The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review

Daum, Corinna; Hubschmid, Monica; Aybek, Selma

doi:10.1136/jnnp-2012-304607

Cited by 152 publications

(115 citation statements)

References 43 publications

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“…Inclusion criteria were (a) age: 16-65 years and (b) newly diagnosed conversion disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (within 12 months) with motor or NEA symptoms assessed by experienced neurologists. The diagnosis was established after extensive history and clinical examination, including systematic evaluation of "positive signs" of conversion disorder [28]. NEA patients had a video-electroencephalogram (EEG) evaluation with provoking maneuvers (verbal suggestion, hyperventilation, intermittent photic stimulation, positioning of a tuning fork on the forehead and -in selected cases -a NaCl nocebo injection) in order to obtain a typical clinical event; diagnosis was made if this corresponded to the habitual spells, was clinically suggestive of NEA and presented without any pathological EEG alteration in accordance with our practice and recent guidelines [29,30].…”

Section: Participantsmentioning

confidence: 99%

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks

Hubschmid

Aybek

Maccaferri

et al. 2015

General Hospital Psychiatry

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Section: Participantsmentioning

confidence: 99%

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks

Hubschmid

Aybek

Maccaferri

et al. 2015

General Hospital Psychiatry

Self Cite

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“…Several neuro- logical symptoms can have psychogenic mechanisms underlying their presentation, including paralysis, sensory loss, blindness, astasia-abasia, amnesia, PNES and PMD [6][7][8][9] . Daum et al performed a systematic and narrative review about the value of "positive" clinical signs for weakness, sensory and gait disorders in conversion disorder 11 . The authors did not study signs for PNES.…”

Section: Functional Neurological Disorders (Conversion Disorders)mentioning

confidence: 99%

“…They concluded that clinical signs for motor, sensory and gait functional neurological symptoms are numerous, and 14 have been validated (7 motor, 5 sensory, and 2 gait related) 11 . Among positive signs of functional motor, sensory and gait disorders, Hoover sign, abductor sign, abductor finger sign, co-contraction, midline splitting, non-anatomical sensory loss, dragging monoplegic gait, and chair test have been validated 11 . 14 .…”

Section: Functional Neurological Disorders (Conversion Disorders)mentioning

confidence: 99%

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

Paola

Marchetti

Teive

et al. 2014

Arq. Neuro-Psiquiatr.

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Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.Keywords: psychogenic nonepileptic seizures, psychogenic movement disorders, conversion disorder, hysteria. RESUMOCrises não-epilépticas psicogênicas (CNEP) e distúrbios do movimento psicogênicos (DMP) são comuns na prática e na atualidade são melhor categorizados no DSM-V como distúrbios neurológicos funcionais/desordens de conversão. Esta revisão enfatiza os principais dados históricos, epidemiológicos, clínicos, critérios diagnósticos, tratamento e o prognóstico destes pacientes, frequentemente negligenciados e desafiadores, os quais, como um grupo, tem intrigado gerações de neurologistas e psiquiatras, caracterizando, de forma justificada o elo definitivo entre estas especialidades.Palavras-chave: crises não-epilépticas psicogênicas, distúrbios do movimento psicogênicos, distúrbio conversivo, histeria.In the medical sciences, a diagnosis is established when a level of certainty regarding the nature of a condition is achieved. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) share a slightly less linear diagnostic route. Historically, making a conversion diagnosis required ruling out the originally considered medical diagnosis, i.e., it is neither epilepsy, nor a neurogenic movement disorder. Only then a non-neurologic (in the sense of not resulting from epileptogenic or known motor circuitry imbalance) condition is suspected and raised to the level of diagnosis 1 . This kind of diagnosis has intrigued generations of physicians and spared no culture, gender or age. A diversity of symptoms, including motor, sensory, cognitive, and/or behavior symptoms are present in these presentations. Patients with PNES or PMD frequently are misdiagnosed as having their initial suspected neurological diseases, and ultimately pose a diagnostic and treatment challenge to many clinicians. Interestingly, it was perhaps this varied presentation that has captured the attention of many professionals through the centuries and lead to the construction and recognition of a very particular diagnosis. Two rather advanced historic civilizations, Egyptians first, and then the Greeks, posited that a displaced hystera (womb), and the consequent suffocation that it produced, was the source of choking, mutism, paralysis and fainting 1 . Hysteria, a natural development on this concept, was claimed as an explanation for similar phenomena in women and reached almost epidemic proportions in the late 19 th century. By th...

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“…It cannot be diagnosed on the basis of associated psychosocial factors and neither is it a diagnosis of exclusion. A number of studies have established the reliability of existing signs such as Hoover's sign for functional limb weakness [14,15] and the entrainment test for functional tremor [16]. A particularly useful study showed that such signs not only have reasonable sensitivity and specificity, but also acceptable inter-rater reliability [17].…”

Section: Advances In Diagnosis and Classification Of Functional Neuromentioning

confidence: 99%

Functional neurological disorders: mechanisms and treatment

et al. 2015

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Functional neurological disorders are common problems in neurologic practice. In the past decade there has been an increasing interest in this group of disorders both from a clinical as well as research point of view. In this review, we highlight some of the most salient and exciting publications from recent years focusing especially on new findings illuminating mechanism and studies examining treatment.

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The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review

Cited by 152 publications

References 43 publications

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

Functional neurological disorders: mechanisms and treatment

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