FND Video Diagnosis Flashcards
Give examples of positive neurological signs for functional movement disorder.
▪️Tremor entrainment
▪️Hoover’s sign
▪️Degree of fluctuation
What signs can you used to distinguish functional seizures from epileptic?
▪️Longer duration
▪️Closed eyes (and resistant)
▪️Hip thrusting
▪️Asynchronous movements
▪️Mirror sign
▪️Pain response
Why might functional disorder follow organic disorder?
▪️Hyperfocus on the body
▪️Illness expectation
Can functional symptoms be identified by videos?
Yes! - Hight rates of expert confidence and inter-rater reliability
Eyes open during a seizure is suggestive of…
Epileptic seizure
Head moving side to side and intense body rotating during a seizure is suggestive of…..
Functional/Non-epileptic seizure
Eyes closed during a seizure is suggestive of….
Functional/Non-epileptic seizure
Head in a fixed position and no rotation of the body during a seizure would be suggestive of….
Epileptic seizure
Out-of-phase limb movements during a seizure is suggestive of….
Functional/Non-epileptic seizure
Limbs moving in phase/same direction during a seizure would suggest….
Epileptic seizure
How is the body axis typically in an epileptic seizure?
Straight/anterior flexion
Opithotonus/arching of the body during a seizure is suggestive of….
Functional/Non-epileptic seizure
What is the typically evolution of an epileptic seizure?
Non-interrupted and continuous
What is the typically evolution of a functional/non-epileptic seizure?
Interrupted and fluctuating
During what kind of seizure might the individual show writhing movements?
Functional/Non-epileptic
What conditions are associated with secondary gain?
Factitious disorder and malingering
What subgroup of people may have FND that presents more like feigning and why?
People with learning disabilities or lower IQ, possibly related to a simpler illness model
How does mass psychogenic illness typically start?
With a high status individual in a group, often female
What is Lyme borreliosis?
A spirochaetsl bacterial infection often transmitted by ticks
What is the hallmark sign of Lyme disease?
A target rash spreading slowly from the site of the bite
What is the first stage of Lyme disease?
Localised infection
▪️Rash at bite
▪️Systemic symptoms such as fever, chills, fatigue, aches
▪️Lymphadenopathy
How long does the first stage of Lyme disease last?
2-30 days
What is the second stage of Lyme disease?
Early disseminated infection
▪️Neurological (facial palsy, meningitis, radiculoneuritis)
▪️Musculoskeletal (myalgia, arthritis)
▪️Cardiovascular (rare)
▪️Ocular and hepatic (very rare)
How long does the second stage of Lyme disease usually last?
Days/months
What stages commonly follow the initial two of Lyme disease?
- Encephalopathy (memory and concentration problems - cytokine mediated?)
- Arthritis of large joints
What are the rarer later stages of Lyme disease?
- Late encephalomyelitis (spastic paraparesis, more severe cognitive impairment, cranial neuropathy, bladder dysfunction, dysarthria)
- Acrodermatitis chronica atrophicans (late skin complication associated with peripheral neuropathy)
What are the four proposed categories of “chronic Lyme disease”?
- Unknown cause + no evidence of borrelia infection
- Well-defined illness unrelated to borrelia infection
- U know cause + antibodies against borrelia but not history of clinical findings consistent with Lyme
- Post-Lyme disease syndrome (only one with post-Lyme symptoms)
What is post-Lyme syndrome?
Symptoms with infective origin
▪️Untreated patients may present with late encephalomyelitis, MS-like presentation
▪️Treated patients may present with persistent nonspecific symptoms
What is ‘chronic Lyme’ of functional aetiology?
Misdiagnosed condition in a patients with no objective clinical or laboratory evidence of current or previous Lyme disease
Why is chronic Lyme disease so big in the media?
▪️Non specific symptoks
▪️Significant rates of false positivity despite low pre-test odds of disease
