Deficit in late-stage contingent negative variation provides evidence for disrupted movement preparation in patients with conversion paresis

• Similar movement performance in conversion and feigned paresis.
• Diminished CNV amplitude in patients for symptomatic limb precues only.
• Reduced CNV may be due to an inhibitory mechanism suppressing preparatory processes.
• Results indicate impaired motor preparation and execution in conversion paresis.
• The CNV data but not performance measures segregated the patients from the feigners.

Conversion paresis is the presence of unexplained weakness without detectable neuropathology that is not feigned. To examine the ‘abnormal preparation’ and ‘disrupted execution’ hypotheses proposed to explain the movement deficits in conversion paresis, electroencephalographic, electromyographic and kinematic measures were recorded during motor preparation and execution. Six patients with unilateral upper limb conversion weakness, 24 participants feigning weakness and 12 control participants performed a 2-choice precued reaction time task. Precues provided advance information about the responding hand or finger. Patients and feigners demonstrated similar diminished force, longer movement time and extended duration of muscle activity in their symptomatic limb. Patients showed significantly suppressed contingent negative variation (CNV) amplitudes, but only when the symptomatic limb was precued. Despite the similarity in performance measures, this CNV suppression was not seen in feigners. Diminished CNV for symptomatic hand precues may reflect engagement of an inhibitory mechanism suppressing cortical activity related to preparatory processes.