Functional Neurological Disorders

Question 1

What is a functional symptom?

Answer 1

Medical symptoms with no known physical cause, arises from a problem in the functioning of the nervous system and not due to a structural or pathologically defined disease

Question 2

What are examples of functional symptoms?

Answer 2

• IBS in GI
• Chronic cough, brittle “asthma” in respiratory
• Chronic pelvis pain in gynaecology
• Non-cardiac chest pain, some palpitations in cardiology

Question 3

What parts of the history are important for functional symptoms?

Answer 3

• List all symptoms
• Ask about disability
  
  • What is a typical day like
• Onset and course
  
  • Timeline
  • “When last did you feel well”
  • “What happened with previous doctors”
• Dissociative symptoms
• Illness beliefs
• Social
  
  • Work, money, the law, relationships
  • History of abuse
    
    • Wait till second consultation
• Get the old notes

Question 4

What part of the examination is important for functional symptoms?

Answer 4

• Inconsistency
• Positive functional signs
• Absence of signs of disease
• Example is a tremor that disappears with distraction

Question 5

What is Hoover’s test?

Answer 5

When pressure is felt the paretic (slight or partial paralysis) leg when the non-paretic leg is raised and no pressure is felt in the non-paretic leg when the paretic leg is being raised

Question 6

What investigations are done for functional symptoms?

Answer 6

• MRI brain scan
  
  • 10-15% incidental findings
• Negative video EEG
• Functional MRI

Question 7

What is the management of functional symptoms?

Answer 7

• Explain what they do and do not have
  
  • Make a positive diagnosis
• Indicate you believe them
• Explain that it is
  
  • Common
  • Potential to get better
  • Self-help is key to recovery
• Consider depression/anxiety
  
  • Antidepressants
• Referral
  
  • Psychiatric
  • Physical rehabilitation
  • Psychological
    
    • Cognitive behavioural therapy
• Support organisations and information
  
  • Patient
  • Family
  • Friends
  • Carers
  • Charities