Functional neurologic disorder is common and a significant cause of disability and stress in neurologic patients. The nature of this disorder has been unclear. Originally called hysteria, the disorder interested Charcot who postulated that a functional lesion, la lésion dynamique, was responsible. Recent studies of functional neurologic disorders now allow us to understand what la lésion dynamique is and identifies these disorders without ambiguity as arising from the brain. Functional neurologic disorders are best understood as a multifactorial process with a biopsychosocial model. There can be a genetic predisposition. Commonly there is early life trauma that leads to a developmental abnormality of the amygdala, including loss of inhibition. This abnormality can be considered a predisposing factor. When stressed, the amygdala becomes hyperactive, driving the limbic system to cause widespread network dysfunction in the brain. This dysfunction can improve, correlating with clinical improvement. Network dysfunction is becoming recognized as an important pathologic process in neurology and psychiatry, as real as any other pathology. We should be able to make progress in helping patients with functional neurologic disorders with this understanding of la lésion dynamique.

中文翻译：

---

功能性神经疾病，动态病变：2024 年瓦滕伯格讲座。


功能性神经障碍很常见，是神经系统患者残疾和应激的重要原因。这种疾病的性质尚不清楚。这种疾病最初被称为歇斯底里症，Charcot 对此很感兴趣，他假设功能性病变 la lésion dynamique 是造成该病灶的原因。最近对功能性神经疾病的研究现在使我们能够理解什么是 la lésion dynamique，并毫不含糊地将这些疾病识别为起源于大脑。功能性神经障碍最好理解为具有生物心理社会模型的多因素过程。可能存在遗传易感性。通常存在导致杏仁核发育异常的早期生活创伤，包括失去抑制。这种异常可以被认为是一个诱发因素。当受到压力时，杏仁核变得过度活跃，驱动边缘系统在大脑中引起广泛的网络功能障碍。这种功能障碍可以改善，与临床改善相关。网络功能障碍正被认为是神经病学和精神病学中的一个重要病理过程，与任何其他病理学一样真实。我们应该能够在帮助功能性神经系统疾病患者了解这种 la lésion dynamique 方面取得进展。