Post-operative functional neurological symptom disorder after anesthesia

Authors

  • Ryan S. D’Souza Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0002-4601-9837
  • Matthew N.P. Vogt Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  • Edwin H. Rho Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0002-0758-9343

DOI:

https://doi.org/10.17305/bjbms.2020.4646

Keywords:

Functional neurological symptom disorder, anesthesia, peri-operative period, psychogenic coma, psychogenic non-epileptic seizures, conversion paralysis

Abstract

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

Post-operative functional neurological symptom disorder after anesthesia

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Published

03-08-2020

How to Cite

1.
Post-operative functional neurological symptom disorder after anesthesia. Biomol Biomed [Internet]. 2020 Aug. 3 [cited 2024 Mar. 19];20(3):381-8. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/4646