FND Video Diagnosis

Question 1

Give examples of positive neurological signs for functional movement disorder.

Answer 1

▪️Tremor entrainment
▪️Hoover’s sign
▪️Degree of fluctuation

Question 2

What signs can you used to distinguish functional seizures from epileptic?

Answer 2

▪️Longer duration
▪️Closed eyes (and resistant)
▪️Hip thrusting
▪️Asynchronous movements
▪️Mirror sign
▪️Pain response

Question 3

Why might functional disorder follow organic disorder?

Answer 3

▪️Hyperfocus on the body
▪️Illness expectation

Question 4

Can functional symptoms be identified by videos?

Answer 4

Yes! - Hight rates of expert confidence and inter-rater reliability

Question 5

Eyes open during a seizure is suggestive of…

Answer 5

Epileptic seizure

Question 6

Head moving side to side and intense body rotating during a seizure is suggestive of…..

Answer 6

Functional/Non-epileptic seizure

Question 7

Eyes closed during a seizure is suggestive of….

Answer 7

Functional/Non-epileptic seizure

Question 8

Head in a fixed position and no rotation of the body during a seizure would be suggestive of….

Answer 8

Epileptic seizure

Question 9

Out-of-phase limb movements during a seizure is suggestive of….

Answer 9

Functional/Non-epileptic seizure

Question 10

Limbs moving in phase/same direction during a seizure would suggest….

Answer 10

Epileptic seizure

Question 11

How is the body axis typically in an epileptic seizure?

Answer 11

Straight/anterior flexion

Question 12

Opithotonus/arching of the body during a seizure is suggestive of….

Answer 12

Functional/Non-epileptic seizure

Question 13

What is the typically evolution of an epileptic seizure?

Answer 13

Non-interrupted and continuous

Question 14

What is the typically evolution of a functional/non-epileptic seizure?

Answer 14

Interrupted and fluctuating

Question 15

During what kind of seizure might the individual show writhing movements?

Answer 15

Functional/Non-epileptic

Question 16

What conditions are associated with secondary gain?

Answer 16

Factitious disorder and malingering

Question 17

What subgroup of people may have FND that presents more like feigning and why?

Answer 17

People with learning disabilities or lower IQ, possibly related to a simpler illness model

Question 18

How does mass psychogenic illness typically start?

Answer 18

With a high status individual in a group, often female

Question 19

What is Lyme borreliosis?

Answer 19

A spirochaetsl bacterial infection often transmitted by ticks

Question 20

What is the hallmark sign of Lyme disease?

Answer 20

A target rash spreading slowly from the site of the bite

Question 21

What is the first stage of Lyme disease?

Answer 21

Localised infection

▪️Rash at bite
▪️Systemic symptoms such as fever, chills, fatigue, aches
▪️Lymphadenopathy

Question 22

How long does the first stage of Lyme disease last?

Answer 22

2-30 days

Question 23

What is the second stage of Lyme disease?

Answer 23

Early disseminated infection

▪️Neurological (facial palsy, meningitis, radiculoneuritis)
▪️Musculoskeletal (myalgia, arthritis)
▪️Cardiovascular (rare)
▪️Ocular and hepatic (very rare)

Question 24

How long does the second stage of Lyme disease usually last?

Answer 24

Days/months

Question 25

What stages commonly follow the initial two of Lyme disease?

Answer 25

3. Encephalopathy (memory and concentration problems - cytokine mediated?)
4. Arthritis of large joints

Question 26

What are the rarer later stages of Lyme disease?

Answer 26

5. Late encephalomyelitis (spastic paraparesis, more severe cognitive impairment, cranial neuropathy, bladder dysfunction, dysarthria)
6. Acrodermatitis chronica atrophicans (late skin complication associated with peripheral neuropathy)

Question 27

What are the four proposed categories of “chronic Lyme disease”?

Answer 27

1. Unknown cause + no evidence of borrelia infection
2. Well-defined illness unrelated to borrelia infection
3. U know cause + antibodies against borrelia but not history of clinical findings consistent with Lyme
4. Post-Lyme disease syndrome (only one with post-Lyme symptoms)

Question 28

What is post-Lyme syndrome?

Answer 28

Symptoms with infective origin

▪️Untreated patients may present with late encephalomyelitis, MS-like presentation
▪️Treated patients may present with persistent nonspecific symptoms

Question 29

What is ‘chronic Lyme’ of functional aetiology?

Answer 29

Misdiagnosed condition in a patients with no objective clinical or laboratory evidence of current or previous Lyme disease

Question 30

Why is chronic Lyme disease so big in the media?

Answer 30

▪️Non specific symptoks
▪️Significant rates of false positivity despite low pre-test odds of disease