Royal Infirmary of Edinburgh, Edinburgh, UK.
Centre for Clinical Brain Services, Edinburgh, UK.
Clin Med (Lond). 2021 Jan;21(1):28-36. doi: 10.7861/clinmed.2020-0987.
We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.
我们介绍了功能性神经障碍（FND）的实用概述，包括其流行病学、评估和诊断、诊断陷阱、治疗、病因和机制。我们介绍了功能性肢体无力、震颤、肌张力障碍和其他异常运动、分离性癫痫发作、功能性认知症状和尿潴留以及“扫描阴性”马尾综合征的最新情况。FND 的诊断应基于明确的阳性证据，通常来自体格检查的体征或癫痫发作的性质的综合。在 FND 的治疗中，明确诊断并让多学科团队参与是有益的。我们建议将 FND 患者转介给具有神经诊断专业知识的专家。FND 在急诊和急性医疗环境中是常见的表现，做出阳性诊断和沟通有许多实用的要素，所有医生都应该熟悉。
