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conversion disorder/functional neurologic symptom disorder

Loss or impairment of function suggestive of a neurologic disorder resulting as a manifestation of psychological conflict or need. * not explained by medical condition & inconsistent with physical exam [2] Etiology: - rare cases after Covid-19 vaccination - not caused by toxin in vaccine [7,8] Pathology: - no brain damage Physical examination: - neurologic examination including malingering/Hoover test Clinical manifestations: 1) examples of motor or sensory symptoms a) paralysis b) numbness c) pseudoseizures d) transient blindness e) mutism [6] 2) other manifestations [7,8] - muscle weakness - fatigue - cognitive impairment - dizziness - gait impairment 3) generally transient Management: 1) supportive measures 2) 'face-saving' techniques 3) encouragement that symptoms will resolve

Specific

atypical seizure; psychogenenic non-epileptic spell; hysterical seizure; pseudoseizure; psychogenic seizure pseudosyncope

General

somatoform (psychosomatic) disorder; somatic symptom & related disorders (SSRD)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1105-1107
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Stone J et al, Systematic review of misdiagnosis of conversion symptoms and hysteria. BMJ 331:989, 2005 PMID: 16223792
  4. Espay AJ, Aybek S, Carson A et al Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. Published online June 4, 2018. PMID: 29868890 https://jamanetwork.com/journals/jamaneurology/fullarticle/2682656
  5. Gelauff JM, Carson A, Ludwig L et al. The prognosis of functional limb weakness: A 14-year case-control study. Brain 2019 Jul; 142:2137 PMID: 31167232
  6. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  7. Frowry F Two More Reports of Functional Neurological Disorder After COVID-19 Vaccine. Medscape. August 30, 2021 https://www.medscape.com/viewarticle/957479 - Kim DD, Kung CS, Perez DL Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations. Lessons Learned From Functional Neurological Disorder. JAMA Neurol. 2021;78(7):789-790. PMID: 33835153 https://jamanetwork.com/journals/jamaneurology/fullarticle/2778192
  8. Butler M, Coebergh J, Safavi F et al Functional Neurological Disorder After SARS-CoV-2 Vaccines: Two Case Reports and Discussion of Potential Public Health Implications. J Neuropsychiatry Clin Neurosci. 2021. July 15. PMID: 34261345 https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.21050116