Functional Neurologic Disorders

Question 1

negative vs positive symptoms of functional neuro disorders

Answer 1

negative - lack of movement (weakness)

positive - abnormal movements (tremors)
- clinical findings provide evidence of incompatibility between their symptoms and recognized neurological or medical condition

Question 2

FND pathophys

Answer 2

pre-conscious phase of motor planning is “corrupted” by:
- abnormal involuntary brain-generated predictions
- interference from emotional oriented networks (limbic system, amygdala)

Question 3

Where have fMRI and SPECT imaging shown increased activation?

Answer 3

Areas for regulating and expressing emotions
- orbitofrontal and cingulate regions

Question 4

S&S of FND

Answer 4

• paralysis
• tremor
• dystonia
• sensory disturbances (including visual loss)
• speech disturbances - forced speech
• seizures

Internall inconsistent or Incongruent with recognized pathology

Question 5

___________ can cause the motor symptoms to temporarily improve.

Answer 5

distraction

Question 6

How to differentiate FND from CVA?

Answer 6

absent pronator drift

Question 7

voluntary strength exam/motor signs

Answer 7

• “give way”/collapsing weakness
• co-contraction of agonist and antagonist
• weakness resolved with opposite and contralateral activation
• absent pronator drift

Question 8

involuntary exam/motor signs

Answer 8

• highly variable (amplitude increase with weight load
• distractibility or entrainment
• “whack-a-mole”

Question 9

gait assessment findings with FND

Answer 9

• leg dragging
• excessive visible effort
• falling towards a support
• excessive slowness, hesitation, or caution
• non-economic posture
• knee buckling
• chair test

Question 10

non-motor, epileptic FND symptoms

Answer 10

• heightened emotional state (> 2 min)
• preserved consciousness
• resistance to passive eye-opening - will force their eyes closed
• rapid recovery from “seizure”

Question 11

symptoms after seizure

Answer 11

• short duration (few seconds)
• no residual limb resistance
• loss bowel/bladder
• tongue damage
• post-ictal babinski

Question 12

What patients have a better prognosis with FND?

Answer 12

younger and more acute patients

Question 13

FND treatments

Answer 13

• education
• positive expectations of improvements
• open and consistent communication between team members
• limited hands-on intervention
• focus on task completion and automatic movements
• avoid use of AD as possible
• co-treat