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.
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.
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