The borderland between functional diseases and neurological diseases
gets blurred especially when the patient presents with a myriad of
symptoms which do not localize to any one level of the neural axis.1 If in
addition the neurological examination is normal (especially the lack of
'hard' neurological signs such as upgoing plantars, cranial nerve signs,
definite asymmetry of the deep tendon reflexes, cerebellar signs and...
The borderland between functional diseases and neurological diseases
gets blurred especially when the patient presents with a myriad of
symptoms which do not localize to any one level of the neural axis.1 If in
addition the neurological examination is normal (especially the lack of
'hard' neurological signs such as upgoing plantars, cranial nerve signs,
definite asymmetry of the deep tendon reflexes, cerebellar signs and gait
disorder) the question of a functional disease certainly crosses the mind.
In my mind there are two ways to approach such patients. One way is to
order an exhaustive battery of tests including laboratory, neurophysiology
and neuroimaging studies. This "fishing" for an answer approach rarely if
ever yields the answer and risks reinforcing the sick role in the
patient's and caregiver's psyche ("I must have a horrible and terrible
illness which the doctor is trying hard to find"). The other approach is
one I have adopted in my practice. If after a thorough history,
examination and relevant investigations the answer still eludes me and I
am reasonably certain (though not 100% sure) that the patient's
presentation is unlikely on account of an organic neurological disease, I
adopt a policy of wait and watch after reassuring the patient that if new
symptoms were to appear or if the current symptoms were to change in
frequency or intensity, I would consider re approaching the diagnosis. The
patient at this point may or may not be ready to see a psychiatrist but I
do suggest that consulting one may be helpful.
References
1. Stone J, Reuber M, Carson A. Functional symptoms in neurology:
mimics and chameleons. Pract Neurol 2013; 13:104-13.
The borderland between functional diseases and neurological diseases gets blurred especially when the patient presents with a myriad of symptoms which do not localize to any one level of the neural axis.1 If in addition the neurological examination is normal (especially the lack of 'hard' neurological signs such as upgoing plantars, cranial nerve signs, definite asymmetry of the deep tendon reflexes, cerebellar signs and...
Pages