Therapeutic sedation for functional (psychogenic) neurological symptoms.
BACKGROUND
Patients with severe functional (psychogenic) neurological symptoms such as paralysis and fixed dystonia present a therapeutic challenge, particularly if no movement is possible during physiotherapy. Sedation has been discussed as a treatment for functional neurological symptoms for 100 years but technique, use of video and outcome has not been systematically described.


METHODS
Therapeutic sedation of patients with severe functional neurological symptoms with propofol and follow up at a neuroscience centre.


RESULTS
Of eleven patients (median duration 14 months), five were cured or had major improvement with sedation. At follow up (median 30 months) four were asymptomatic, two were significantly improved and one had minor improvements. We describe a standardized anesthetic and physician technique, refined over consecutive treatments.


CONCLUSIONS
In carefully chosen patients, therapeutic sedation with propofol can be a useful adjunctive treatment for patients with severe functional neurological symptoms. The treatment deserves randomized evaluation.
Dept. Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK. Electronic address: Jon.Stone@ed.ac.uk.
Jon
J
Stone
Dept. Neurology, Royal Victoria Hospital, Belfast, UK. Electronic address: ahoeritzauer01@qub.ac.uk.
Ingrid
I
Hoeritzauer
Dept. Anaesthetics, Western General Hospital, Edinburgh, UK. Electronic address: Kirsteen.Brown@nhslothian.scot.nhs.uk.
Kirsteen
K
Brown
Dept. Psychiatry, University of Edinburgh, Western General Hospital, Edinburgh, UK. Electronic address: A.Carson@ed.ac.uk.
Alan
A
Carson
D000328:Adult; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000188:drug therapy* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D010817:Physician-Patient Relations; D015742:Propofol / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D006993:Hypnotics and Sedatives; D015742:Propofol
Conversion disorder; Psychogenic movement disorder