Nadler Martine, Cary Isabel, Symeon Christopher
Department of Physiotherapy Wolfson Neurological Rehabilitation Centre, Queen Mary's Hospital (part of St George's Hospitals NHS Foundation Trust) Roehampton Lane London United Kingdom.
Department of Psychiatry Wolfson Neurological Rehabilitation Centre, Queen Mary's Hospital (part of St George's Hospitals NHS Foundation Trust) Roehampton Lane London United Kingdom.
Mov Disord Clin Pract. 2021 Jun 26;8(6):932-939. doi: 10.1002/mdc3.13264. eCollection 2021 Aug.
Some patients with FND and FEVD cannot re-establish walking ability with standard treatment alone.
Novel invasive treatment of FEVD trialed in three females, aged 19, 30 and 33 years with >18 month history of FND. None could walk and all were wheelchair-dependent needing home carers. Standard treatment plus novel step-wise escalation of invasive "intervention+" was individually tailored to correct FEVD; functional electrical stimulation, botulinum toxin injections, tibial nerve block, serial casting, and for Case 3, manipulation under anesthetic and surgical tendon lengthening. All regained walking ability and discontinued carers. Case 1 resumed dancing and Case 3 returned to employment. Improvements were largely maintained at 3 and 6 month follow-up.
As a last resort, invasive adjuncts may be considered in a very small proportion of FND patients who fail to regain walking ability with standard treatment alone and reach a "dead end" where no further progress is feasible.
一些功能性神经疾病（FND）和功能性步态障碍（FEVD）患者仅通过标准治疗无法恢复行走能力。
对三名年龄分别为19岁、30岁和33岁且患有超过18个月功能性神经疾病的女性进行了新型FEVD侵入性治疗试验。她们均无法行走，全部依赖轮椅，需要家庭护理人员照顾。标准治疗加上针对纠正FEVD的新型逐步升级的侵入性“干预+”方案是根据个体情况量身定制的；包括功能性电刺激、肉毒杆菌毒素注射、胫神经阻滞、连续石膏固定，对于病例3，还进行了麻醉下手法治疗和手术肌腱延长术。所有患者均恢复了行走能力并停止了护理。病例1恢复了跳舞，病例3重返工作岗位。在3个月和6个月的随访中，改善情况基本得以维持。
作为最后的手段，对于极少数仅通过标准治疗无法恢复行走能力且陷入“死胡同”、无法取得进一步进展的FND患者，可考虑采用侵入性辅助治疗。
