Functional Neurological Symptom Disorder: A Diagnostic Algorithm

Table 1

Patient’s symptoms and PoSP results.

Source	Symptom	DSM-5	Expected results	PoSP results	Repeated scan
Our patient 1	Tremor (tongue and both arms)	Abnormal movement	Hyperperfusion basal ganglia	Hypoperfusion fronto-temporo-parietal bilateral	No stability
Our patient 2	Left sensorimotor deficit	Mixed (motor+sensory loss)	Hypoperfusion right frontoparietal lobe	Hypoperfusion fronto-temporo -parietal bilateral	No stability
Our patient 3	Motor deficit (left arm)	Weakness or paralysis	Hypoperfusion right frontal lobe	Hypoperfusion temporoparietal left	NA
Tiihonen et al. [10]	Left sensorimotor deficit	Mixed (motor+sensory loss)	Hypoperfusion right frontoparietal lobe	Hypoperfusion frontoparietal right	No stability
Yazici and Kostakoglu [11]	Imbalance, expression aphasia	Speech	Hypoperfusion left parietal lobe	Hypoperfusion parietal left	NA
Gürses et al. [12]	Imbalance, tremor of 4 limbs	Abnormal movement	Hyperperfusion left parietotemporal lobe	Hypoperfusion parietotemporal left	No stability
Vuilleumier et al. [13]	Left arm sensory deficit	Anesthesia or sensory loss	Hypoperfusion right parietal lobe	Hypoperfusion basal ganglia right	No stability
	Left sensorimotor deficit	Mixed (motor+sensory loss)	Hypoperfusion right frontoparietal lobe	Hypoperfusion basal ganglia right	No stability
	Right motor deficit	Weakness or paralysis	Hypoperfusion left frontal lobe	Hypoperfusion basal ganglia left	No stability
	Right leg sensorimotor deficit	Mixed (motor+sensory loss)	Hypoperfusion left frontoparietal lobe	Hypoperfusion basal ganglia left	No stability
	Left motor deficit, right sensory deficit	Mixed (motor+sensory loss)	Hypoperfusion right frontal lobe, left parietal lobe	Hypoperfusion basal ganglia bilateral	Stable in time
	Left motor deficit	Weakness or paralysis	Hypoperfusion right frontal lobe	Hypoperfusion basal ganglia right	Stable in time
	Right sensory deficit, motor deficit of 4 limbs	Mixed (motor+sensory loss)	Hypoperfusion left parietal lobe, bilateral frontal lobes	Hypoperfusion basal ganglia right	Stable in time
Garcia-Campayo et al. [14]	Left-sided manifestations	NA	NA	Normal	NA
	Left-sided manifestations	NA	NA	Hypoperfusion brain stem right	NA
	Right-sided manifestations	NA	NA	Hypoperfusion frontal left, brain stem right	NA
	Bilateral manifestations	NA	NA	Hypoperfusion frontal	NA
	Bilateral manifestations	NA	NA	Normal	NA
	Left-sided manifestations	NA	NA	Hypoperfusion brain stem right	NA
	Bilateral manifestations	NA	NA	Normal	NA
	Left-sided manifestations	NA	NA	Hypoperfusion frontotemporo parietooccipital right	NA
	Left-sided manifestations	NA	NA	Normal	NA
	Bilateral manifestations	NA	NA	Hypoperfusion temporo-parieto-frontal bilateral	NA
	Left-sided manifestations	NA	NA	Hypoperfusion right brain stem, temporoparietal bilateral	NA
Marshall et al. [15]	Left sensory deficit	Weakness or paralysis	Hypoactivation right frontal lobe	Hypoactivation frontal right	NA
Spence et al. [2]	Left arm sensory deficit	Weakness or paralysis	Hypoactivation right frontal lobe	Hypoactivation frontal left	NA
	Left arm sensory deficit	Weakness or paralysis	Hypoactivation right frontal lobe	Hypoactivation frontal left	NA
	Right arm sensory deficit	Weakness or paralysis	Hypoactivation left frontal lobe	Hypoactivation frontal left	NA

NA: data nonavailable. Limited data was available; PET imaging.