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“I just completely forgot about looking after myself.” Lisa McHugh on her recent diagnosis of Functional Neurological Disorder. #LateLate

23,333 Aufrufe • vor 7 Monaten •via X (Twitter)

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Do you know how to perform the “whack-a-mole” or WAM sign on your neurological examination? Just like the arcade or fair game; reemergence of involuntary movement in different body part after suppression of movement by examiner. Original name Japan: mole buster or mole smash. Key points: - It is specific but not very sensitive for functional movement disorders. - Diagnosis of a functional movement disorder ideally supported by demonstrating positive signs during neurological examination. - Development and evaluation of new positive signs is an important to improving diagnostic certainty. - WAM sign was a highly specific (78%) and moderately sensitive (52%) test for the diagnosis of FMD. Tested across a variety of functional hyperkinetic movements. - Since stress or being under pressure may worsen abnormal movements during suppression of another body part and this makes it tough to be completely sensitive or specific. - Marked difference in the inter-observer agreement values for the WAM sign between FMD and organic movement disorder patients (0.77 vs. 0.28). - Greater than a third of persons tested, intra-person variability of the WAM sign. Translation: the test result depended on which part of the body was suppressed. - History lesson: Whac-A-Mole arcade game created in 1975 by the amusements manufacturer TOGO in Japan. - Original name Mogura Taiji モグラ退治, Mole Buster or Mogura Tataki モグラたたき, Mole Smash. - Criticized for teaching children to be cruel towards animals. - Used in rehabilitation to teaching auditory processing and attention. My take is that you should never diagnose a functional movement disorder based on one examination maneuver or one visit in the clinic or hospital setting.

Michael Okun

23,006 Aufrufe • vor 2 Jahren