Difficulties in Management of Functional Movement Disorders: Three Illustrative Cases.
FEVD
FND
novel treatment
rehabilitation
Journal
Movement disorders clinical practice
ISSN: 2330-1619
Titre abrégé: Mov Disord Clin Pract
Pays: United States
ID NLM: 101630279
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
05
10
2020
revised:
03
05
2021
accepted:
20
05
2021
entrez:
17
8
2021
pubmed:
18
8
2021
medline:
18
8
2021
Statut:
epublish
Résumé
Some patients with FND and FEVD cannot re-establish walking ability with standard treatment alone. Novel invasive treatment of FEVD trialed in three females, aged 19, 30 and 33 years with >18 month history of FND. None could walk and all were wheelchair-dependent needing home carers. Standard treatment plus novel step-wise escalation of invasive "intervention+" was individually tailored to correct FEVD; functional electrical stimulation, botulinum toxin injections, tibial nerve block, serial casting, and for Case 3, manipulation under anesthetic and surgical tendon lengthening. All regained walking ability and discontinued carers. Case 1 resumed dancing and Case 3 returned to employment. Improvements were largely maintained at 3 and 6 month follow-up. As a last resort, invasive adjuncts may be considered in a very small proportion of FND patients who fail to regain walking ability with standard treatment alone and reach a "dead end" where no further progress is feasible.
Sections du résumé
BACKGROUND
BACKGROUND
Some patients with FND and FEVD cannot re-establish walking ability with standard treatment alone.
CASES
METHODS
Novel invasive treatment of FEVD trialed in three females, aged 19, 30 and 33 years with >18 month history of FND. None could walk and all were wheelchair-dependent needing home carers. Standard treatment plus novel step-wise escalation of invasive "intervention+" was individually tailored to correct FEVD; functional electrical stimulation, botulinum toxin injections, tibial nerve block, serial casting, and for Case 3, manipulation under anesthetic and surgical tendon lengthening. All regained walking ability and discontinued carers. Case 1 resumed dancing and Case 3 returned to employment. Improvements were largely maintained at 3 and 6 month follow-up.
CONCLUSIONS
CONCLUSIONS
As a last resort, invasive adjuncts may be considered in a very small proportion of FND patients who fail to regain walking ability with standard treatment alone and reach a "dead end" where no further progress is feasible.
Identifiants
pubmed: 34401406
doi: 10.1002/mdc3.13264
pii: MDC313264
pmc: PMC8354088
doi:
Types de publication
Case Reports
Langues
eng
Pagination
932-939Informations de copyright
© 2021 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society.
Déclaration de conflit d'intérêts
The authors did not receive any funding for this study. The authors have no conflicts of interest to declare.
Références
J Neurol Neurosurg Psychiatry. 2015 Oct;86(10):1113-9
pubmed: 25433033
JAMA Neurol. 2018 Sep 1;75(9):1132-1141
pubmed: 29868890
J Rehabil Med. 2012 Jul;44(8):614-23
pubmed: 22729787
Mov Disord. 2011 Jul;26(8):1410-4
pubmed: 21484872
Lancet Neurol. 2012 Mar;11(3):250-60
pubmed: 22341033
Clin Neurol Neurosurg. 2010 Nov;112(9):747-51
pubmed: 20646830
Neurotherapeutics. 2014 Jan;11(1):201-7
pubmed: 24356785
J Neurol. 2020 Jul;267(7):2164-2172
pubmed: 32193596
Neurophysiol Clin. 2014 Oct;44(4):363-73
pubmed: 25306077
Brain. 2004 Oct;127(Pt 10):2360-72
pubmed: 15342362