Functional Neurological Symptom Disorder

Unexplained

Step 1: View clinicals

A 35 year old widow presents with several episodes of jerky movements during the past 1 week. The movements began in her left shoulder and subsequently spread down to her left arm and both legs. Each episode lasted for 1 to 2 minutes, and was followed by 10 to 15 seconds of gagging and apnea. She was fully awake and aware at all times. She also complains of difficulty in walking after these episodes started. Her medical and family histories are unremarkable, and she is not on any medications. Her daughter died 4 years ago, at the age of 3; she required several sessions of counselling at that time.


Step 2: Order all relevant investigations

MRI Brain and Spine

The MRI scans appear normal.

Video EEG Monitoring

The EEG appears normal.

Metabolic Profile

Serum Glucose, Na+, K+, Cl- levels: all within normal parameters.

Lumbar Puncture

The lumbar puncture will be carried out tomorrow.


Step 3: Select appropriate management

Carbamazepine
Cognitive Behavioral Therapy
Physiotherapy
Transcranial Magnetic Stimulation


Score: ★★☆