Objective: To develop evidence-based consensus recommendations for the neurological examination of motor Functional Neurological Disorders (FND)/Conversion Disorder, weakness and abnormal movements, on behalf of the Committee on Research of the American Neuropsychiatric Association (ANPA).

Background: FND is a neuropsychiatric condition at the intersection of neurology and psychiatry. The current diagnostic criteria emphasize the identification of positive examination findings in support of the diagnosis. However, the specificity and sensitivity of particular neurological examination findings are variable, and the neurological evaluation of FND is not well standardized.

Methods: An eight-member multi-specialty committee will evaluate available evidence from a structured literature review using PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Database. Methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used. All recommendations will be evaluated, rated, and agreed upon during a consensus conference using formal consensus methodology. The recommendation will then undergo approval by a panel of international experts in the fields of movement disorders and neuropsychiatry.

Results: Based on previously published results in a systematic review¹ and a pilot validity study², preliminary evidence suggests that give-way weakness, drift without pronation, co-contraction, and Hoover’s sign are reliable signs for functional limb weakness. Although physical examination findings have been less well studied in functional movement disorders, the literature suggests that tremor amplification with increased patient attention towards the affected limb, distractability, entrainment and the co-activation sign may be reliable signs for functional tremor and other functional movement disorders.

Conclusions: These work-in-progress recommendations represent an important first step towards greater standardization in the examination-based assessment of motor FND and will inform clinical research and practice internationally.

References: 1.         Daum C, Hubschmid M, Aybek S. The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 2014;85:180-90.

2.         Daum C, Gheorghita F, Spatola M, Stojanova V, Medlin F, Vingerhoets F, Berney A, Gholam-Rezaee M, Maccaferri GE, Hubschmid M, Aybek S. Interobserver agreement and validity of bedside ‘positive signs’ for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. J Neurol Neurosurg Psychiatry 2015;86:425-30.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neurological-examination-of-motor-functional-neurological-disorders-an-evidence-based-review-towards-the-development-of-consensus-guidelines-from-the-committee-on-research-of-the-anpa/