Lecture 38 Functional Neurological Symptoms

Question 1

Define Funcional Neurological Disorders

Answer 1

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

Question 2

Examination

Answer 2

o Inconsistency
o Positive functional signs
o Absence of signs of disease
o Eye movements: convergence spasm
o Tremor: disappears with distraction, entrainment
o Paralysis:
 Leg dragged, hip internally/ externally rotated
 “Give way weakness”
 Inverted pyramidal weakness (Extensors vs Flexors)
o “Fixed” dystonia, complex regional pain after minor injury
o 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.
o Functional sensory disturbance

Question 3

What is the diagnostic criteria for the diagnosis of conversion disorder

Answer 3

A. the patient has >1 symptoms of altered voluntary motor or sensory function
B. Clinical findings provide evidence of incompatibility between the symptom and recognised neurological or medical conditions
C. The symptom or deficit is not better explained by any other medical or mental disorder
D. The symptoms or deficit causes clinically significant distress or impairment in social, occupational or other important ares

Question 4

Investigations

Answer 4

• MRI brain scan
• Negative video EEG
• Functional MRI

Question 5

Management

Answer 5

–	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 ⁸
–	Metaphors
•	Hardware and software
–	The role of depression/ anxiety
•	Antidepressants
–	Referral 
•	Psychiatry
•	Physical Rehabilitation
•	Psychology : cognitive behavioural therapy
–	Support organisations and information
•	Patient
•	Family
•	Friends
•	Carers
•	Charities