Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK.
J Neurol Sci. 2017 Oct 15;381:188-191. doi: 10.1016/j.jns.2017.08.3248. Epub 2017 Aug 24.
Symptoms and signs of functional (psychogenic) motor and sensory disorder are often said to be dependent on the patients' idea of what symptoms should be, rather than anatomy and physiology. This hypothesis has however rarely been tested.
Inspired by a brief experiment carried out in 1919 by neurologist Arthur Hurst we aimed to assess the views of healthy non-medical adults towards paralysis and numbness and their response to tests for functional disorders when asked to pretend to have motor and sensory symptoms.
When subjects were asked to pretend they had a paralysed arm 80% thought there would be sensory loss. Of these 60% thought it would have a circumferential (functional) distribution at the wrist, elbow or shoulder. Hoover's sign of functional weakness was only positive in 75% of patients pretending to have leg paralysis with 23% maintaining weakness of hip extension in the feigned weak leg, a rare finding in neurological practice. 20% of subjects managed to continue having their feigned tremor during the entrainment test. 52% of subjects thought there was asymmetry of a tuning fork across their forehead even when no prior instruction had been given.
The study confirmed Hurst's finding that non-medical people generally expect sensory loss to go along with paralysis, especially if the examiner suggests it. When present, it usually conforms to functional patterns of sensory loss. Clinical tests for functional and motor disorders appear to behave somewhat differently in patients asked to pretend to have symptoms suggesting that larger more detailed studies would be worthwhile.
功能性（心因性）运动和感觉障碍的症状和体征通常被认为取决于患者对症状应该是什么的想法，而不是解剖学和生理学。然而，这一假设很少得到验证。
受神经学家 Arthur Hurst 于 1919 年进行的一项简短实验的启发，我们旨在评估健康的非医学成年人对瘫痪和麻木的看法，以及当他们被要求假装出现运动和感觉症状时，对功能性障碍测试的反应。
当被要求假装手臂瘫痪时，80%的人认为会有感觉丧失。其中 60%的人认为它会在手腕、肘部或肩部出现环状（功能性）分布。只有 75%假装腿部瘫痪的患者出现 Hoover 功能性无力征，而在假装无力腿中，有 23%的患者保持髋关节伸展无力，这在神经科实践中很少见。20%的受试者设法在诱发电位测试中继续出现假装震颤。即使事先没有给予指示，也有 52%的受试者认为他们额头上的音叉不对称。
该研究证实了 Hurst 的发现，即非医学人士通常期望瘫痪伴随着感觉丧失，尤其是当检查者暗示时。如果存在，它通常符合功能性感觉丧失模式。要求患者假装出现症状的功能性和运动障碍的临床检查似乎在表现上有所不同，这表明进行更大、更详细的研究是值得的。
