title: Medically unexplained neurologic symptoms: a primer for physicians who make the initial encounter.
abstract: Medically unexplained symptoms are ubiquitous in clinical practice. Medical use costs of medically unexplained symptoms are projected at approximately $256 billion per year. When initially seen, these symptoms are often baffling, not only to the patients but also to the physicians who encounter them. Because of this, properly diagnosing them is seen generally as difficult at best, leading to massive overuse of unnecessary testing. Subsequently, their management can be cumbersome. All this burdens the patients with unnecessary costs, financially and emotionally. This primer discusses historical perspectives of these and the changing nomenclature, and outlines how to think about these complex symptoms and neurologic findings that will enable a positive diagnosis rather than a diagnosis of exclusion. We also offer useful heuristic principles of their management so that physician-patient relationships can be better maintained and the quality of life of these patients can be improved by way of some simple, economic approaches.
authors.affiliation: School of Medicine, University of South Carolina, Columbia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Evens
authors.affiliation: School of Medicine, University of South Carolina, Columbia.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Vendetta
authors.affiliation: Movement Disorders Program, Department of Neurology, School of Medicine, University of South Carolina, Columbia.
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Krebs
authors.affiliation: Movement Disorders Program, Department of Neurology, School of Medicine, University of South Carolina, Columbia. Electronic address: priyantha.herath@uscmed.sc.edu.
authors.forename: Priyantha
authors.initials: P
authors.lastname: Herath
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D009422:Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D010817:Physician-Patient Relations; D011788:Quality of Life; D013001:Somatoform Disorders / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology
keywords: Functional neurologic disorders; Management; Medically unexplained symptoms; Movement disorder; Psychogenic symptoms