scholarly journals Revising a diagnosis of functional neurological disorder—a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Alex J Berry ◽  
Sarah Wiethoff
Keyword(s):  
Case Report ◽  
Functional Impairment ◽  
Symptom Onset ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Neurodegenerative Disorder ◽  
Evidence Base ◽  
Clinical Progression ◽  
Degree Of Confidence ◽  
Functional Neurological Disorder

ABSTRACT We report a case of a 62-year-old female diagnosed with functional neurological disorder (FND), where the diagnosis was eventually revised to progressive supranuclear palsy 3 years after symptom onset. FND is a commonly encountered condition and can be diagnosed with a considerable degree of confidence in most cases. FND is associated with significant functional impairment and may occur alongside other neurological disorders, and there is now a growing evidence base for symptom-specific FND treatments. Charting clinical progression of symptoms and serial neuroimaging were useful in refining the diagnosis in this case. Alhough the diagnosis was ultimately revised to a neurodegenerative disorder, a degree of functional overlay likely remained present. The case highlights the importance of recognizing and avoiding diagnostic overshadowing in those with FND.

scholarly journals Psychedelic treatment of functional neurological disorder: a systematic review

2020 ◽  
Vol 10 ◽  
pp. 204512532091212 ◽  
Author(s):  
Matthew Butler ◽  
Mathieu Seynaeve ◽  
Timothy R. Nicholson ◽  
Susannah Pick ◽  
Richard A. Kanaan ◽  
...  
Keyword(s):  
Neurological Disorder ◽  
Neural Circuits ◽  
Therapeutic Potential ◽  
Conversion Disorder ◽  
Evidence Base ◽  
Control Groups ◽  
Recent Interest ◽  
Psychedelic Drugs ◽  
Neuropsychiatric Conditions ◽  
Functional Neurological Disorder

Functional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatric services, yet the therapeutic evidence base is somewhat limited. There has been recent interest in the therapeutic potential of psychedelics such as psilocybin and lysergic acid diethylamide (LSD), and in recent studies psychedelics have shown promise in treating a range of neuropsychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 and 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified. In most cases, patients received a course of psychotherapy with variable adjunctive administration of psychedelics (in a combination known as ‘psycholytic therapy’), with protocols varying between studies. Of those treated, 69% ( n = 18) were found to have made at least some recovery on heterogeneous and subjective clinician-rated criteria. Adverse events were mostly mild and transient; however, at least one patient terminated the study due to distressing effects. All included studies were of low quality, often lacking control groups and valid outcome measures. Although no conclusions on efficacy may be drawn from these data, further research may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.

scholarly journals Functional neurological disorders in patients with brain tumours

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Charmaine Toh ◽  
Dorothy Joe ◽  
Katia Cikurel ◽  
Julia Johnson ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Brain Tumours ◽  
Neurological Symptoms ◽  
Adult Brain ◽  
Case Review ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Abstract Aims Signs and symptoms that develop in people with brain tumours are often attributed to their tumour. The prevalence and management of functional neurological symptoms in brain tumour patients have received little attention. This is surprising because functional neurological symptoms complicate management greatly and misdiagnosis can lead to inappropriate treatment and iatrogenic side-effects. Therefore, we investigated the presentation, diagnosis and management of functional neurological disorders (FND) in patients who had a brain or meningeal tumour. Method A retrospective case review was performed from 2017 - 2021 to identify adult brain tumour patients who developed a functional neurological disorder that caused significant disability necessitating expedited investigations. All patients attended a regional neuro-oncology centre. We recorded type of brain tumour and diagnostic investigations. The onset of functional symptoms was divided into three time windows: before tumour diagnosis, after diagnosis and before treatment or after tumour treatment. A neuropsychological review looked for evidence of previous adverse life events. Therapeutic interventions for functional neurological disorder and their outcomes were documented. The case review was combined with a systematic review of the literature to identify the published presentations of functional neurological disorder in the adult brain tumour population. MEDLINE, EMBASE and PsycINFO databases were searched for studies published between January 1980 and February 2021. Results Six patients (5 female, 1 male) were identified from the case review with a median age of 41 (range 29 - 56) years old. Four patients had non-epileptic attack disorder, which was diagnosed with videotelemetry of habitual attacks. One patient had a functional hemiparesis with normal central motor conduction time. One patient had a functional speech disorder with normal EEG. Half of these patients had functional neurological symptoms prior to surgery/oncological treatment. Five patients (83%) were referred for further neuropsychiatric or psychological evaluation. A history of significant psychological trauma prior to the brain tumour diagnosis was elicited in four (66%) patients. Conclusion Patients with either a brain or meningeal tumour may develop functional neurological symptoms. Our findings suggest the possibility that diagnosis of a brain tumour may precipitate a debilitating functional neurological disorder. The neurobiological basis for functional neurological disorders is being actively investigated. There are suggestions in the literature that some brain diseases increase the risk of developing a functional neurological disorder. Further work is needed to determine whether this is true for patients with brain tumours. Increased awareness of functional neurological disorders will improve management. Withdrawal of unnecessary treatment, such as anticonvulsant drugs, reduces the risk of iatrogenic side effects. Initiation of multi-disciplinary care pathways, e.g. physiotherapy, speech and language therapy and psychological treatments, promotes recovery. Collectively, these interventions improve our patients’ quality of life.

scholarly journals 21 Psychedelic treatment of functional neurological disorder – a systematic review

