease: Insights from the bedside. Mov Disord Clin Pract 4:141-144
Espay, Alberto J; Schwarzschild, Michael A; Tanner, Caroline M et al. (2017) Biomarker-driven phenotyping in Parkinson's disease: A translational missing link in disease-modifying clinical trials. Mov Disord 32:319-324
Erro, Roberto; Bhatia, Kailash P; Espay, Alberto J et al. (2017) The epileptic and nonepileptic spectrum of paroxysmal dyskinesias: Channelopathies, synaptopathies, and transportopathies. Mov Disord 32:310-318
Sokol, Leonard L; Espay, Alberto J (2016) Clinical signs in functional (psychogenic) gait disorders: a brief survey. J Clin Mov Disord 3:3

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