RT Journal Article
SR Electronic
T1 Functional neurological disorders: acute presentations and management
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 414
OP 417
DO 10.7861/clinmedicine.18-5-414
VO 18
IS 5
A1 Hannah R Cock
A1 Mark J Edwards
YR 2018
UL http://www.rcpjournals.org/content/18/5/414.abstract
AB Functional neurological disorders (FND) are common and associated with significant morbidity and healthcare costs. Patients with FND often present acutely, particularly with dissociative seizures (resembling epilepsy) or persistent weakness resembling a stroke. History and careful observation and examination are critical to diagnosis, as investigations will often be normal or non-contributory. The nature of convulsive movements in dissociative seizures often differs from that in epilepsy, and long duration of individual events, waxing and waning, closed eyes and high reported frequency in an apparently well individual are all suggestive. In those with stroke-like episodes, demonstration of normal power even briefly (eg Hoover's sign, ‘give way’ weakness) together with distractability are positive physical features indicating a functional disorder. A positive diagnosis and clear non-judgemental explanation, backed up by reliable information sources associated with prompt onward referral to a neurologist can greatly reduce distress and ultimately improve outcomes.