Function Neurologic Disorder

Question 1

Functional Movement disorder

Answer 1

abnormal involuntary movement that are incongruent with a known structural neurological cause

Question 2

How common is a referral to neurology for functional movement disorders

Answer 2

2nd most common referral

Question 3

What percentage of FND patients stop working

Answer 3

50%

Question 4

Is FND more common in women or men

Answer 4

women

Question 5

individuals with FND have to have an adverse life event

Answer 5

false

Question 6

What is FND pathophysiology?

Answer 6

lack of habituation to stimuli
automatic defensive behavior
overactive “fight or flight” response

increased activation of amygdala on fMRI

altered autonomic function
Lack of connection with bodily symptoms

Question 7

Common features of FND

Answer 7

sudden onset- can usually tell you the exact day and time the symptoms started
Rapid progression to very severe symptoms
variability in severity- very specific circumstances when the symptoms are better or worse
changes in phenomenology

Question 8

How has the new DSM-5 diagnostic criteria

Answer 8

clinical finding provide evidence for incompatibility between the symptoms and recognized neurological or medical conditions

Question 9

FND by DSM-5 criteria

Answer 9

1. one or more symptoms of altered voluntary motor or sensory function
2. physical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions
3. the symptom or deficit is not better explained by another medical or mental disorder
4. the symptom or deficit causes clinically significant distress or impairment in social, occupational or other important areas of functioning or warrants medical evaluation

Question 10

FMD is a diagnosed positively, NOT a diagnosis of ______

Answer 10

exclusion

Question 11

mismatch between impairments seen on ________ and _______ disability

Answer 11

examination and subjective disability

Question 12

During the exam the patient has

Answer 12

variability and distractibility

Question 13

La Belle indifference

Answer 13

lack of concern about symptoms even if they are severe and debilitating

Question 14

Functional tremor occurs in ____% of patients with FMD

Answer 14

50%

Question 15

describe a functional tremor

Answer 15

variability in amplitude, frequency or direction of tremor
improves with distraction

Question 16

Entrainment

Answer 16

tremor takes on frequency of contralateral movements

Question 17

Functional dystonia

Answer 17

fluctuations in severity and variation in tone with passive manipulation

Question 18

Functional gait disorder

Answer 18

complaints of unsteadiness
knee buckling gait is most common presentation

exaggerated compensatory maneuvers
-tightrope walking
-waling on ice
-huffing and puffing

Question 19

treatment of FMD

Answer 19

demonstration of positive examination features
role of attention and distraction techniques
potential reversibility of symptoms

Question 20

Mayo clinic FMD protocol

Answer 20

focus on aberrant movement and posture
appropriate patterns are reinforced
start with very elementary movements
use distracting motor tasks
positive gains are reinforced
repetition to lock in gains

Question 21

Current intervention themes for FND

Answer 21

reshaping movement patterns/behaviors
interdisciplinary team approach
listening, validating and establishing open communication
biopsychosocial model