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Neuro 2 > FND > Flashcards

FND Flashcards

1
Q

Criterion A

A

One or more symptoms of altered voluntary motor or sensory function
Negative symptoms: lack of movement - weakness
Positive symptom: abnormal movement - tremors

physical exam

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2
Q

Criterion B

A

Clinical findings provide evidence of incompatibility between their symptom and recognized neurological or medical condition
Psychological stressor is recorded as present or absent

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3
Q

who are front line for dx of FND

A

neurologist

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4
Q

current model of patho for FND

A

Pre-conscious phase of motor planning is “corrupted” by:
Abnormal involuntary brain-generated predictions
Interference from emotionally oriented networks
limbic system, amygdala

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5
Q

what type of issue is FND

A

motor planning

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6
Q

what was the first diagnostic imaging to confirm FND as dx

A

F-MRI

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7
Q

fMRI and SPECT show what

A

inc activation of orbitofrontal and cingulate regions

areas for regulating and expressing emotions

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8
Q

hx of FND

A

multiple s/s
onset and course
concers and expectations
stress/life events

TRIGGERING EVENTS
- amnesia around event

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9
Q

FND disorder of what

A

voluntary motor
sensory

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10
Q

genuine s/s of criteria A

A

Paralysis
Tremor
Dystonia
Sensory disturbances (including visual loss)
Speech disturbances (stutter, forced speech)
Seizures

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11
Q

types of FND

A

seizure and motor

ten you can have mixed - most common

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12
Q

what is a hallmark sign of FND

A

internally inconsistent

quacks like a horse

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13
Q

FND exam criterion B

A

Incongruency
Variability of symptoms
Distractibility – gets better
Enhancement with attention
Motor inconsistency
Suggestibility

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14
Q

voluntary signs of FND strength

A

Strength Examinations
“Give-way”/collapsing weakness – caught yourself
*Could also be from pain, different from functional weakness

Co-contraction of agonist and antagonist

Weakness resolved with opposite and contralateral activation

Absent pronator drift =hands forward and one starts to drop and pronate
Differentiate from CVA

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15
Q

involuntary FND signs tremor

A

Tremor - main point

Highly variable
Amplitude increase with weight load

Distractibility (makes it better) or Entrainment
Mimics external frequency

“Whack-a-mole” = as you head in to one the impairment bounces around and slowly comes into all over the place which shouldn’t make sense

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16
Q

gait assessment of FND

A

Leg dragging
Excessive visible effort (“huffing and puffing”)
Falling towards a support
Excessive slowness, hesitation, or caution
Non-economic posture
Knee buckling
“Chair test”

17
Q

FND seizures (PNES)

A

PNES
heightened emotional state
duration = 2 min

preserved consciousness

resistance to passive eye opening

rapid recovery
- no postictal confusion

18
Q

normal epileptic seizure

A

duration = usually few seconds

no residual limb resistance

loss b/b
tongue dmg
postical s/s

19
Q

dx epileptic seizures

A

gold standard video EEG

20
Q

FND criterion C

A

s/s or deficit NOT be better explained by other dx

comorbidities common

use of imaging
IE: EMG, EEG MRI

21
Q

FND Criterion D

A

“Symptoms or deficits cause clinically significant distress or impairment in social, occupational or other areas warranting medical evaluation”
Health-related Quality of Life
PNES < epilepsy
Motor FND = PD, MS

22
Q

pt edu on FND

A

Validate symptoms as genuine
Name the condition - FND
Brief mechanical explanation
Address effective and ineffective treatment
Foster hope for improvement

23
Q

FND prognosis

A

Pediatric (better) vs adult
Acute (better) vs chronic
Multidisciplinary approach

changing up interventions better then not changing it up

24
Q

FND OMs

A

PNES: frequency of seizures
PMDRS: Rating Scale for Psychogenic Movement Disorders

25
Q

TEAM for FND

A

TEAM:
Psychiatry
Neurology
Therapists
PT, OT, ST

Not much pharma
More for anxiety, depression, sleep…

26
Q

general FND tx focus

A

Education of FND
Positive expectations of improvements
Open and consistent communication between team members – psych is lead
Limited hands on intervention
Focus on task completion and automatic movements
Avoid use of AD as possible
Co-treat other diagnoses

27
Q

motor FND tx focus

A

retraining diverted attention

Neuro 2 (9 decks)

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