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- Functional neurological disorders (FND) are unintentional and involuntary.
- Imaging and electrophysiological studies have shown cerebral dysfunctions in attention and perception, which may explain why symptoms often improve with distraction.
- Diagnosis requires demonstration of inconsistency and/or incongruency with recognized neurological or medical conditions.
- No clinical sign alone is diagnostic.
- Patients may have comorbidities such as multiple sclerosis, stroke, or epilepsy.
- Hoover’s sign and drift without pronation have been described as positive signs for FND.
- These can also be seen in patients with pain, neglect, or apraxia.
- Avoid maneuvers that may harm the patient, such as dropping their arm onto their face.
- A high-pitched tuning fork applied to the nostrils is an effective stimulus to assess responsiveness.
- Avoid using terms like non-organic, psychogenic, or pseudoseizure.
- When counseling a patient, avoid only explaining what conditions they do not have or attributing symptoms to psychological problems or stress.
- Instead, name the diagnosis, explain that their symptoms are real and common, and emphasize that symptoms are potentially reversible.
- Early diagnosis of FND is associated with improved physical and psychological outcomes.
Bottom Line: Functional neurological disorders (FND) are commonly encountered in the ED. A thorough neurological exam may reveal positive signs suggestive of FND. Early diagnosis and referral to specialists may improve outcomes.
References
Finkelstein SA, Cortel-LeBlanc MA, Cortel-LeBlanc A, Stone J. Functional neurological disorder in the emergency department. Acad Emerg Med. 2021 Apr 18 [Online ahead of print]
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