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J Psychosom Res. 2014 Feb;76(2):165-8. doi: 10.1016/j.jpsychores.2013.10.003. Epub 2013 Oct 18.

Therapeutic sedation for functional (psychogenic) neurological symptoms.

Author information

1
Dept. Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK. Electronic address: Jon.Stone@ed.ac.uk.
2
Dept. Neurology, Royal Victoria Hospital, Belfast, UK. Electronic address: ahoeritzauer01@qub.ac.uk.
3
Dept. Anaesthetics, Western General Hospital, Edinburgh, UK. Electronic address: Kirsteen.Brown@nhslothian.scot.nhs.uk.
4
Dept. Psychiatry, University of Edinburgh, Western General Hospital, Edinburgh, UK. Electronic address: A.Carson@ed.ac.uk.

Abstract

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.

CONCLUSION:

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.

KEYWORDS:

Conversion disorder; Psychogenic movement disorder

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