Functional neurological symptoms.

Area of Science:

• Neurology
• Psychiatry

Background:

• Functional neurological symptoms (FNS) are neurological conditions not explained by disease, often misdiagnosed as epilepsy or stroke.
• Common FNS include non-epileptic attacks and functional weakness, frequently encountered in emergency and general medical settings.

Purpose of the Study:

• To provide practical guidance on diagnosing and managing functional neurological symptoms.
• To address physician uncertainty regarding patient symptom validity and diagnostic confidence.

Main Methods:

• Review of existing literature and clinical experience regarding FNS.
• Emphasis on positive diagnostic signs (e.g., Hoover's sign) and characteristic features of non-epileptic attacks.
• Utilization of a 'functional' model for understanding and explaining symptoms.

Main Results:

• FNS are not 'made up' and have a low misdiagnosis rate when assessed by experts.
• Diagnosis relies on identifying positive signs of inconsistency rather than ruling out organic disease.
• A functional model aids in both conceptualizing and communicating the diagnosis to patients.

Conclusions:

• Confident diagnosis of FNS is achievable through specific clinical signs.
• Effective management strategies exist, often independent of detailed etiological understanding.
• A clear explanation using a functional model improves patient understanding and engagement.