Jon Stone1, Ingrid Hoeritzauer2, Kirsteen Brown3, Alan Carson4. 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.
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.
Authors: Alexander Lehn; Jeannette Gelauff; Ingrid Hoeritzauer; Lea Ludwig; Laura McWhirter; Stevie Williams; Paula Gardiner; Alan Carson; Jon Stone Journal: J Neurol Date: 2015-09-26 Impact factor: 4.849
Authors: Jeannette M Gelauff; Yasmine E M Dreissen; Marina A J Tijssen; Jon Stone Journal: Curr Treat Options Neurol Date: 2014-04 Impact factor: 3.598
Authors: Glenn Nielsen; Jon Stone; Audrey Matthews; Melanie Brown; Chris Sparkes; Ross Farmer; Lindsay Masterton; Linsey Duncan; Alisa Winters; Laura Daniell; Carrie Lumsden; Alan Carson; Anthony S David; Mark Edwards Journal: J Neurol Neurosurg Psychiatry Date: 2014-11-28 Impact factor: 10.154