Functional Neurological Symptoms

Question 1

What is 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

Common symptoms of FND?

Answer 2

Non-epileptic seizures, muscle weakness, functional sensory disturbance

Question 3

What is found on examination of a functional 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
• “Give way weakness”
• Inverted pyramidal weakness (Extensors vs Flexors)
• “Fixed” dystonia, complex regional pain after minor injury

Question 4

What is the hoover’s sign?

Answer 4

Hoover’s sign. (A) Hip extension is weak when tested directly. (B) Hip extension is normal when the patient is asked to flex the opposite hip.

Question 5

What are relevant investigations for FND?

Answer 5

MRI brain scan
Negative Video EEG
Functional MRI

Question 6

What is management of FND?

Answer 6

Explain to the patient what they do and don’t have
Indicate that you believe them
Explain that there is a potential to get better and that the condition is common
REFER - psychiatry, physical rehabilitation and psychology (cognitive behavioural therapy)
Support organisations and information for the patient, family, friends and careers