Exploring the Role of Functional Neurology Symptoms

[LostLamb]

I know a lot of us have been told we have “ functional symptoms of neurology” (unexplained symptoms that are benign (hate that word) rather than a true disease. Thought you might find the following article interesting. It is the model a lot of neurologists seem to use today ( especially in uk nhs) to assess and determine if our neurology symptoms are related to disease or are just functional . i.e. how they build a profile of us on a clinically and psychological level during examination. Describes why they ask certain questions, and what they are trying to establish from certain lines of questioning. The article is from the British Medical Journal and written for neurologists not their patients (so gives us a sneaky inside fly on the wall view). Take from it what you may, myself I found it a bit patronising in places to patients, but that might just be me. Anyway interesting read and nothing to do with ALS so safe to read. In it remember when reading the word “ Functional” refers to symptoms of no clinical relevance. i.e. of no real clinical significance to any specific pathology ( pseudo symptom ) example perceived weakness is a “ Functional symptom” true weakness is a pathological symptom associated with disease.hxxxps having a rubbish time at the moment with symptoms ,not sleeping as I get numb everytime I lie down now, and twitches are in hyperdrive, wonder where my old life went. The light is reading the forum, especially the comments from the old timers (length of time with symptoms, not age). Thank you so much for being there.

 

[sirdevil]

Thank you for your post. it is a very interesting article.I understand why it such things appear patronising as it suggests that functional patients are 'making up' their symptoms. With BFS fasciculations, these are real and involuntary, even though they do not have clinical significance. Functional symptoms are more usually encountered in the context of sensation and motor function (ie weakness). I recently treated a lady in hospital who had been walking with 2 sticks and a walking frame for over 5 months with a very obvious foot drop. She had also been treated as a stroke patient by another hospital. She had several MRI scans and a CT, all of which were normal and was about to have a lumbar puncture to rule out some kind of infective process as well as NCS. One of our neuro physiotherapists suggested she took her to the rehab centre and assess her there. During a 30 minute session involving a treadmill and parallel bars, this lady completely recovered and had no weakness whatsoever when she returned back with the physio. She left hospital the following day completely normal. This lady was not 'putting on' her symptoms. She fully believed she had weakness and really didn't think she could walk. This is typical of functional patients. It is very different from a malingerer who may seek attention for a weakness, but knows very well that they don't have the symptoms which they display to medical professionals and others including their friends and family. Functional weakness is a complex psychomotor illness which is not well understood, but it often accompanies or follows anxiety and stress. It is really hard to accurately examine these people, but there are often inconsistencies which provide clues. I can fully see why some people with BFS are convinced that they have particular muscle weakness when, in fact, they do not have any neurological deficit. An eminent consultant I used to work with had a very nice way with such patients and would explain to them that 'although all the nerves are working properly, the brain is having difficulty in letting the nerves send messages to the muscles to make them move' This helped patients understand their condition as well as realise it was treatable. Sorry to hear about your rubbish time. We all have good and bad days/weeks/months and I guess this is why we come here -because while we may be having a bad time, others are having a better one and can offer support and encouragement. The more of us there are, the more we can believe that this is both common and benign. Hope it all improves for you.