FND Flashcards
(47 cards)
FND is the _ most common neuro diagnosis in neurology clinics
2nd most common
does FND affect women or men more?
women (3:1)
FND is a _ problem, not a _ problem
software (functional changes)
not a hardware (structural)
A group of neurons working together across structural/anatomical boundaries.
neural network
Thought to be 7-17 known neural networks in the brain, that are continuously communicating.
FND is a common neuropsychiatric condition that can vary significantly in presentation and include numerous symptoms such as…
weakness, seizures; sensory, speech, and cognitive changes.
age range for FND
4-94 years
mean onset late 30s
FND: level of physical disability similar to _
MS or epilepsy
*wide range of presentations, functional impairment depending on what subtype they present with
What are subtypes of FND
* Functional movement disorder
(We’ll likely see most frequently)
* Functional seizures
* Functional cognitive disorders
* Persistent perceptual postural dizziness (3PD or PPPD)
* Persistent post concussion symptoms (PPCS)
* Complex regional pain syndrome (CRPS)
who is the founder of modern neurology?
Charcot (described patterns of neurological symptoms, used hypnosis as a popular treatment strategy in 19th centruy)
Who recognized painful emotion with functional symptoms and start of epidemiology in the 19th century?
Briquet
T or F: Freud and PTSD from WW1 (shell shock) were influencers for concept of FND
TRUE
*neuro and psychology –> leading to symptoms
What do brain scans look like for someone with functional paralysis vs feigned paralysis?
- Feigned Paralysis: Primary motor cortex
- Functional paralysis: Primary motor cortex with connections to precuneus and vmPrefrontal cortex
What are 4 key patterns of signs and symptoms of FND?
rule IN signs (+ dx)
1. variable (stiff leg one day, paresis leg another day AND how long, where, and when CHANGES
2. distractible
3. entrainable
4. suppressible
symptoms can be altered by saying “can you copy me” or by asking them to tap their foot (example: hand tremor changes tempo to match foot tempo, can pause or stop)
entrainable
T or F: FND improves with dual tasking
true: distractible, suppressible and entrainable
T or F: FND is a DX of exclusion
T or F: FND is a purely psych condition/ONLY occurs with psych history
F and F
Diagnosis of inclusion of 4 signs
can occur without a psych comorbidity or prior stressful life event
DSM-5 criteria for FND diagnosis
1 or more symptoms of altered voluntary motor or sensory function
*Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
What may a subjective history of FND look like?
- waxing/waning
- complete remission at times
- altered types of movments
- migration through body
What may testing look like in a patient with FND?
variable
* entrainment test
* whack a mole test
* varying frequency and/or direction of tremor
external focus
* Hoover’s sign
* change in performance with dual task
* attention to body increases abnormal mvmt/weakness
What are other positive tests of FND?
- drift without pronation
- cocontraction around joint without spasticity
- collapsing weakness (buckle without fall)
- delayed and/or excessive startle
- dragging leg gait without circumduction ( or walking on ice)
- sensory loss pattern changing, perfect midline split down sternum
- speech struggle behaviors
- Over mouthing
- Excessive and/or exaggerated eye blinking
- facial contortions
- Effortful breathing
Which are validated motor signs for a positive diagnosis of FND?
- distractibility when engaging in motor/cog task
- variability: observe for changes/periods of unexplained improvement
- Hoover sign: weakness of hip extension resolved during resisted contralateral hip flexion
- Monoplegic leg dragging gait: weak leg dragging like piece of wood
General FND patterns: what to look for with diff Dx
- variable
- distractible
- sudden onset
- global weakness w/ no pattern
- suppressible
- entrainable
- full remissions
- Hoover signs
What are common co-morbid diagnoses with FND?
- autism (at least 1 symptom reported in 86.7%)
- EDS/HDS
- chronic pain (17% of ppl with chronic pain)
What constructs and neural circuits are related to FND?
agency: TPJ-based circuit
emotional processing: salience, limbic circuits
attention: fronto-parietal circuits
