Functional Neurologic Disorders Flashcards
negative vs positive symptoms of functional neuro disorders
negative - lack of movement (weakness)
positive - abnormal movements (tremors)
- clinical findings provide evidence of incompatibility between their symptoms and recognized neurological or medical condition
FND pathophys
pre-conscious phase of motor planning is “corrupted” by:
- abnormal involuntary brain-generated predictions
- interference from emotional oriented networks (limbic system, amygdala)
Where have fMRI and SPECT imaging shown increased activation?
Areas for regulating and expressing emotions
- orbitofrontal and cingulate regions
S&S of FND
- paralysis
- tremor
- dystonia
- sensory disturbances (including visual loss)
- speech disturbances - forced speech
- seizures
Internall inconsistent or Incongruent with recognized pathology
___________ can cause the motor symptoms to temporarily improve.
distraction
How to differentiate FND from CVA?
absent pronator drift
voluntary strength exam/motor signs
- “give way”/collapsing weakness
- co-contraction of agonist and antagonist
- weakness resolved with opposite and contralateral activation
- absent pronator drift
involuntary exam/motor signs
- highly variable (amplitude increase with weight load
- distractibility or entrainment
- “whack-a-mole”
gait assessment findings with FND
- leg dragging
- excessive visible effort
- falling towards a support
- excessive slowness, hesitation, or caution
- non-economic posture
- knee buckling
- chair test
non-motor, epileptic FND symptoms
- heightened emotional state (> 2 min)
- preserved consciousness
- resistance to passive eye-opening - will force their eyes closed
- rapid recovery from “seizure”
symptoms after seizure
- short duration (few seconds)
- no residual limb resistance
- loss bowel/bladder
- tongue damage
- post-ictal babinski
What patients have a better prognosis with FND?
younger and more acute patients
FND treatments
- education
- positive expectations of improvements
- open and consistent communication between team members
- limited hands-on intervention
- focus on task completion and automatic movements
- avoid use of AD as possible
- co-treat
