FND Flashcards
Criterion 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
Criterion B
Clinical findings provide evidence of incompatibility between their symptom and recognized neurological or medical condition
Psychological stressor is recorded as present or absent
who are front line for dx of FND
neurologist
current model of patho for FND
Pre-conscious phase of motor planning is “corrupted” by:
Abnormal involuntary brain-generated predictions
Interference from emotionally oriented networks
limbic system, amygdala
what type of issue is FND
motor planning
what was the first diagnostic imaging to confirm FND as dx
F-MRI
fMRI and SPECT show what
inc activation of orbitofrontal and cingulate regions
areas for regulating and expressing emotions
hx of FND
multiple s/s
onset and course
concers and expectations
stress/life events
TRIGGERING EVENTS
- amnesia around event
FND disorder of what
voluntary motor
sensory
genuine s/s of criteria A
Paralysis
Tremor
Dystonia
Sensory disturbances (including visual loss)
Speech disturbances (stutter, forced speech)
Seizures
types of FND
seizure and motor
ten you can have mixed - most common
what is a hallmark sign of FND
internally inconsistent
quacks like a horse
FND exam criterion B
Incongruency
Variability of symptoms
Distractibility – gets better
Enhancement with attention
Motor inconsistency
Suggestibility
voluntary signs of FND strength
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
involuntary FND signs tremor
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
gait assessment of FND
Leg dragging
Excessive visible effort (“huffing and puffing”)
Falling towards a support
Excessive slowness, hesitation, or caution
Non-economic posture
Knee buckling
“Chair test”
FND seizures (PNES)
PNES
heightened emotional state
duration = 2 min
preserved consciousness
resistance to passive eye opening
rapid recovery
- no postictal confusion
normal epileptic seizure
duration = usually few seconds
no residual limb resistance
loss b/b
tongue dmg
postical s/s
dx epileptic seizures
gold standard video EEG
FND criterion C
s/s or deficit NOT be better explained by other dx
comorbidities common
use of imaging
IE: EMG, EEG MRI
FND Criterion D
“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
pt edu on FND
Validate symptoms as genuine
Name the condition - FND
Brief mechanical explanation
Address effective and ineffective treatment
Foster hope for improvement
FND prognosis
Pediatric (better) vs adult
Acute (better) vs chronic
Multidisciplinary approach
changing up interventions better then not changing it up
FND OMs
PNES: frequency of seizures
PMDRS: Rating Scale for Psychogenic Movement Disorders
TEAM for FND
TEAM:
Psychiatry
Neurology
Therapists
PT, OT, ST
Not much pharma
More for anxiety, depression, sleep…
general FND tx focus
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
motor FND tx focus
retraining diverted attention
