Functional Neurological Disorders Flashcards
why did FND change to no longer a diagnosis of exclusion
improved diagnostic methods
failure to distinguish co-diagnoses in studies
in DSM-5 what is FND considered
a rule in disorder
what is the criteria for the physical exam
one or more symptoms of altered voluntary motor or sensory function
what is a negative symptom for physical exam criteria
lack of movement - weak
what is a positive symptoms for physical exam criteria
abnormal movement - tremor
what criteria is part of semilogical features
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
what is the pre-conscious phase of motor planning corrupted by
abnormal involuntary brain generated predictions
interference from emotionally oriented networks - limbic, amygdala
a fMRI and SPECT imaging have shown increased activation of what
orbitofrontal and cingulate regions - areas for regulating & expressing emotions
symptoms of FND
multiple symptoms that don’t make sense
paralysis
tremor
dystonia
sensory/speech disturbances
seizures
what is the most common FND
mixed - seizure & motor
what are some positive diagnostic signs
functional limb weakness - hoovers sign, hip abductor sign
functional movement disorders
functional/dissociative seizures
functional visual signs
voluntary motor signs
strength examinations –
give way / collapsing weakness
co-contraction of agonist and antagonist
weakness from resolved with opposite and contralateral activation
absent pronator drift
involuntary motor signs
tremor -
highly variable - amplitude increase with weight load
distractibility or entrainment
“whack-a-mole”
what is commonly seen in the gait assessment with FND
leg dragging
excessive visible effort
falling towards a support
excessive slowness, hesitation, caution
non-economic posture
knee buckling
“chair test”
psychogenic non-epileptic seizures
functional/dissociative seizures
look like what?
heightened emotional state
preserved consciousness
resistance to passive eye-opening
rapid recovery - no postictal confusion
common reasons for missing the dx of FND
an absence of psychological comorbidity
no prior functional disorders
pt that dont fit a false stereotypical profile - like male, older, working
common reasons for making a wrong dx of FND
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
FND examination criteria D include what
symptoms or deficits cause clinically significant distress or impairment in social, occupational or other areas warranting medical eval
prognosis of FND
better prognosis for peds and acute onset
do interventions help FND
no change or improvement
what are some FND treatments
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
