STEP 2: Concussion Live Course - November 5-6, 2024, in San Diego, CA-Risk Factors for Delayed Recovery and Beyond

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The document presents an overview of Functional Neurologic Disorder (FND), its differentiation from malingering, and various associated factors and treatment implications. FND is characterized by motor and/or sensory symptoms originating from the voluntary nervous system, perceived as involuntary, and can significantly impair quality of life despite treatment. A major concern with FND is differentiating between genuinely experienced symptoms and those that are voluntary or deceptive, such as in malingering where symptoms are exaggerated for external gain.<br /><br />Key distinctions between FND and malingering include that FND symptoms are unintentional without secondary gain and can persist for years, whereas malingering involves intentional symptom production for external rewards and is often resistant to treatment.<br /><br />Risk factors for FND include severe life events, neurological diseases, stress, anxiety, and genetics. Symptom perpetuation can occur due to factors like diagnostic uncertainty and abnormal illness beliefs. FND can present with various unusual symptoms, including tremors, difficulty swallowing, and abnormal gait, slipping into categories of both organic and functional disorders.<br /><br />FND is sometimes misinterpreted as other conditions, such as after a concussion, where it may present as functional dizziness or seizures, often complicating diagnoses. Up to 33% of functional dizziness cases can follow a concussion.<br /><br />FND diagnosis typically involves excluding other neurologic disorders and recognizing inconsistencies, distractibility, and reversibility of symptoms. Treatments involve multidisciplinary approaches including physical and occupational therapy, psychotherapy, and education to manage and remediate symptoms. Diagnosis accuracy is crucial; an incorrect identification can lead to unnecessary tests and the false belief in permanent brain injury.

Asset Subtitle

Priyanca B. Shah, DO MBA

Keywords

Functional Neurologic Disorder

FND

malingering

motor symptoms

sensory symptoms

diagnostic uncertainty

treatment implications

risk factors

multidisciplinary approaches

symptom reversibility