What is a functional neurological disorder?
Anything causing symptoms without visible organic change in tissue
What history should be taken in a functional neurological disorder?
Symptoms Disability Onset and course Dissociative symptoms Illness beliefs Social Old notes
What is found on examination with functional neurological disorders?
Inconsistencies Positive functional signs Notable absence of disease signs Convergent eye spasms Tremor that disappears on distraction Paralysis Fixed dystonia
What is found in paralysis inFunctional neurological disorders?
Leg dragging, hip rotated
Inverted pyramidal weakness
What is fixed dystonia?
Fixed abnormal limb postures and pain after minor injury
What investigations should be done for functional neurological disorders?
MRI
Video EEG
Functional MRI- more research than clinical
What is the management of functional neurological disorders?
Give a positive diagnosis
Watch for mental health issues
Educate patient, friends and family
What is the prognosis of functional neurological disorders?
Reduction in attendance at A&E/GP after positive diagnosis
Misdiagnosis of 5%
What are the positive functional signs in functional neurological disorders?
Hoover’s sign
Functional sensory disturbance
What is Hoover’s sign?
Weak hip extension when asked but strong extension when feeling opposite hip flex
What is a functional sensory disturbance?
Sensory loss straight down midline