Functional Stroke Symptoms: A Narrative Review and Conceptual Model

Area of Science:

• Neurology
• Neuroscience
• Psychiatry

Background:

• Stroke services are increasingly focused on early intervention, leading to the identification of patients with functional symptoms mimicking stroke.
• A significant proportion of patients in stroke care pathways present with functional neurological symptoms, either in isolation or alongside vascular stroke.
• Current understanding of the mechanisms, management, and dedicated care pathways for functional stroke symptoms is limited.

Purpose of the Study:

• To propose a conceptual model for understanding functional symptoms within stroke services.
• To generate hypotheses regarding the underlying mechanisms and perpetuating factors of functional stroke.
• To inform the development of theory-based interventions and a dedicated care pathway for functional stroke.

Main Methods:

• A narrative review of the functional neurological disorder literature.
• Development of a conceptual model based on the review findings.
• Formulation of hypotheses regarding predisposing and perpetuating factors.

Main Results:

• Functional stroke symptoms are heterogeneous, with varied onset and duration, influenced by individual predisposing factors.
• Predisposing factors may include illness experiences, stressors, and chronic autonomic arousal.
• Perpetuating factors involve cognitive processes, conditioning, illness beliefs, and behavioral responses, offering potential treatment targets.

Conclusions:

• The proposed conceptual model provides a framework for understanding functional stroke symptoms.
• The identified factors suggest potential targets for theory-based interventions.
• The model supports the development of a much-needed functional stroke care pathway.