An Integrated Approach to Other Functional Neurological Symptoms and Related Disorders

Abstract

Patients with dissociative (nonepileptic) seizures (DS) commonly, although not always, present with comorbid somatic and psychological symptoms. This chapter reviews the epidemiology, diagnosis, and treatment of other functional somatic symptoms and disorders in relation to DS with a particular emphasis on other functional neurological symptoms such as movement disorder and sensory disturbance. Clinical assessment is presented as the start of treatment in patients with multiple functional symptoms including DS. The chapter discusses the importance of making a diagnosis of functional disorders, especially those in neurological settings, using positive evidence from the physical examination, such as Hoover’s sign for limb weakness or the tremor entrainment test for tremor. Practical methods of explaining these diagnoses to patients are reviewed, emphasizing the importance of transparency, educational materials, and presenting a model that focuses on mechanism more than etiology. The chapter concludes with a review of the evidence for treatment of a range of functional disorders often comorbid with DS.