Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations that can cause persistent and disabling neurological symptoms.
Motor functional neurological disorders (FND) are a subset of functional (psychogenic) neurological conditions that include psychogenic nonepileptic seizures (PNES), functional weakness, and functional movements such as tremor, dystonia, and gait abnormalities. Fatigue, pain and cognitive difficulties are common additional symptoms. As the earlier terms “hysteria” and “conversion disorder” reflected psychological theories that do not universally apply, the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) uses FND synonymously with conversion disorder. “Functional,” rather than “psychogenic,” is the preferred term for somatic signs presenting at the intersection of neurology and psychiatry. FND is common, with 30% of neurology outpatients lacking a traditional neurologic explanation for their complaints, and half of those manifesting FND.
Historically, FND has been a “rule-out” diagnosis, making assessment and management in the ED difficult. Recently, increasing emphasis has been placed on the role of neurologists in the management of FND. This practice replaces a traditional neurological approach of excluding a neurological disease process and either discharging the patient or referring to a psychiatrist. Instead, an extended role for neurologists can include a specific expertise in the diagnosis of FND, diagnostic explanation, treatment and follow-up, often serving as coordinator for a multidisciplinary team-based approach to management.
The aim of our Special Issue is to help neurologists and healthcare professionals in the Emergency Department recognize patients with functional neurological disorders through symptoms, signs and a “normal” diagnostic explanation structure similar to that used in delivering the diagnosis of other neurological disorders. Another important outcome: helping to explain to patients and their relatives what functional disorders are as well as their potential treatments and possible implications on life, work, and social & familial relationships. Finally, an interdisciplinary approach beginning at the early stages of diagnostic assessment once an individual is suspected of having motor FND should be encouraged.
Dr. Filippo Manelli
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