Therapeutic sedation for functional (psychogenic) neurological symptoms

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. (C) 2013 Elsevier Inc. All rights reserved.