Functional Neurological Disorders Flashcards
definition of functional neurological disorders?
change in function rather than structure of a system (blackouts, paralysis, abnormal movements). Symptoms not explained by a neurological disease.
what should be covered in a history taking on functional symptoms in neurology?
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- second consultation
GET THE OLD NOTES
what should be looked for in examination of functional symptoms for neurology?
Inconsistency
Positive functional signs
Absence of signs of disease
Eye movements: convergence spasm
Tremor: disappears with distraction, entrainment
Paralysis:
Leg dragged, hip internally/ externally rotated
“Give way weakness”
Inverted pyramidal weakness (Extensors vs Flexors)
“Fixed” dystonia, complex regional pain after minor injury
what is hoovers sign?
Hoover’s sign was described by Dr. Charles Franklin Hoover more than 100 years back to differentiate between the organic and functional weakness of pyramidal origin. This test is usually performed in the lower limbs and is valuable when on bedside one is not sure about the nature of hemiparesis.
how is functional sensory disturbance assesed?
Say “yes” when you feel me touch you and “no” when you don’t
It typically affects all modes of sensation, either in a hemisensory distribution (“I feel as if I’m cut in half”) or affecting a whole limb.
what investigations are done to assess functional symptoms in neurology?
MRI brain scan
10-15% incidental findings
Negative Video EEG
Functional MRI
how are functional symptoms in neurology managed?
Explain what they do and don’t have
Indicate you believe them
Explain that it is
Common
Potential to get better
Self-help is key to recovery ⁸
Metaphors
Hardware and software
The role of depression/ anxiety
Antidepressants
potential referral to:
Psychiatry
Physical Rehabilitation
Psychology : cognitive behavioural therapy
what is prognosis of functional symptoms in neurology?
Regular A&E attendance dropped (50-18%) in 260 patients with non-epileptic attacks in Glasgow ⁹
6 months after diagnosis in non-epileptic attacks cost dropped by 84%¹⁰
what are different outcomes of functional symptoms in neurology?
Misdiagnosis
Same as other Neurological conditions 5% ¹¹
Litigation
Disability and incapacity benefits
Aids and appliances
Complaints
