Psychogenic non-epileptic seizures among patients with functional neurological disorder: A case series from a Tanzanian referral hospital and literature review

ObjectiveForeign accent syndrome (FAS) is widely understood as an unusual consequence of structural neurological damage, but may sometimes represent a functional neurological disorder. This observational study aimed to assess the prevalence and utility of positive features of functional FAS in a large group of individuals reporting FAS.MethodsParticipants self-reporting FAS recruited from informal unmoderated online support forums and via professional networks completed an online survey. Speech samples were analysed in a subgroup.ResultsForty-nine respondents (24 UK, 23 North America, 2 Australia) reported FAS of mean duration 3 years (range 2 months to 18 years). Common triggers were: migraine/severe headache (15), stroke (12), surgery or injury to mouth or face (6) and seizure (5, including 3 non-epileptic). High levels of comorbidity included migraine (33), irritable bowel syndrome (17), functional neurological disorder (12) and chronic pain (12). Five reported structural lesions on imaging. Author consensus on aetiology divided into, ‘probably functional (n=35.71%), ‘possibly structural’ (n=4.8%) and ‘probably structural’ (n=10.20%), but positive features of functional FAS were present in all groups. Blinded analysis of speech recordings supplied by 13 respondents correctly categorised 11 (85%) on the basis of probable aetiology (functional vs structural) in agreement with case history assignment.ConclusionsThis largest case series to date details the experience of individuals with self-reported FAS. Although conclusions are limited by the recruitment methods, high levels of functional disorder comorbidity, symptom variability and additional linguistic and behavioural features suggest that chronic FAS may in some cases represent a functional neurological disorder, even when a structural lesion is present.

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EMDR to Treat Functional Neurological Disorder: A Review

Journal of EMDR Practice and Research ◽

10.1891/1933-3196.12.3.118 ◽

2018 ◽

Vol 12 (3) ◽

pp. 118-132 ◽

Cited By ~ 3

Author(s):

Sarah R. Cope ◽

Lucy Mountford ◽

Jared G. Smith ◽

Niruj Agrawal

Keyword(s):

Neurological Disorder ◽

Web Of Science ◽

Case Series ◽

Cochrane Library ◽

Functional Movement ◽

Treatment Pathway ◽

Prisma Statement ◽

Meta Analyses ◽

Emdr Therapy ◽

Functional Neurological Disorder

Eye movement desensitization and reprocessing (EMDR) therapy is an established treatment for posttraumatic stress disorder (PTSD), but there is increasing evidence for its use beyond PTSD. EMDR can be effective at treating distressing memories not associated with PTSD, as well as somatic symptoms (like chronic pain), and as such could potentially be used as a treatment for patients with functional neurological disorder (FND). Searches were conducted for published peer-reviewed articles on the use of EMDR for FND. The databases selected and searched were Medline, Embase, Cochrane Library, CINAHL Plus, Web of Science, PsychINFO, PubMed, and Francine Shapiro Library. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three relevant articles were found. The studies included are one case series and two case studies. Of the five participants included in the studies, four experienced functional non-epileptic attacks; and one experienced functional movement disorder. Four out of the five patients were successfully treated with EMDR. EMDR is potentially a useful treatment of FND, but further research, including controlled trials, is required. The authors propose that EMDR could be useful in treating patients with FND and comorbid PTSD, as well as patients without comorbid PTSD. We discuss the clinical implications and propose how EMDR could fit into the FND treatment pathway.

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A case series of sodium glucose co-transporter-2 inhibitor (SGLT-2i) related diabetic ketoacidosis and literature review of the possible pathophysiology

Endocrine Abstracts ◽

10.1530/endoabs.44.p75 ◽

2016 ◽

Author(s):

Jawad Bashir ◽

Steve Bain ◽

Irfan Khan ◽

Tamar Saeed

Keyword(s):

Literature Review ◽

Diabetic Ketoacidosis ◽

Case Series

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Faculty Opinions recommendation of Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735118803.793558383 ◽

2019 ◽

Author(s):

Jon Stone

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Neurological Disorder ◽

Case Control Study ◽

Case Control ◽

Control Study ◽

Functional Neurological Disorder

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Infrapopliteal Arterial Pseudoaneurysm Development Secondary to Blunt Trauma: Case Series and Literature Review

Vascular and Endovascular Surgery ◽

10.1177/1538574420907184 ◽

2020 ◽

Vol 54 (4) ◽

pp. 367-374

Author(s):

Matthew T. Chrencik ◽

Brian Caraballo ◽

John Yokemick ◽

Peter J. Pappas ◽

Brajesh K. Lal ◽

...

Keyword(s):

Literature Review ◽

Blunt Trauma ◽

Case Series ◽

Duplex Ultrasound ◽

Endovascular Coiling ◽

Skeletal Trauma ◽

Delay In Diagnosis ◽

Tibial Arteries ◽

Pulsatile Mass ◽

Orthopedic Injuries

Objectives: Infrapopliteal arterial pseudoaneurysms (IAP) following blunt trauma with associated orthopedic injuries are uncommon, often present in a delayed fashion, and encompass a diagnostic and therapeutic dilemma. Herein, we present a series of IAPs that were diagnosed following blunt trauma and their management. Methods: Case series consisting of 3 patients and a review of the international literature. Results: Our case series included 3 patients presenting with IAPs following blunt trauma with associated orthopedic injuries. They were all identified in a delayed manner (>3 weeks) after the orthopedic injuries were treated. All patients presented with pain and a pulsatile mass while one concurrently had neurologic deficits. The pseudoaneurysms were diagnosed by duplex ultrasound and confirmed by angiography to be originating from the tibioperoneal trunk, anterior tibial, and posterior tibial arteries respectively. Two patients were treated with surgical excision. Of these, one required an arterial bypass procedure while the other underwent direct ligation only. The third patient was treated by endovascular coiling. A literature review from 1950 to the present found 51 reported cases of IAP resulting from blunt trauma. Ninety percent of trauma-related infrapopliteal injuries occurred in men with a mean delay in diagnosis of 5.6 months (median 1.8 months) after injury. Since 1950, management has shifted from primarily ligation to incorporating minimally invasive endovascular techniques when appropriate. Conclusions: Infrapopliteal artery pseudoaneurysms are rare following blunt skeletal trauma. A delay in diagnosis often occurs and can result in major morbidity and extensive surgical intervention. We recommend a high index of suspicion and a thorough vascular examination in patients with lower extremity skeletal trauma to help identify and treat these injuries early and effectively.

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