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Functional neurological disorders: acute presentations and management

Hannah R Cock and Mark J Edwards
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DOI: https://doi.org/10.7861/clinmedicine.18-5-414
Clin Med October 2018
Hannah R Cock
AInstitute of Medical and Biomedical Education, St George's University of London, London, UK
BAtkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Trust, London, UK
Roles: professor of epilepsy and medical education, consultant neurologist
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Mark J Edwards
CInstitute of Molecular and Clinical Sciences, St George's University of London, London, UK
DAtkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Trust, London, UK
Roles: professor of neurology, consultant neurologist
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  • For correspondence: medwards@sgul.ac.uk
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    Table 1.

    Clinical features helpful in distinguishing epileptic from dissociative seizures.7–9

    Favour dissociative seizuresNot useful discriminators
    Long (>5 min) duration of individual eventsTongue biting (except significant lateral tongue biting)
    Fluctuating course (waxing and waning)Incontinence
    Asynchronous rhythmic movementsaGradual onset
    Pelvic thrustingaNon-stereotyped c
    Side-to-side head/body movements during a convulsionFlailing/thrashing movements
    Closed eyesOpisthotonous
    Ictal cryingHistory of associated Injuries
    Recall of items during eventb
    • ↵aCan be seen in frontal lobe focal seizures.

    • ↵bPatients often report being able to hear what is going on around them but not being able to respond.cClinical experience suggests that dissociative seizures are less stereotyped than epileptic seizures, but stereotyped attacks of itself does not argue strongly in favour or epilepsy. Features favouring epileptic seizures include prolonged post-event confusion and sterturous breathing.

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Functional neurological disorders: acute presentations and management
Hannah R Cock, Mark J Edwards
Clinical Medicine Oct 2018, 18 (5) 414-417; DOI: 10.7861/clinmedicine.18-5-414

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Functional neurological disorders: acute presentations and management
Hannah R Cock, Mark J Edwards
Clinical Medicine Oct 2018, 18 (5) 414-417; DOI: 10.7861/clinmedicine.18-5-414
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