2020 ◽  
Vol 91 (8) ◽  
pp. e16.2-e17
Author(s):  
Matthew Butler ◽  
Mathieu Seynaeve ◽  
Timothy R Nicholson ◽  
Susannah Pick ◽  
Richard A Kanaan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Neurological Disorder ◽  
Conversion Disorder ◽  
Evidence Base ◽  
Control Groups ◽  
Open Label ◽  
Therapeutic Outcomes ◽  
Psychedelic Drugs ◽  
Psychiatric Conditions ◽  
Functional Neurological Disorder

AimsFunctional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatry services, yet the therapeutic evidence base is limited. Research into psychedelics such as psilocybin and lysergic acid diethylamide (LSD) is currently being undertaken with significant renewed interest, and in recent studies psychedelics have shown promise in treating a range of psychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. METHODS: We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 – 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified.ResultsLSD was the most commonly used psychedelic, with some studies also using psilocybin and/or mescaline. The number of therapeutic sessions of psychotherapy ± psychedelic substance administration ranged from one to 26, with descriptions of therapeutic methods used widely varying, and in some cases not described in any detail. Psychedelics were given either orally or intramuscularly, with doses of LSD ranging from 25 to 2,000 micrograms (mcg), and doses of psilocybin ranging from 3 to 15 milligrams (mg). Of those treated, 69% (n=18) were found to have made at least some recovery, with 23% (n=6) having completely recovered after psychedelic therapy. Adverse events were typically mild and transient.ConclusionsStudies were generally of low quality, often lacking control groups and valid outcome measures. Despite this, the degree of improvement is considerable, even if the presumptive bias in favour of the treatment in the studies is taken into consideration. Furthermore, good therapeutic outcomes and lack of adverse events in modern open-label trials utilising psychedelic therapy for neuropsychiatric disorders is encouraging. Advances in the understanding of the neurobiology of FND, as well as further modern clinical research into the therapeutic utility of psychedelics, may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.

scholarly journals Writer’s Cramp or Focal Dystonia- Case report of a Rare Neurological Disorder

2019 ◽  
Vol 10 (4) ◽  
pp. 3560-3562
Author(s):  
Ghalaut P S ◽  
Meenal Babra
Keyword(s):  
Case Report ◽  
Medical Treatment ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Behavioural Therapy ◽  
Focal Dystonia ◽  
Severe Disability ◽  
Treatment Modalities ◽  
Single Treatment ◽  
Writer's Cramp

There are various neurological disorders which are clinically diagnosed and treated every day. Focal dystonia's such as Writer’s cramps or musician’s cramps is one such neurological disorder that is not very common, but if remains undiagnosed or not treated appropriately causes severe disability and anxiety to the patient. It not only hampers them emotionally and socially but also leads to professional problems. There are various treatment modalities available. Patients complain of spasm or cramping of muscles, which is sometimes associated with pain and inability to write or play an instrument which he/she used to play perfectly some time ago. Identifying this disorder and treating it in time can benefit the patient to a great extent. Though not a single treatment has turned successful in all patients. Some patients get relieved by behavioural therapy, while others respond to medical treatment.

scholarly journals Severe but Self-Limiting Polyarthralgia with Functional Impairment Following ChAdOx1 nCov-19 Vaccination in an Elderly Recipient

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1220
Author(s):  
Joel Ern Zher Chan ◽  
Anand Irimpen
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Functional Impairment ◽  
Close Monitoring ◽  
Clinical Progression ◽  
Acute Phase Reactants ◽  
Post Vaccination ◽  
Delayed Onset ◽  
Elderly Female ◽  
New Onset

A 79-year-old female patient with no pre-existing rheumatological conditions presented with severe functional impairment secondary to polyarthralgia, most likely an adverse reaction following her first dose of Oxford/AstraZeneca ChAdOx1 nCov-19 vaccination against SARS-CoV-2, the causative agent of Coronavirus Disease 2019 (COVID-19). The presentation mimicked clinical features of polymyalgia rheumatica and was distinctive in its pattern and delayed onset. Its severity in an elderly patient was significant against trial findings of decreasing reactogenicity of ChAdOx1 nCov-19 vaccine with increasing age, and traumatic to the patient. Acute phase reactants were elevated, consistent with recent similar reports among mostly elderly, female patients. New onset rheumatological conditions and flares of pre-existing, well-controlled conditions had been well established in COVID-19 and, to a lesser extent, post-vaccination. Viral arthralgias as a distinct clinical entity in COVID-19 is only beginning to be recognized. It could be that this case report represents a similar entity which occurs following vaccination against SARS-CoV-2. Despite this, the benefits of vaccination continue to outweigh such risks, although this case report is important for providing understanding of clinical progression when such reactions occur, aiding in patient discussions and clinical decisions to weigh up further investigations or empirical treatment against reassurance and close monitoring.

scholarly journals The Arc de Siècle: functional neurological disorder during the ‘forgotten’ years of the 20th century

Brain ◽  
2020 ◽  
Vol 143 (4) ◽  
pp. 1278-1284
Author(s):  
Max Fend ◽  
Louise Williams ◽  
Alan J Carson ◽  
Jon Stone
Keyword(s):  
20Th Century ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Oral Histories ◽  
Pragmatic Approach ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Using archived records, plus oral histories from retired neurologists, Fend et al. examine attitudes to functional neurological disorders in the mid-20th century. While frequently scathing in their correspondence, most neurologists of the time adopted a pragmatic approach with many referring patients to psychiatrists.

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