Neurosciences Functional Neurological Disorder Masterclass · 2020. 5. 12. · with functional...
Transcript of Neurosciences Functional Neurological Disorder Masterclass · 2020. 5. 12. · with functional...
Kingrsquos Health Partners
Neurosciences
Functional Neurological
Disorder Masterclass
Neurological assessment in functional disorders
a positive approach
Dr Biba Stanton Consultant Neurologist Kingrsquos College Hospital
NHS Foundation Trust and South London and Maudsley NHS
Foundation Trust and Visiting Senior Lecturer Kingrsquos College
London
9th May 2019
bull Understand the importance of a positive approach to diagnosing functional symptoms
bull Know the key positive signs of FND in the neurological examination and their reliability
bull Feel confident in talking about the diagnosis of FND to your patients
Patient presents with symptoms
bull AampE medical ward outpatients
Diagnosis
bull History examination investigations
bull Recognise typical patterns and exclude other possibilities
Treatment
bull Explain the diagnosis
bull Treat what we can
bull Refer on to other professionals
bull Are we more concerned about over-diagnosing FND than other disorders and does this relate to stigma about mental distress
bull What are the potential harms of not making a clear diagnosis of FND
history
ldquoSymptoms not explainable by neurological diseaserdquo
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
bull Understand the importance of a positive approach to diagnosing functional symptoms
bull Know the key positive signs of FND in the neurological examination and their reliability
bull Feel confident in talking about the diagnosis of FND to your patients
Patient presents with symptoms
bull AampE medical ward outpatients
Diagnosis
bull History examination investigations
bull Recognise typical patterns and exclude other possibilities
Treatment
bull Explain the diagnosis
bull Treat what we can
bull Refer on to other professionals
bull Are we more concerned about over-diagnosing FND than other disorders and does this relate to stigma about mental distress
bull What are the potential harms of not making a clear diagnosis of FND
history
ldquoSymptoms not explainable by neurological diseaserdquo
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
Patient presents with symptoms
bull AampE medical ward outpatients
Diagnosis
bull History examination investigations
bull Recognise typical patterns and exclude other possibilities
Treatment
bull Explain the diagnosis
bull Treat what we can
bull Refer on to other professionals
bull Are we more concerned about over-diagnosing FND than other disorders and does this relate to stigma about mental distress
bull What are the potential harms of not making a clear diagnosis of FND
history
ldquoSymptoms not explainable by neurological diseaserdquo
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
bull Are we more concerned about over-diagnosing FND than other disorders and does this relate to stigma about mental distress
bull What are the potential harms of not making a clear diagnosis of FND
history
ldquoSymptoms not explainable by neurological diseaserdquo
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
history
ldquoSymptoms not explainable by neurological diseaserdquo
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
ldquoSymptoms not explainable by neurological diseaserdquo
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
ldquoSymptoms not explainable by neurological diseaserdquo
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
Picture from Stone et al 2005 JNNP
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
Highly reliable
bull Give way weakness
bull Hooverrsquos sign
bull Co-contraction
bull Splitting the midline
bull Splitting of vibration sense
bull Drift without pronation
Reliable
bull ldquoSpinal injury testrdquo
bull Sternocleidomastoid
bull Collapsing weakness
bull Systematic failure
bull Non-anatomical sensory loss
bull Leg dragging
bull Expressive behaviour
Suggestive
bull Falls always towards support
bull Non-economic posture
bull Knee buckling
bull Irregular drift
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
Not just about the way you explain the diagnosis
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
ldquojust be normalrdquo
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
Label Number needed to offend
All in the mind 2
Hysterical weakness 2
Psychosomatic weakness 3
Medically unexplained 3
Stress-related weakness 6
Chronic fatigue 7
Functional weakness 9
Stroke 9
Multiple sclerosis 22
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
bull Motor
bull Seizures
bull Pain ldquoa change in the way the brain processes sensory informationrdquo bull Acute pain arises from tissue damage but chronic pain usually arises from changes in pain
processing so that pain is perceived even though no tissue damage is present
bull Cognitive symptoms ldquoa problem with attention rather than memoryrdquo bull Depleted attentional reserve bull Cognitive hypervigilance bull Shift from automatic to effortful cognitive processing
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61
bull Daum C Hubschmid M Aybek S The value of positive clinical signs for weakness sensory and gait disorders in conversiondisorder a systematic and narrative review J Neurol Neurosurg Psychiatry 2014 Feb85(2)180-90
bull Edwards M Functional neurological symptoms welcome to the new normal Practical Neurology Feb 2016 16 (1) 2-3
bull Stone J Functional neurological disorders the neurological assessment as treatment Stone J Pract Neurol2016167ndash1
bull Stone J1 Edwards M Trick or treat Showing patients with functional (psychogenic) motor symptoms their physical signs Neurology 2012 Jul 1779(3) 282-4
bull Kaski D1 Bronstein AM2 Edwards MJ3 Stone J4 Lancet Neurol Cranial functional (psychogenic) movement disorders 2015 Dec14(12)1196-205
bull Carson A1 Lehn A2 Ludwig L1 Stone J1 Explaining functional disorders in the neurology clinic a photo story Pract Neurol 2016 Feb16(1)56-61