A practical review of functional neurological disorder (FND) for the general physician

Bennett, Karina; Diamond, Clare; Hoeritzauer, Ingrid; Gardiner, Paula; McWhirter, Laura; Carson, Alan; Stone, Jon

doi:10.7861/clinmed.2020-0987

Cited by 88 publications

(84 citation statements)

References 51 publications

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“…We contemplate whether the clinical manifestations of propofol neuroexcitation, along with acute pain, were "stressors" that triggered FND. 11 Uniquely, the patient had no preexisting mental disorders, but surprisingly, neurologic symptoms persisted for 3 months. In comparison, patients with postoperative conversion paralysis were found to have a median symptom duration of 3 days.…”

mentioning

confidence: 90%

A Case Report of “Propofol Frenzy”: Anesthetic Considerations for a Severe Propofol-Induced Neuroexcitation Reaction

Panchamia¹,

Amundson²,

Demirci³

et al. 2022

A&A Practice

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Propofol “frenzy” is considered a severe propofol-induced neuroexcitatory reaction involving nonepileptic spells of extremity thrashing, marked agitation, irregular eye movements, and impaired consciousness. Patients with propofol neuroexcitation present unique challenges for anesthesia providers due to underrecognition, lack of diagnostic tests, and differentiating from other comparable disorders that require medications that can exacerbate symptoms. We present a case of a healthy young patient whose postoperative course was complicated by propofol frenzy and functional limb paralysis following hip surgery with a spinal anesthetic and propofol sedation. This case highlights anesthesia considerations for propofol frenzy and discusses dexmedetomidine as a promising modality for prompt management.

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mentioning

confidence: 90%

A Case Report of “Propofol Frenzy”: Anesthetic Considerations for a Severe Propofol-Induced Neuroexcitation Reaction

Panchamia¹,

Amundson²,

Demirci³

et al. 2022

A&A Practice

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“…Different reports have suggested dysfunctions in top-down processes. However, the lack of statistically powered studies makes these findings still largely anecdotical [14,15,33,38].…”

Section: Other Potential Mechanismsmentioning

confidence: 99%

“…The recent neurologic literature has proposed a clear-cut separation of conversion/functional neurologic disorders (FND) from factitious disorders [14,15]. However, as mentioned above, the DSM classification system underlines the frequent overlap between different forms of somatic symptom disorders, once termed hysteria and, therefore, a hystero-malingering continuum has been suggested [12,16].…”

mentioning

confidence: 99%

The factitious/malingering continuum and its burden on public health costs: a review and experience in an Italian neurology setting

et al. 2021

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Factitious disorder is classified as one of the five aspects of somatic symptom disorders. The fundamental element of factitious disorder is deception, i.e., pretending to have a medical or psychiatric disorder, but the enactment of deception is considered unconscious. Indeed, volition, i.e., the perception of deliberate deception, is blurred in patients presenting with factitious disorder. In the USA and the UK, factitious disorder has received constant media attention because of its forensic implications and outrageous costs for the National Health Systems. Unfortunately, a comparable level of attention is not present in Italian National Health System or the Italian mass media. The review analyzes the classifications, disorder mechanisms, costs, and medico-legal implications in the hope of raising awareness on this disturbing issue. Moreover, the review depicts 13 exemplification cases, anonymized and fictionalized by expert writers. Finally, our paper also evaluates the National Health System’s expenditures for each patient, outlandish costs in the range between 50,000 and 1 million euros.

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“…In our previous study, we surveyed general practitioners about diagnosis, treatment, and management of FND patients [26]. The survey revealed the persistence among general practitioners of old myths about FND [26,27], with a psychological view often prevailing over a multidisciplinary approach to patients with FND. For the present study, members of the Italian Society of Neurology (SIN) were invited to participate in a survey on how they manage this complex disorder.…”

Section: Introductionmentioning

confidence: 99%

Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey

et al. 2021

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Background Functional neurological disorders (FND) are disabling medical conditions commonly seen in neurological practice. Neurologists play an essential role in managing FND, from establishing a diagnosis to coordination of multidisciplinary team-based treatment for patients. With this study, we investigated the knowledge and the clinical experience of Italian neurologists in managing patients with FND. Methods Members of the Italian Society of Neurology were invited via e-mail to participate in this ad hoc online survey; 492 questionnaires were returned completed. Results The term “Functional neurological disorders” in reference to FND was used more frequently than other psychological (e.g., psychogenic or conversion), or descriptive terms (e.g., non-organic or stress-related). When speaking with patients, the respondents stated that they preferred explaining symptoms based on abnormal functioning of the nervous system than discussing mental illness and that they would refer their patient to a psychologist rather than to a psychiatrist. Few considered that physiotherapy and psychiatric interventions are useful approaches to treating FND. Some believed that patients simulate their symptoms. Conclusions Overall, the responses suggest that knowledge about scientific advances in FND is somewhat sparse. A psychiatric-centered view of FND opens the way to an approach in which neurobiological and psychological aspects constitute essential factors of the condition. In this context, professional education could improve understanding of FND and optimize patient management.

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A practical review of functional neurological disorder (FND) for the general physician

Cited by 88 publications

References 51 publications

A Case Report of “Propofol Frenzy”: Anesthetic Considerations for a Severe Propofol-Induced Neuroexcitation Reaction

A Case Report of “Propofol Frenzy”: Anesthetic Considerations for a Severe Propofol-Induced Neuroexcitation Reaction

The factitious/malingering continuum and its burden on public health costs: a review and experience in an Italian neurology setting

Opinion, knowledge, and clinical experience with functional neurological disorders among Italian neurologists: results from an online survey

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