Functional Stroke Symptoms: A Narrative Review and Conceptual Model

Jones, Abbeygail; O’Connell, Nicola; David, Anthony S.; Chalder, Trudie

doi:10.1176/appi.neuropsych.19030075

Cited by 13 publications

(14 citation statements)

References 84 publications

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“…It might be indicative of an important role for the vascular and circulatory system in a subset of individuals with FND/CD. Suggestions for some vascular link have been made in a case study ( Gürses et al., 2008 ) and in a recent review considering that a proportion of patients entering the care pathway present with functional symptoms mimicking stroke or have functional symptoms in addition to vascular stroke ( Jones et al., 2020 ). The possibility that VEGFa and microRNA might play a role in this should be investigated in future studies.…”

Section: Discussionmentioning

confidence: 99%

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

Feltz-Cornelis¹,

Brabyn²,

Ratcliff³

et al. 2021

Brain, Behavior, & Immunity - Health

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Background Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown. Aim 1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND. Method Feasibility study. Results The study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients. Conclusion It is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND.

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Section: Discussionmentioning

confidence: 99%

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

Feltz-Cornelis¹,

Brabyn²,

Ratcliff³

et al. 2021

Brain, Behavior, & Immunity - Health

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“…Medical mimics are more common and comprise 50-80% of cases in most large series [4,6]. Functional mimics or conversion disorders are less frequent [7][8][9][10]. Although they have characteristic clinical features can sometimes be very difficult to differentiate from an ischaemic stroke (see Table 2).…”

Section: The Significance Of the Clinical Problemmentioning

confidence: 99%

Stroke mimics: incidence, aetiology, clinical features and treatment

et al. 2021

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Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

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“…It is important stroke clinicians engage with the many guidelines on how to address and manage functional symptoms. 24,32,33 This study has a number of limitations. These findings represent results from one city with a specific hyperacute stroke model, although versions of acute SUs now exist in most major cities in the world.…”

Section: Discussionmentioning

confidence: 97%

“…This group would likely benefit from more targeted intervention within the stroke ward prior to discharge or referral to other interventions. 24 The vignettes suggest family support, employment, and belief in symptom control are protective factors in recovery.…”

Section: Discussionmentioning

confidence: 99%

<p>Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study</p>

O’Connell¹,

Jones²,

Chalder³

et al. 2020

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Introduction: A proportion of patients admitted to acute-stroke settings have not had a stroke, but have conditions mimicking a stroke. Approximately 25% of suspected stroke cases are "stroke mimics" and 2% are patients with functional symptoms-"functional stroke mimics". This study aimed to explore experiences and illness perceptions of patients with functional symptoms admitted to hyperacute stroke wards. Methods: This study used mixed methods. Patients with functional stroke symptoms participated in semistructured qualitative interviews immediately after admission to one of two acute-stroke units in London and again 2 months after hospital discharge. Qualitative data were assessed using thematic analysis. The Brief Illness Perception Questionnaire (Brief-IPQ) measured illness perceptions at admission and at 2-month follow-up. Results: A total of 36 participants completed baseline interviews and 25 completed followup. Six themes emerged: physical symptom experience, emotional and coping responses, symptom causes, hospital experiences, views on the future, and uncertainty after hospital discharge. Mean Brief-IPQ score at admission was 49.3 (SD: 9.9), indicating a moderatehigh level of perceived illness threat. Participants presented with a range of functional symptoms. At baseline, participants were highly concerned about their symptoms, but this had decreased at 2-month follow-up. Two months later, many were confused as to the cause of their admission. Conclusion: This is the first study to examine functional stroke patients' experiences of acute-stroke admission. At admission, patients expressed confusion regarding their diagnosis, experienced high levels of emotional distress, and were concerned they were perceived as time wasting by stroke clinicians. While most participants experienced symptom recovery, there was a significant subgroup for whom symptoms persisted or worsened. A lack of care guidelines on the management of functional stroke patients may perpetuate functional symptoms.

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Functional Stroke Symptoms: A Narrative Review and Conceptual Model

Cited by 13 publications

References 84 publications

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

Stroke mimics: incidence, aetiology, clinical features and treatment

<p>Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study</p>

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