Functional Neurological Disorder: Overview and a Case Study

Published:September 21, 2021DOI:https://doi.org/10.1016/j.nurpra.2021.08.020

      Abstract

      Functional neurological disorder (FND) is a common and disabling condition that is associated with motor and sensory symptoms in the absence of structural lesions. Patients tend to be dismissed and/or often undergo extensive diagnostic evaluations that can be unrevealing. Current recommendations stress that FND be ruled in rather than ruled out and that this process is best initiated by primary care providers. Misdiagnosis is rare when careful analysis of symptoms and positive physical signs leads to an accurate assessment which results in improved treatment. A case study demonstrates the usefulness of this approach.

      Keywords

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      References

        • Stone J.
        • Burton C.
        • Carson A.
        Recognizing and explaining functional neurological disorder.
        BMJ. 2020; 371: m3745https://doi.org/10.1136/bmj.m3745
        • Clemente Fuentes R.W.
        • Bucaj M.
        • Wonnum S.
        Functional neurological disorder: a practical guide to an elusive Dx.
        J Fam Pract. 2021; 70: 69-79https://doi.org/10.12788/jfp.0155
        • Price J.R.
        • Okai D.
        Functional disorders and medically unexplained physical symptoms.
        Psychiatr Aspects Gen Med. 2018; 44: 706-710https://doi.org/10.1016/j.mpmed.2016.09.012
        • Espay A.J.
        • Aybek S.
        • Carson A.
        • Edwards M.J.
        • et al.
        Current concepts in diagnosis and treatment of functional neurological disorders.
        JAMA Neurol. 2018; 75: 1132-1141https://doi.org/10.1001/jamaneurol.2018.1264
        • Bennett K.
        • Diamond C.
        • Hoeritzauer I.
        • et al.
        A practical review of functional neurological disorder (FND) for the general physician.
        Clin Med (Lond). 2021; 21: 28-36https://doi.org/10.7861/clinmed.2020-0987
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
        American Psychiatric Association, 2013https://doi.org/10.1176/appi.books.9780890425596
        • O’Neal M.A.
        • Baslet G.
        Treatment for patients with a functional neurological disorder (conversion disorder): an integrated approach.
        Am J Psychiatry. 2018; 175: 307-314https://doi.org/10.1176/appi.ajp.2017.17040450
        • O’Neal M.A.
        • Baslet G.C.
        • Polich G.R.
        • Raynor G.S.
        • Dworetzky B.A.
        Functional neurologic disorders: the need for a model of care.
        Neurol Clin Pract. 2021; 11: e152-e156https://doi.org/10.1212/CPJ.0000000000000949
        • Popkirov S.
        • Stone J.
        • Buchan A.M.
        Functional neurological disorder: a common and treatable stroke mimic.
        Stroke. 2020; 51: 1629-1635https://doi.org/10.1161/STROKEAHA.120.029076
        • Perez D.L.
        • Aybek S.
        • Popkirov S.
        • et al.
        A review and expert opinion on the neuropsychiatric assessment of motor functional neurological disorders.
        J Neuropsychiatry Clin Neurosci. 2020; https://doi.org/10.1176/appi.neuropsych.19120357
      1. Brigham and Women’s Hospital Department of Rehabilitation Services Physical Therapy. Standard of care: functional neurological disorder.
        (Accessed April 1, 2021) (2019)
        • Nonnekes J.
        • Růžička E.
        • Serranová T.
        • et al.
        Functional gait disorders: a sign-based approach.
        Neurology. 2020; 94: 1093-1099https://doi.org/10.1212/WNL.0000000000009649
        • Stone J.
        • Sharpe M.
        Functional symptoms in neurology: case studies.
        Neurol Clin. 2006; 24: 385-403https://doi.org/10.1016/j.ncl.2006.01.008
        • Roelofs J.J.
        • Teodoro T.
        • Edwards M.J.
        Neuroimaging in functional movement disorders.
        Curr Neurol Neurosci Rep. 2019; 19: 12https://doi.org/10.1007/s11910-019-0926-y
        • Pringsheim T.
        • Edwards M.
        Functional movement disorders: five new things.
        Neurol Clin Pract. 2017; 7: 141-147https://doi.org/10.1212/CPJ.0000000000000350
        • O’Connell N.
        • Watson G.
        • Grey C.
        • et al.
        Outpatient CBT for motor functional neurological disorder and other neuropsychiatric conditions: a retrospective case comparison.
        J Neuropsychiatry Clin Neurosci. 2020; 32: 58-66https://doi.org/10.1176/appi.neuropsych.19030067

      Biography

      Jill Muhrer, DNP, FNP-BC, is an advanced nurse practitioner at the Early Intervention Program, Camden, NJ, and can be contacted at [email protected] .