Functional Neurological Disorders

Question 1

why did FND change to no longer a diagnosis of exclusion

Answer 1

improved diagnostic methods
failure to distinguish co-diagnoses in studies

Question 2

in DSM-5 what is FND considered

Answer 2

a rule in disorder

Question 3

what is the criteria for the physical exam

Answer 3

one or more symptoms of altered voluntary motor or sensory function

Question 4

what is a negative symptom for physical exam criteria

Answer 4

lack of movement - weak

Question 5

what is a positive symptoms for physical exam criteria

Answer 5

abnormal movement - tremor

Question 6

what criteria is part of semilogical features

Answer 6

clinical findings are incompatibility btw their symptom and recognized neurological or medical condition

psychological stressor is recorded as present/absent

neurologists are front line for dx

Question 7

what is the pre-conscious phase of motor planning corrupted by

Answer 7

abnormal involuntary brain generated predictions

interference from emotionally oriented networks - limbic, amygdala

Question 8

a fMRI and SPECT imaging have shown increased activation of what

Answer 8

orbitofrontal and cingulate regions - areas for regulating & expressing emotions

Question 9

symptoms of FND

Answer 9

multiple symptoms that don’t make sense

paralysis
tremor
dystonia
sensory/speech disturbances
seizures

Question 10

what is the most common FND

Answer 10

mixed - seizure & motor

Question 11

what are some positive diagnostic signs

Answer 11

functional limb weakness - hoovers sign, hip abductor sign
functional movement disorders
functional/dissociative seizures
functional visual signs

Question 12

voluntary motor signs

Answer 12

strength examinations –

give way / collapsing weakness
co-contraction of agonist and antagonist
weakness from resolved with opposite and contralateral activation
absent pronator drift

Question 13

involuntary motor signs

Answer 13

tremor -

highly variable - amplitude increase with weight load
distractibility or entrainment
“whack-a-mole”

Question 14

what is commonly seen in the gait assessment with FND

Answer 14

leg dragging
excessive visible effort
falling towards a support
excessive slowness, hesitation, caution
non-economic posture
knee buckling
“chair test”

Question 15

psychogenic non-epileptic seizures
functional/dissociative seizures

look like what?

Answer 15

heightened emotional state
preserved consciousness
resistance to passive eye-opening
rapid recovery - no postictal confusion

Question 16

common reasons for missing the dx of FND

Answer 16

an absence of psychological comorbidity
no prior functional disorders
pt that dont fit a false stereotypical profile - like male, older, working

Question 17

common reasons for making a wrong dx of FND

Answer 17

placing too much emphasis on psychological comorbidity
relying on single signs rather than combinations
relying on normal tests
unusual or unexpected symptoms, but no positive diagnostic signs of FND

Question 18

FND examination criteria D include what

Answer 18

symptoms or deficits cause clinically significant distress or impairment in social, occupational or other areas warranting medical eval

Question 19

prognosis of FND

Answer 19

better prognosis for peds and acute onset

Question 20

do interventions help FND

Answer 20

no change or improvement

Question 21

what are some FND treatments

Answer 21

co-treat
education of FND
positive expectation of improvement
open and consistent communication btw team members
limit hands on intervention
focus on task completion and automatic movements
avoid use of AD