Functional Neurological Disorders

Question 1

What is a functional neurological disorder?

Answer 1

Change in function rather than structure of system - blackouts, paralysis, abnormal movements
- symptoms not explained by known neurological disease

Question 2

What might you look for on examination in suspected functional neurological disorder?

Answer 2

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
Fixed dystonia complex regional pain after minor injury

Hoover’s sign

• A - Hip extension is weak when tested directly
• B - Hip extension is normal when patient asked to flex opposite hip

Question 3

What investigations might be done in suspected functional disorder?

Answer 3

MRI brain

• 10-15% incidental findings
• negative video EEG
• functional MRI

Question 4

How are functional disorders treated?

Answer 4

Explain what they do and don’t have - positive diagnosis
Indicate you believe them
Explain that it is common - potential for recovery
Depression/anxiety treatment

Referral

• psychiatry
• physical rehabilitation
• psychology - CBT

Support
- family, friends, carers, charity