Functional neurological symptoms refer to neurological symptoms
that are not explained by disease. They may also be called psychogenic, nonorganic,
somatoform, dissociative or conversion symptoms. The most common
functional neurological symptoms are non-epileptic attacks and functional
weakness. These are common in neurology and general medical practice,
especially in emergency situations, where they can be mistaken for epilepsy or
stroke. Many studies have shown that these symptoms often persist, are
associated with distress and disability and, in the right hands, have a low rate of
misdiagnosis. Physicians are often uncertain how to approach patients with these
problems. Are patients making up the symptoms? How can the diagnosis be made
confidently? What is the best way to explain the diagnosis to the patient? Does
treatment ever help? This review takes readers through these questions with
practical tips for avoiding common pitfalls, both in diagnosis and management.
There is no good evidence that these symptoms are any more ‘made up’ than
irritable bowel symptoms or chronic pain. The diagnosis should usually be made
by a neurologist on the basis of positive signs of inconsistency such as Hoover’s
sign or the typical features of a non-epileptic attack. A ‘functional’ model of the
symptoms is useful both in thinking about the problem and when explaining the
symptoms to the patient. There are many useful steps in management that do not
require a detailed understanding of aetiology in an individual patient.
