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Functional weakness and sensory loss.

Douglas J Lanska¹

¹VA Medical Center, Tomah, Wisconsin 54660, and Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA.

Seminars in Neurology

|June 23, 2006

Summary

Functional weakness and sensory loss are common neurological issues. Bedside tests aid diagnosis, but management requires a multidisciplinary approach addressing psychological and social factors for improved patient functioning.

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Area of Science:

Neurology
Psychiatry

Background:

Functional weakness and sensory loss are prevalent clinical challenges with diverse manifestations.
These conditions often present with inconsistencies and nonanatomic signs, complicating diagnosis.

Observation:

Specific bedside tests, such as the arm drop test and Hoover tests, can aid in diagnosing functional weakness.
Diagnostic tools for functional sensory loss, including the yes-no test, are available but often lack sensitivity and specificity.
Clinicians should consider the possibility of co-occurring organic and functional diagnoses.

Findings:

Recent research indicates a low misdiagnosis rate (<5%) for functional weakness and sensory loss.
Neurologists often find managing these patients more challenging than those with purely organic neurological conditions.

Implications:

Management strategies emphasize supportive psychotherapy, behavioral interventions, and addressing psychological and social issues.
Treatment also includes managing comorbid depression or anxiety and fostering adaptive coping mechanisms.
Many patients experience persistent or relapsing symptoms, impacting social, occupational, and psychological functioning.

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