Dolbow James, El-Azzouni Soheil, Zhang Yiyi, Geiger Christopher
Department of Epilepsy, University Hospitals-Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA.
Department of Neuromuscular Neurology, University Hospitals-Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA.
J Neurol. 2025 May 27;272(6):427. doi: 10.1007/s00415-025-13139-4.
Functional neurological symptom disorder, specifically, functional limb weakness, is a commonly seen condition in clinical neurological practice and requires careful examination for diagnosis. Specific and detailed examination techniques have been developed and validated over the past 100 years to help clinicians differentiate functional limb weakness from objective neurological weakness. These techniques vary in sensitivity, specificity, clinical application, and limitations. However, over time, the studied and/or validated forms of these exam techniques may have been lost and often not performed or taught in the way it was originally studied, thus decreasing the reliability of the examiner's findings. With many new examination techniques for functional limb weakness having been studied in recent years, it is important to not only review the form of each of these examination techniques, but also discuss the clinical applications, limitations, and utility of each. To date, there has been no comprehensive review demonstrating the exact form of all the studied and/or validated examination techniques for functional limb weakness and their proposed clinical utility. This review analyzes 9 examination techniques for functional limb weakness that have been studied for validity and provides readers with the exact technique of examination used to study each. It also outlines their sensitivity, specificity, clinical applications, and limitations to help clinicians accurately diagnose functional limb weakness.
功能性神经症状障碍，具体而言，功能性肢体无力，是临床神经科实践中常见的病症，诊断时需要仔细检查。在过去100年里，已经开发并验证了特定且详细的检查技术，以帮助临床医生区分功能性肢体无力与客观性神经源性无力。这些技术在敏感性、特异性、临床应用及局限性方面各不相同。然而，随着时间的推移，这些检查技术经过研究和/或验证的形式可能已经失传，而且常常没有按照最初研究的方式进行操作或传授，从而降低了检查者结果的可靠性。近年来，有许多针对功能性肢体无力的新检查技术得到了研究，不仅要回顾这些检查技术各自的形式，还要讨论其临床应用、局限性和实用性，这一点很重要。迄今为止，尚无全面的综述展示所有针对功能性肢体无力且经过研究和/或验证的检查技术的确切形式及其提议的临床实用性。本综述分析了9种针对功能性肢体无力且已研究其有效性的检查技术，并为读者提供了用于研究每种技术的确切检查方法。它还概述了这些技术的敏感性、特异性、临床应用和局限性，以帮助临床医生准确诊断功能性肢体无力。
