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Предыдущая публикация
Rory Higgins

Sensory symptoms (e.g. numbness, pins and needles) in Functional Neurological Disorder (#FND) are common, but often overlooked. Our new prospective case-control study compares sensory symptoms of 102 people with motor-FND vs 75 people with recent #stroke. Here’s what we found 🧵

110
Rory Higgins

Prevalence: Sensory symptoms are extremely common (96% of motor-FND and 67% of stroke). When asked to list symptoms... 70% of motor-FND reported sensory symptoms without prompting. 96% endorsed them after prompting. That’s higher than stroke (31% unprompted, 67% prompted).

Обсуждение

1 прямых ответов · 10 сообщений

Rory Higgins

"It feels like my limb is dead." While both groups reported numbness, people with motor-FND described a broader spectrum including: “dead” or an absent limb (19% motor-FND vs 1% stroke). This is not a rare phenomenon for people with motor-FND.

Ответ для Rory Higgins
Rory Higgins

The distribution of symptoms in motor-FND is complex. Complete sensory loss in an area? • 27% of motor-FND vs 11% stroke Classic “glove and stocking” patterns? • 20% of motor-FND vs 3% of stroke

Ответ для Rory Higgins
Rory Higgins

Quantitative sensory testing (QST)? Added little information to assessment. Often detected abnormalities patients didn’t report.

Ответ для Rory Higgins
Rory Higgins

Classic sensory FND signs (midline splitting of light touch and vibration) were uncommon and had poor diagnostic specificity when compared with stroke. These signs may still hold value as part of the accumulation of evidence in making a diagnosis. Clinical context is important.

Ответ для Rory Higgins
Rory Higgins

The motor-FND group experienced pain more frequently than the stroke group (88% vs 41%) and more frequently endorsed having a high pain tolerance (70% vs 49%). Self-reported hypersensitivity was more common in FND (to light 63% FND vs 20% stroke; sound 65% FND vs 15% stroke).

Ответ для Rory Higgins
Rory Higgins

Sensory symptoms were often perceived as severe and were statistically associated with higher disability and depression. Only one-third of motor-FND reported improvement in sensory symptoms at 12 months.

Ответ для Rory Higgins
Rory Higgins

Concept conflation: 50% of patients struggled to distinguish the concepts of "weakness" from "numbness." Exploring what patients mean by their words is crucial in assessment.

Ответ для Rory Higgins
Rory Higgins

The large variation in sensory experiences documented in this study implies multifactorial mechanisms contribute to sensory symptoms in motor-FND. Potential mechanistic explanations:

Ответ для Rory Higgins
Rory Higgins

1. Dual processing of motor & sensory signals Sensory and motor symptoms may be mutually consequential - two sides of the same coin. These two processes are intrinsically linked and processed together within the brain. Improving one may result in improvement in the other.

Ответ для Rory Higgins
Rory Higgins

2. Dissociation & compartmentalisation Experiences of depersonalisation/derealisation are common in motor-FND. Reports of insensate limbs or unnoticed injuries suggest impaired integration of sensory signals, consistent with the concept of compartmentalisation.