{"title":"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。","authors":"Ioannis Mavroudis, Katerina Franekova, Foivos Petridis, Alin Ciobica, Sotirios Papagiannopoulos, Dimitrios Kazis","doi":"10.3390/brainsci15090997","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background</b>: 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. <b>Objectives</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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. <b>Conclusions</b>: 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.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468354/pdf/","citationCount":"0","resultStr":"{\"title\":\"Positive Clinical Signs in Functional Neurological Disorders: A Narrative Review and Development of a Clinical Decision Tool.\",\"authors\":\"Ioannis Mavroudis, Katerina Franekova, Foivos Petridis, Alin Ciobica, Sotirios Papagiannopoulos, Dimitrios Kazis\",\"doi\":\"10.3390/brainsci15090997\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background</b>: 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. <b>Objectives</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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. <b>Conclusions</b>: 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.</p>\",\"PeriodicalId\":9095,\"journal\":{\"name\":\"Brain Sciences\",\"volume\":\"15 9\",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468354/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brain Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/brainsci15090997\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"NEUROSCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain Sciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/brainsci15090997","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
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.
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.