Institute of Medical and Biomedical Education, St George's University of London, London, UK.
Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Trust, London, UK.
Clin Med (Lond). 2018 Oct;18(5):414-417. doi: 10.7861/clinmedicine.18-5-414.
Functional neurological disorders (FND) are common and associated with significant morbidity and healthcare costs. Patients with FND often present acutely, particularly with dissociative seizures (resembling epilepsy) or persistent weakness resembling a stroke. History and careful observation and examination are critical to diagnosis, as investigations will often be normal or non-contributory. The nature of convulsive movements in dissociative seizures often differs from that in epilepsy, and long duration of individual events, waxing and waning, closed eyes and high reported frequency in an apparently well individual are all suggestive. In those with stroke-like episodes, demonstration of normal power even briefly (eg Hoover's sign, 'give way' weakness) together with distractability are positive physical features indicating a functional disorder. A positive diagnosis and clear non-judgemental explanation, backed up by reliable information sources associated with prompt onward referral to a neurologist can greatly reduce distress and ultimately improve outcomes.
功能性神经疾病（FND）较为常见，与较高的发病率和医疗保健费用相关。FND 患者通常为急性起病，尤其是出现分离性癫痫发作（类似于癫痫）或类似于中风的持续性无力。病史、仔细的观察和检查对于诊断至关重要，因为检查结果通常正常或无明显异常。分离性癫痫发作中的抽搐运动性质通常与癫痫不同，单个事件的持续时间较长、时强时弱、闭眼以及在明显健康个体中报告的高频率均提示为分离性癫痫发作。对于那些出现类似中风的发作，即使短暂地表现出正常肌力（如胡佛征，“让步”无力）以及注意力分散，这些阳性的体格特征提示为功能性疾病。明确的非评判性诊断和解释，以及可靠的信息来源支持，并及时转介给神经科医生，可以极大地减轻痛苦，最终改善预后。
