Anaesthesia and the development of functional neurological disorder: A systematic review and case series

Huepe-Artigas, Daniela; Singh, Parramajaypal; Weinberg, Laurence; Kanaan, Richard A A

doi:10.1016/j.genhosppsych.2022.07.011

Cited by 4 publications

(10 citation statements)

References 39 publications

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“…Various models have offered diverse interpretations of FS, ranging from the activation of dissociated material to physical manifestations of emotional distress, hard‐wired reflex responses, or learned behaviors. However, most of these models fall short in providing a comprehensive explanation for the phenomenology of FS (Almis et al., 2013 ; Bakvis et al., 2009 ; Binder et al., 1994 ; Bogaerts et al., 2010 ; Cassady & Baslet, 2023 ; Huepe‐Artigas et al., 2022 ; Lanius et al., 2012 ).…”

Section: Discussionmentioning

confidence: 99%

Functional seizures: Are they consistent over time?

Bahous,

Wagner,

Herskovitz

2024

Brain and Behavior

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BackgroundOur previous study showed that functional seizures (FS) are consistent in the same patient during a single video EEG monitoring (VEEG). This study aimed to check whether FS remains consistent across VEEG sessions even after several years.MethodsThe study evaluated the consistency of FS across different VEEG sessions using five criteria: FS type, the main anatomical region involved (specifically, the body part most affected during the seizure), other involved anatomical regions, frequency of movements, and duration of FS. Consistency levels were categorized as low (one consistent axis), moderate (two consistent axes), and high (three or more consistent axes).ResultsFourteen patients were included in the final analysis. The mean time between monitoring was 3.8 ± 2.5 years (0.5–8 year). In 13 of 14 patients, the first and second monitoring events were classified into the same FS category. There was consistency in the main anatomical region involved in 9 out of 12 patients with motor FS. In 9 out of 12 patients with motor FS, the other anatomical regions involved were consistent in both sessions. The mean duration of the FS between sessions was inconsistent in most of the patients. Ten patients were classified with high consistency, one patient with moderate consistency, two patients with low consistency, and in one patient, the events were classified as inconsistent.ConclusionsOur results show that FS tends to remain consistent in a single patient even after several years, and there is probably no correlation between the degree of consistency and the time between VEEG sessions. These findings have implications for supporting the concept of FS as a consistent phenomenon. Additionally, they may suggest potential avenues for future research to elucidate the origins of FS. Subsequent studies are essential to validate and expand upon these preliminary observations.

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Section: Discussionmentioning

confidence: 99%

Functional seizures: Are they consistent over time?

Bahous,

Wagner,

Herskovitz

2024

Brain and Behavior

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“…The beneficial effects of this treatment might be achieved through the experience of normal positioning and functioning of the limb. However, motor blocks should be used with caution as there is only sparse evidence for a potential therapeutic effect, and anesthesia can sometimes also be a precipitating factor for FND [6].…”

Section: Discussionmentioning

confidence: 99%

Could motor blocks be a therapeutic option for treatment‐resistant functional dystonia? A case series of three patients

Garcin,

Cinquin,

Degos

et al. 2023

Euro J of Neurology

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The diagnosis of functional dystonia is challenging because it is difficult to distinguish functional dystonia from other types of dystonia. After diagnostic explanation, multidisciplinary care is recommended, but some patients are resistant to treatments. We used motor blocks in three patients with severe resistant functional dystonia of the upper limbs to test (i) whether joint contracture was present and (ii) whether motor blocks have a therapeutic effect on functional dystonia. Patient 1 showed a good and sustained therapeutic response, Patient 2 experienced a resolution of the dystonic posture that lasted for 10 days, and Patient 3 experienced no effect. Motor blocks may be a useful therapeutic option in chronic treatment‐resistant functional dystonia. The treatment effect might be achieved through the experience of normal positioning and functioning of the limb.

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“…Functional neurological symptom disorder (FNSD) or functional neurological disorder (FND) or conversion disorder, is a syndrome of neurological complications unexplained by neuropathology [ 1 ]. It is described as the occurrence of neurological symptoms due to malfunction, rather than neuropathology or neurological disease of the nervous system [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent review of patients who had developed FNSD within 48 hours of anesthesia, concluded that there is support for an etiological role for anesthesia [ 1 ]. The review suggested that procedures involving anesthesia were relatively common triggers for the development of FNSD.…”

Section: Introductionmentioning

confidence: 99%

“…Deficits that have been reported include monoplegia, hemiplegia, paraplegia, quadriplegia, amnesia, aphonia, delayed awakening, blindness, deafness, and seizures. It has been contemplated whether anesthetic agents or the anesthetized state predispose a vulnerable brain to manifest these symptoms and signs [ 1 , 5 , 6 ]. Although the existence of psychological factors, such as conflicts or stress, are common and judged to be associated with the deficits [ 4 ], they are not universally present [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

Chin¹,

Kumaraswami²

2023

Cureus

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Functional neurological symptom disorder (FNSD) or functional neurological disorder (FND) or conversion disorder, is a syndrome of neurological complications unexplained by neuropathology. The term FNSD or FND is now preferred, as conversion disorder is not an etiologically neutral term and is thus falling from use by researchers and clinicians in the field.We report a case of new-onset postoperative neurological deficit in a patient who had undergone uneventful general anesthesia for a urology procedure. Postoperatively, in the post-anesthesia care unit, the patient was found to be unable to move her upper and lower limbs. Organic pathology was excluded and a diagnosis of FNSD was made. Four weeks after the surgery, the patient was only able to ambulate with the help of a mechanical walker device.It is now suggested that procedures involving anesthesia are relatively common triggers for the development of FNSD. The occurrence of FNSD in the postoperative period is increasingly being attributed to the effects of anesthesia, the hypothesis being that it arises from the abreactive or dissociative effects of anesthetic agents. Another theory is the vulnerability of the anesthetized state which may evoke previous traumatic experiences. Psychiatric co-morbidities such as anxiety and depression may be seen in these patients. Preoperative psychological assessment may help identify patients at risk for FNSD. If postoperative neurological deficit occurs, detailed neurological, metabolic, and psychiatric assessments should be done with FNSD being a diagnosis of exclusion. We present this case to increase awareness regarding this uncommon condition which can cause significant distress to the patient and healthcare team. Management should comprise honest disclosure, reassurance of recovery, and reinforcement of alternative coping strategies. The development of preoperative screening tools may help identify patients at risk for this disorder.

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Anaesthesia and the development of functional neurological disorder: A systematic review and case series

Cited by 4 publications

References 39 publications

Functional seizures: Are they consistent over time?

Functional seizures: Are they consistent over time?

Could motor blocks be a therapeutic option for treatment‐resistant functional dystonia? A case series of three patients

Functional Neurological Symptom Disorder: A Continuing Conundrum for the Perioperative Physician

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