Functional Neurological Disorders

Question 1

Define a functional neurological disorder

Answer 1

Change in function rather than structure of a system (blackouts, paralysis, abnormal movements). Symptoms not explained by a neurological disease.

Question 2

What do you ask in the history of a functional neurological disorder?

Answer 2

• List all symptoms
• Ask about disability - “ What is a typical day like?”
• Onset and Course
• Dissociative symptoms
• Illness beliefs
• Social
  - Work, money, the law, relationships
  - History of abuse - second consultation

Question 3

What do you look for in the examination of a functional symptoms in neurological disorder?

Answer 3

• 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
• “Fixed” dystonia, complex regional pain after minor injury

Question 4

What is the Hoover’s sign?

Answer 4

• Hip extension is weak when tested directly.

* Hip extension is normal when the patient is asked to flex the opposite hip.

Question 5

What is a sign of functional weakness?

Answer 5

Hoover’s sign

Question 6

What is a sign of functional sensory disturbance?

Answer 6

Say yes when you feel the cotton bud/pin prick

Question 7

Name the investigations used in functional neurological disorders

Answer 7

• MRI brain scan
• Negative video EEG
• Function MRI

Question 8

Why is a MRI brain scan used?

Answer 8

To look at brain or spinal cord - must warn patient about incidental findings which may not be the cause of the problem

Question 9

Why is a negative video EEG used?

Answer 9

Blackout or dissociative attack, or non epiletptic seizures – EEG to capture events that they are experiencing and this shows that they are not experiencing epileptic fit

Question 10

What is the management of of functional neurological disorders?

Answer 10

• Explain what they do and don’t have - make a positive diagnosis
• Indicate you believe them and that it is common
• Self-help is key to recovery
• The role of depression/ anxiety - antidepressants
• Referral: psychiatry, rehabilitation, psychology (cognitive behavioural therapy)