Highlights & Basics
- Functional neurologic disorder (previously termed conversion disorder) and somatic symptom disorder are both characterized by somatic symptoms associated with significant distress or impairment.
- The underlying cause is not fully understood. Although psychological stressors can be important risk factors and may perpetuate symptoms, they are not necessary to make the diagnosis.
- Functional neurologic disorder can be diagnosed on the basis of positive "rule in" features on neurologic examination - it is no longer considered a diagnosis of exclusion.
- Good therapeutic alliance, validation of the patient's suffering, and shared clinician-patient understanding of the condition are essential for effective management.
- Treatment includes cognitive behavioral therapy, physical therapy, and avoiding unnecessary medicines, tests, and procedures. Diagnosis and treatment of associated comorbid psychiatric conditions can benefit overall functioning and recovery.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
a) Hoover sign; hip extension is weak on direct testing (left) but strength becomes normal when there is contralateral hip flexion against resistance; b) Hip abductor sign; hip abduction is weak on direct testing (left) but strength becomes normal when there is contralateral hip abduction against resistance (right)
"Entrainment test": watch the other (patient's left) hand while the patient copies the examiner's rhythmic pincer movements with their right hand; the functional tremor in the left hand stops during the task
Functional dystonia; orange shading shows typical areas of fixed muscular contraction in functional dystonia
a) A tubular visual field defect at 150cm which is the same width as at 50cm; b) "Spiralling" on Goldmann perimetry
Citations
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Löwe B, Levenson J, Depping M, et al. Somatic symptom disorder: a scoping review on the empirical evidence of a new diagnosis. Psychol Med. 2022 Mar;52(4):632-48.[Abstract][Full Text]
Stone J, Burton C, Carson A. Recognising and explaining functional neurological disorder. BMJ. 2020 Oct 21;371:m3745.
Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder (FND) for the general physician. Clin Med (Lond). 2021 Jan;21(1):28-36.[Abstract][Full Text]
Baslet G, Bajestan SN, Aybek S, et al. Evidence-based practice for the clinical assessment of psychogenic nonepileptic seizures: a report from the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci. 2021 Winter;33(1):27-42.[Abstract][Full Text]
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Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet. 2007 Mar 17;369(9565):946-55.[Abstract]
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