Functional neurological disorders

Question 1

List some examples of body systems and functional symptoms within these

Answer 1

GI - IBS 
endocrine - borderline TFT's 
MSK - chronic back pain 
cardio - palpitations and non cardiac chest pain 
gynaecology- dysmenorrhea 
rheumatology - fibromyalgia

Question 2

Define functional neurological disorders

Answer 2

Change in function rather than structure of a system eg blackouts and paralysis, and the symptoms are not explained by a neurological disease

Question 3

History of functional neurological disorders

Answer 3

disability 
symptoms 
onset and course 
look at old notes 
social 
dissociative symptoms

Question 4

What sign is used with functional weakness?

Answer 4

hoovers

Question 5

Describe hoovers sign

Answer 5

Hip extension is weak when tested directly but normal when asked to flex opposite hip

Question 6

How to test functional sensory disturbance

Answer 6

say yes when you feel me touch you and no when you don’t

Question 7

Investigations include…

Answer 7

MRI
EEG
functional MRI

Question 8

How to explain and manage functional neurological disorders

Answer 8

explain what they do and do not have and describe difference with metaphor eg software and hardware
indicate you believe them
role of depression and anxiety
explain it is common and need self help and good recovery

Question 9

Who to refer these patients to?

Answer 9

psychiatry
psychology
physical rehabilitation
support organisations

Question 10

Symptoms of functional neurological disorders on examination

Answer 10

paralysis 
tremor - disappears with distraction 
fixed dystonia 
inconsistency 
absence of signs of disease 
eye movements - convergence spasm 
positive functional signs