Functional Neurological Symptoms

Question 1

Functional symptoms in medicine: gastroenterology

Answer 1

IBS

Question 2

Functional symptoms in medicine: endocrinology

Answer 2

Borderline TFTs

Question 3

Functional symptoms in medicine: respiratory

Answer 3

• Chronic cough

- Brittle ‘asthma’

Question 4

Functional symptoms in medicine: rheumatology

Answer 4

• Fibromyalgia

- Some chronic back pain

Question 5

Functional symptoms in medicine: gynaecology

Answer 5

• Chronic pelvic pain

- Some dysmenorrhoea

Question 6

Functional symptoms in medicine: cardiolgy

Answer 6

• Atypical/non-cardiac chest pain

- Some palpitations

Question 7

Functional symptoms in medicine: infectious diseases

Answer 7

Post viral chronic fatigue (CFS/ME)

Question 8

Functional symptoms in medicine: ENT

Answer 8

• Globus

- Functional dysphonia

Question 9

Definition of functional symptoms

Answer 9

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

Question 10

What is important when taking a history?

Answer 10

-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

Question 11

What may be found on examination?

Answer 11

• 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 12

What tests can assess functional weakness?

Answer 12

• Hoover’s sign

- Abductor’s sign

Question 13

What investigations can be carried out?

Answer 13

• MRI brain
• Negative video EEG
• Functional MRI

Question 14

How should functional symptoms be managed?

Answer 14

• Explain, reassure
• Use of metaphors to explain
• Discuss role of depression/anxiety (antidepressants)
• Referral
• Support organisations and information

Question 15

What are the outcomes of functional symptoms in neurology?

Answer 15

• Prognosis (attendance at A+E usually drops)
• Misdiagnosis (5%)
• Litigation
• Disability and incapacity benefits
• Aids and appliances