Arianna J. Caradonna, MD
PM&R Resident Physician
University of Connecticut
Farmington, Connecticut, United States
David Monti, MD
Medical Director, Inpatient Rehabilitation Unit
Hartford Hospital
Hartford, Connecticut, United States
Functional Neurological Disorder (FND)
A twenty-two-year-old woman with chronic Lyme disease treated with "Antibiotic Augmented Thermo-Eradication" in which she contracted MRSA bacteremia, presented with severe back pain. She developed an epidural abscess and was treated with two laminectomies/decompressions and IV antibiotics. She was then admitted to rehab with a diagnosis of non-traumatic spinal cord injury with lower extremity weakness. Her exam was notable for strength testing between 1 and 2 for her hip flexors bilaterally and between 2 and 3 on knee extensors bilaterally, while shaking uncontrollably. Notably, she had no sensory abnormalities. Her clinical findings were not compatible with typical neurologic dysfunction seen with SCI. Initially, she was moderate assist with transfers. After one week of therapy, she progressed to contact guard assist. The team discussed the FND diagnosis with the patient and her family, to which they were accepting. She continued to make great progress and was discharged at a supervision level.
There are no specific guidelines yet on the rehabilitation of FND patients due to the wide array of presenting symptoms. As FND can be a debilitating disorder, additional research is warranted.
