Functional Neurological Disorders Flashcards

1
Q

What is a functional symptom?

A

Medical symptoms with no known physical cause, arises from a problem in the functioning of the nervous system and not due to a structural or pathologically defined disease

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2
Q

What are examples of functional symptoms?

A
  • IBS in GI
  • Chronic cough, brittle “asthma” in respiratory
  • Chronic pelvis pain in gynaecology
  • Non-cardiac chest pain, some palpitations in cardiology
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3
Q

What parts of the history are important for functional symptoms?

A
  • List all symptoms
  • Ask about disability
    • What is a typical day like
  • Onset and course
    • Timeline
    • “When last did you feel well”
    • “What happened with previous doctors”
  • Dissociative symptoms
  • Illness beliefs
  • Social
    • Work, money, the law, relationships
    • History of abuse
      • Wait till second consultation
  • Get the old notes
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4
Q

What part of the examination is important for functional symptoms?

A
  • Inconsistency
  • Positive functional signs
  • Absence of signs of disease
  • Example is a tremor that disappears with distraction
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5
Q

What is Hoover’s test?

A

When pressure is felt the paretic (slight or partial paralysis) leg when the non-paretic leg is raised and no pressure is felt in the non-paretic leg when the paretic leg is being raised

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6
Q

What investigations are done for functional symptoms?

A
  • MRI brain scan
    • 10-15% incidental findings
  • Negative video EEG
  • Functional MRI
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7
Q

What is the management of functional symptoms?

A
  • Explain what they do and do not have
    • Make a positive diagnosis
  • Indicate you believe them
  • Explain that it is
    • Common
    • Potential to get better
    • Self-help is key to recovery
  • Consider depression/anxiety
    • Antidepressants
  • Referral
    • Psychiatric
    • Physical rehabilitation
    • Psychological
      • Cognitive behavioural therapy
  • Support organisations and information
    • Patient
    • Family
    • Friends
    • Carers
    • Charities
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