NHNN team helps patients with ‘medically unexplained’ symptoms 

21/11/2013 00:00 
When Hayley Thorne graduated from university earlier this year, the thing uppermost on her mind was the handshake which would accompany the presentation of her certificate.

“I didn’t know whether I’d be able to do it. I had stopped shaking people’s hands because of the uncontrollable shaking in my right arm,” she says.

Ms Thorne developed the tremor after she gave blood in July 2012. “I went to give blood and when the needle was pulled out, I was sick, started shaking all over and couldn’t stop.”

Even when her condition eventually improved, her right arm kept shaking. She sought medical help, but “I realised that doctors believed it was all ‘in my head’. I refused to accept this assessment, and then someone suggested I see Dr (Mark) Edwards at the National and after I met him I knew he would help me”.

Ms Thorne spent five days at the National Hospital for Neurology and Neurosurgery (NHNN) this summer. “After treatment, my shaking improved a lot. I can now open up my hand and lay it flat on a table. I can write and I can cut up my food. I have regained the use of my right hand, and I have got back into work,” Ms Thorne said.

Ms Thorne’s story and the work of the functional movement disorders clinic was featured on BBC Radio 4’s Frontiers programme yesterday. The programme, which is available here, focused on the crucial role of the unconscious, and how scientists are now harnessing its powers.

Presenter Geoff Watts interviewed Ms Thorne and Dr Edwards at the NHNN clinic for patients with functional neurological symptoms.

Dr Edwards explained: “These are patients with neurological symptoms which are real but have fundamental differences from symptoms caused by degenerative or structural neurological disease.

“For many people a simplistic explanation of symptoms as being due to ‘stress’ does not make sense, and often is taken to imply that symptoms are not real, are imagined or are ‘all in the mind’. Patients with functional symptoms often feel let down by healthcare professionals as they do not receive a clear diagnosis or explanation for their symptoms and do not therefore have good access to information or treatment.”

He said there were probably many risk factors that make a person more likely to develop functional symptoms, which may include psychological factors, and specialist assessment and treatment can include neurologists, neuropsychiatrists, physiotherapists, occupational therapists, psychologists and specialist nurses.

Recent work at UCL and UCLH has led to the development of a new physiotherapy-based programme at the NHNN. Here, selected patients with functional motor symptoms (weakness, tremors, abnormal postures) are admitted for five days for a physiotherapy-based programme run by NHNN neurophysiotherapist Glenn Nielsen.

Dr Edwards said approximately 65% of patients going through the five-day programme report themselves to be better or much better on discharge, and that this benefit seems to be maintained.

He says more research and resources are needed into helping patients with functional neurological symptoms, which cause disability, distress and high healthcare costs.

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