functional neurological symptoms

Question 1

what are functional neurological symptoms

Answer 1

change in function rather than structure of a system (blackouts, paralysis, abnormal movements)

symptoms not explained by a neurological disease

Question 2

give some examples of conditions that cause functional symptoms in neurology

Answer 2

dissociative disorders
conversion disorder
hypochondriasis
factitious disorder (purpose medical care)
munchausen
malingering (purpose material gain)
non-organis
psychosomatic 
abnormal illness behaviour

Question 3

what should be covered in a history of functional symptoms

Answer 3

List all symptoms

Ask about disability

Onset and Course - timeline

Dissociative symptoms

Illness beliefs

Social

• Work, money, the law, relationships
• History of abuse- second consultation

GET THE OLD NOTES

Question 4

what should be looked out for in an examination for functional symptoms

Answer 4

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 5

what is the hoovers sign and what does it indication

Answer 5

Hip extension is weak when tested directly
BUT
Hip extension is normal when the patient is asked to flex the opposite hip

can indicate functional paresis

Question 6

how can you test for functional sensory disturbance

Answer 6

Say “yes” when you feel me touch you and “no” when you don’t

Question 7

what investigations can be done for functional symptoms

Answer 7

MRI brain scan
- 10-15% incidental findings

Negative Video EEG

Functional MRI

Question 8

what is the management of functional symptoms

Answer 8

Explain what they do and don’t have
- Make a positive diagnosis

Indicate you believe them

Explain that it is

• Common
• Potential to get better
• Self-help is key to recovery

Metaphors
- Hardware and software

The role of depression/ anxiety
- Antidepressants

Question 9

where can you refer patients with functional symptoms

Answer 9

Psychiatry

Physical Rehabilitation

Psychology : cognitive behavioural therapy