功能性神经疾病的阳性临床体征:临床决策工具的叙述回顾和发展。

IF 2.8 3区 医学 Q3 NEUROSCIENCES
Ioannis Mavroudis, Katerina Franekova, Foivos Petridis, Alin Ciobica, Sotirios Papagiannopoulos, Dimitrios Kazis
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引用次数: 0

摘要

背景:功能性神经系统疾病(FNDs)包括一系列致残状况,包括功能性肢体无力、震颤、步态障碍、癫痫发作和认知障碍。虽然以前通过排除诊断,但现在越来越多的共识支持使用阳性临床体征作为诊断的基础。尽管这种模式发生了转变,但一线临床医生缺乏一种综合的、可获得的临床工具来指导FND亚型的诊断推理。目的:本研究旨在(1)综合FND主要亚型阳性临床体征的当代证据;(2)开发一个结构化的临床决策工具,以支持常规临床环境中的早期和自信诊断。方法:使用同行评审的出版物和神经学参考文献进行集中的叙述性回顾,确定与FND诊断相关的可重复的阳性临床体征。提取标志,按亚型制表,并整合到模块化决策框架中,旨在实现门诊、急诊和专科环境的可用性。结果:该综述在7种FND亚型中发现了60多个阳性体征。这些症状包括四肢无力的胡佛症候群,震颤的夹带,NESs的可变反应,以及功能性认知障碍的矛盾记忆表现。开发了一种临床决策工具,具有特定亚型的检查清单、诊断置信度指标和红旗警报,目前以可打印格式提供。结论:本研究为促进FND的阳性诊断提供了一种新颖的、基于证据的决策工具。通过将可观察到的体征整合为实用格式,旨在减少诊断延误,避免不必要的检查,并加强患者与临床医生的沟通。未来的工作将集中在临床验证和数字化实施上。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Positive Clinical Signs in Functional Neurological Disorders: A Narrative Review and Development of a Clinical Decision Tool.

Background: Functional Neurological Disorders (FNDs) encompass a spectrum of disabling conditions, including functional limb weakness, tremor, gait disorders, seizures, and cognitive impairments. While previously diagnosed by exclusion, a growing consensus now supports the use of positive clinical signs as a basis for diagnosis. Despite this paradigm shift, frontline clinicians lack an integrated, accessible clinical tool for guiding diagnostic reasoning across FND subtypes. Objectives: This study aims to (1) synthesize the contemporary evidence on positive clinical signs across major FND subtypes and (2) develop a structured Clinical Decision Tool to support early and confident diagnosis in routine clinical settings. Methods: A focused narrative review was conducted using peer-reviewed publications and neurology reference texts, identifying reproducible positive clinical signs relevant to FND diagnosis. Signs were extracted, tabulated by subtype, and integrated into a modular decision-making framework designed for usability across outpatient, emergency, and specialist contexts. Results: The review identified 60+ positive signs across seven FND subtypes. These include Hoover's sign for limb weakness, entrainment for tremor, variable responsiveness in NESs, and paradoxical memory performance in Functional Cognitive Disorder. A Clinical Decision Tool was developed, featuring subtype-specific checklists, diagnostic confidence indicators, and red flag alerts, and it is currently available in printable format. Conclusions: This study offers a novel, evidence-based decision tool to facilitate the positive diagnosis of FND. By consolidating observable signs into a practical format, it aims to reduce diagnostic delays, avoid unnecessary investigations, and enhance patient-clinician communication. Future efforts will focus on clinical validation and digital implementation.

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来源期刊
Brain Sciences
Brain Sciences Neuroscience-General Neuroscience
CiteScore
4.80
自引率
9.10%
发文量
1472
审稿时长
18.71 days
期刊介绍: Brain Sciences (ISSN 2076-3425) is a peer-reviewed scientific journal that publishes original articles, critical reviews, research notes and short communications in the areas of cognitive neuroscience, developmental neuroscience, molecular and cellular neuroscience, neural engineering, neuroimaging, neurolinguistics, neuropathy, systems neuroscience, and theoretical and computational neuroscience. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. Electronic files or software regarding the full details of the calculation and experimental procedure, if unable to be published in a normal way, can be deposited as supplementary material.
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