Difficulties in Management of Functional Movement Disorders: Three Illustrative Cases

Abstract

BackgroundBackground: Some patients with FND and FEVD cannot re-establish walking ability with standard treatment alone. Cases Cases: Novel invasive treatment of FEVD trialed in three females, aged 19, 30 and 33 years with >18 month history of FND. None could walk and all were wheelchair-dependent needing home carers. Standard treatment plus novel step-wise escalation of invasive "intervention+" was individually tailored to correct FEVD; functional electrical stimulation, botulinum toxin injections, tibial nerve block, serial casting, and for Case 3, manipulation under anesthetic and surgical tendon lengthening. All regained walking ability and discontinued carers. Case 1 resumed dancing and Case 3 returned to employment. Improvements were largely maintained at 3 and 6 month follow-up. Conclusions Conclusions: As a last resort, invasive adjuncts may be considered in a very small proportion of FND patients who fail to regain walking ability with standard treatment alone and reach a "dead end" where no further progress is feasible.

Use of non-invasive neurostimulation for rehabilitation in functional movement disorders

“…The other two cases had more severe impairments, with one of them presenting with severe, fixed, soft tissue contractures. These two cases were not responsive to FES alone but responded to combination therapies including more invasive interventions like tibial nerve block, serial casting and joint manipulation under anesthesia ( 60 ). Another study discusses a case of functional paresis that received daily treatment with FES applied to the weak quadriceps and the paralyzed tibialis anterior muscles for two weeks.…”