Sandra de Mel, MD
Resident Physician
University of Miami/ Jackson Health System
Miami, Florida, United States
Carolina Mallar, BS
Medical Student
University of Miami
Miami, Florida, United States
Gemayaret Alvarez, MD
Associate Professor
University of Miami
Miami, Florida, United States
A 30-year-old female with a history of fibromyalgia was admitted to inpatient rehabilitation for Functional Neurological Disorder (FND). Over the past two years she experienced episodes of catatonia and drop attacks triggered by strong emotions, loud sounds or sudden movements. They lasted seconds to hours and were aborted with noxious smells. FND impacted her mobility and activities of daily living (ADLs), necessitating wheelchair use outside the home and significant assistance from her husband.
Physical exam was normal for inspection, strength, sensation, and special testing. During the initial encounter she experienced four catatonic episodes of eye closing and extremity flexion lasting 5 to 30 seconds, triggered by unknown stimuli, and resolved with menthol exposure. Initial therapy evaluations revealed gait instability, poor endurance, and frequent episodes. Her initial functional status was minimal/moderate assistance with transfers and dressing, and she was moderate assistance/dependent for mobility. Psychology assessments indicated concurrent fibromyalgia-related pain and anxiety.
Discussions:
At the time of discharge, she had progressed to supervision/independent for most ADLs and mobility. She was able to ambulate for 30 minutes without an episode, compared to the 10 feet she tolerated on admission. She reported no episodes on the days leading up to discharge, in addition to an increase in confidence and stress-handling ability.
This case exemplifies how FND represents an intricate interplay of physical and psychological factors, necessitating a multidisciplinary rehabilitation approach tailored to each patient. Inpatient rehabilitation provides a structured environment for thorough assessment and interventions, which is crucial to foster recovery and functional independence. This case demonstrates the role of multidisciplinary care in optimizing outcomes for FND patients.
Conclusions:
An interdisciplinary rehabilitation approach that encompasses medical, physical, occupational, and psychological therapies can facilitate meaningful gains in functional outcomes and quality of life for FND patients.
