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Functional neurological symptoms.

J Stone1

  • 1Department of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK. jon.stone@ed.ac.uk

The Journal of the Royal College of Physicians of Edinburgh
|March 3, 2011
PubMed
Summary
This summary is machine-generated.

Functional neurological symptoms are common and often misdiagnosed. This review offers practical guidance for confident diagnosis and management, emphasizing positive signs and a functional model for patient communication.

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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.