When neurological symptoms are not what they appear: the challenge of caring for patients with conversion disorders.

Conversion Disorders involve the psychogenic loss or disturbance of sensory, motor or other physical functions in a manner suggestive of neurologic or other somatic disease but without any actual finding of the latter. These problems are subconscious, with patients not being able to control their symptoms. Jean-Marie Charcot, in the 19th century, was fascinated with this disorder and his work, followed by that of Sigmund Freud, laid the foundation for our modern concept of Conversion Disorder. Multiple Sclerosis, with its fluctuating and unpredictable symptoms has frequently been erroneously diagnosed in these cases. The often bizarre, flamboyant presentations, while interesting, pose many difficult and complex management problems. This paper will describe three of the more severe and disabled examples of this condition seen in the London Multiple Sclerosis Clinic and an attempt will be made to uncover common patient characteristics. Current thoughts regarding the management of these patients will be outlined, the emphasis being on helping neuroscience nurses develop an approach which is informed, positive and compassionate.

Assessing the prevalence of cognitive impairment in multiple sclerosis: implications for patient management.

Many patients with multiple sclerosis exhibit behavioural changes, including alterations cognitive functions and psychiatric abnormalities. Increasingly sophisticated neuropsychologic assessment techniques plus magnetic resonance imaging have added to our knowledge in this area, showing that these alterations may be more common than previously recognized. Research studies have attempted to address the question of whether these changes are primarily function of the demyelinating process itself or a reaction to the disability produced by the disorder. This is an important issue in terms of possible intervention. This paper will include a review of the literature.

Temporal lobectomy: an increasingly viable option for seizure patients.

Over the past ten years, the treatment options available to people with epilepsy have changed drastically, resulting in new concepts, treatment methods and philosophies. Complex partial seizures (temporal lobe or psychomotor) account for one third of all chronic seizure disorders. Following temporal lobectomy, the majority of these patients no longer requires medication. The neuroscience nurse must understand the selection criteria, diagnostic tests and perioperative course in order to teach and support these individuals and their families.