Freund, P; Friston, K; Thompson, AJ; Stephan, KE; Ashburner, J; Bach, DR; Nagy, Z; ... Weiskopf, N; + view all Freund, P; Friston, K; Thompson, AJ; Stephan, KE; Ashburner, J; Bach, DR; Nagy, Z; Helms, G; Draganski, B; Mohammadi, S; Schwab, ME; Curt, A; Weiskopf, N; - view fewer (2016) Embodied neurology: an integrative framework for neurological disorders. Brain , 139 (6) pp. 1855-1861. 10.1093/brain/aww076.

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Abstract

From a systems biology perspective, the brain and spinal cord are interwoven with the body, through afferent and efferent synaptic connections—they are literally ‘embodied’ (Adams et al., 2013). Neurologists appreciate the embodied nature of neurological disorders in terms of diagnosis, classification and their understanding of the underlying pathophysiology. They routinely use a combination of physical examinations (e.g. scales that test motor, sensory and autonomic function) in conjunction with physiological, biochemical and anatomical measures (e.g. electrophysiology, serum and CSF, and radiology) of the peripheral and central nervous system. These measures often produce combinations of symptoms and signs that translate into conventional nosological classifications. While therapeutics focus on the ‘treatable’ cause of a disorder, it is difficult to separate out the impact on the patient due to the primary effects of a lesion/insult etc. and the effects of (possibly delayed) secondary processes that may be reasonable targets for interventions on their own. Moreover, standard neurological assessments often fail to distinguish between pathogenic and compensatory processes. This state of affairs calls for a better understanding of neurological disease within a formal framework that links pathology to phenomenology (i.e. symptoms, impairment and physical signs). We suggest that such a framework should pay special attention to the embodied nature of the nervous system and the implicit pathophysiological and compensatory processes that can be present throughout the neuroaxis. In particular, we postulate that reciprocal information flows, between the body and the nervous system, are crucial for understanding and treating neurological disorders. This framework aims to link pathology to phenomenology, while respecting the ‘embodied’ nature of the nervous system. If fully realized, the framework of embodied neurology has the potential to improve functional outcome following individualized treatment (i.e. precision neurology), promote successful translation of novel therapeutics into clinical use, and refine nosology in the context of disease heterogeneity.Our description of embodied neurology is largely theoretical and is based on a series of focused workshops. It draws on recent advances in biophysical modelling of functional (Deco et al., 2008) and microstructural processes and neuroimaging (Weiskopf et al., 2015). These advances—together with preclinical research—constitute the three tenets of embodied neurology: biophysical modelling, quantitative physiological measures (with an emphasis on non-invasive neuroimaging) and preclinical research on basic mechanisms. These three have a particular focus on the entire nervous system.

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