From the Guidelines
Management of a patient with right-sided weakness and numbness suspected to be due to somatoform disorder, now more accurately referred to as Functional Neurological Disorder (FND), requires a careful, multidisciplinary approach, prioritizing occupational therapy and physical rehabilitation as outlined in the 2020 consensus recommendations 1.
Key Considerations
- The diagnosis of FND should be made by a neurologist using 'positive clinical signs' such as Hoover’s sign, distractibility, entrainment of tremor, and variability in symptoms during function, as noted in the study by 1.
- It is crucial to rule out organic causes through a comprehensive neurological examination, brain imaging (MRI or CT), and appropriate laboratory tests before confirming an FND diagnosis.
- Treatment should focus on cognitive behavioral therapy (CBT) and physical therapy to maintain function and prevent deconditioning, with strategies tailored to the specific symptoms presented, such as functional tremor, jerks, dystonia, or limb weakness, as detailed in 1.
Intervention Strategies
- For functional tremor, strategies may include superimposing alternative rhythms, using the unaffected limb to dictate a new rhythm, and assisting the person to relax the muscles in the limb to prevent cocontraction 1.
- For functional jerks, addressing unhelpful prejerk cognitions and movement, general relaxation techniques, and encouraging slow movement activities like yoga or tai chi can be beneficial 1.
- For dystonia, encouraging optimal postural alignment, even distribution of weight, and grading activity to increase the use of the affected limb in functional activities is recommended 1.
- For functional limb weakness, engaging the person in tasks that promote normal movement, good alignment, and even weight-bearing, such as transfers, sit to stand, and standing with the aid of a standing frame, can be helpful 1.
Additional Considerations
- Employing anxiety management and distraction techniques when undertaking tasks, and using video recording interventions with consent to demonstrate changeability and highlight successes, can also be useful 1.
- Splinting should be considered with caution, as it may prevent restoration of normal movement and function, and removable splints should be monitored regularly for potential harm 1.
From the Research
Management of Somatoform Disorder
To manage a patient with right-sided weakness and numbness thought to be due to somatoform disorder, the following approaches can be considered:
- A combination of pharmacotherapy and psychotherapy may be effective, as suggested by studies on body dysmorphic disorder 2 and obsessive-compulsive disorder 3.
- Cognitive behavioral therapy (CBT) has been shown to be useful in treating patients with body dysmorphic disorder 2 and may also be beneficial for somatoform disorders.
- Selective serotonin reuptake inhibitors (SSRIs) may be effective in reducing symptoms of somatoform disorders, as suggested by studies on body dysmorphic disorder 2 and depression/anxiety 4.
Neuroanatomical Correlates
Studies have investigated the neuroanatomical correlates of somatoform disorders, including:
- Gray matter volume alterations in patients with somatoform disorders compared to healthy controls 5.
- Associations between symptom severity and cognitive measures, such as attention and memory 5.
Treatment Considerations
When treating patients with somatoform disorders, the following considerations should be taken into account:
- Comorbidity with other psychiatric conditions, such as depression and anxiety, is common and may affect treatment response 6, 3.
- Patient characteristics, such as age and symptom severity, may influence treatment response 4.
- A multidisciplinary approach, incorporating both pharmacological and psychological interventions, may be necessary to effectively manage somatoform disorders 2, 6, 4, 3.