#7215 The full house: the top five clinical tests for functional neurological disorders to teach non-specialists

<h3>Introduction</h3> Functional Neurological Disorders (FND) are commonly seen across medical and surgical disciplines. Both ICD 11 and DSM-5-TR have moved towards a more ‘positive’ diagnosis of FND rather than being a diagnosis of exclusion. A key component is the correct use of clinical tests for FND. However, teaching of FND and clinical tests to healthcare professionals has been reported in surveys internationally to be insufficient. Hoover’s test is the best-known clinical test for FND but may not be relevant for patients with other areas of functional weakness, or functional sensory loss, functional movement disorders or functional seizure disorders. Over 50 different clinical tests have been described for FND and clarity of choice of these tests may help both teaching and retention of knowledge amongst non- specialists. <h3>Aims</h3> Our research group examined existing literature on common presentations of FND, the range of reported clinical tests for FND and the validity of these tests focussing on specificities in the 90–100% range in keeping with the current approach to FND of ‘ruling it in’. <h3>Methods</h3> We examined the available literature on the following: Frequency of presentation in FNS Names and descriptions of published clinical tests for FND Teaching of FND clinical tests Validity and specificity of clinical tests <h3>Results</h3> The commonest FND presentation was hemiplegia (63%), however, weakness can be seen only in one limb. Sensory symptoms have been reported in between 8–43% of patients with FND. Both functional movement disorders and functional seizures are common in specialist movement disorder and epilepsy clinics-approaching 10% and 25% of cases respectively. Tremor was the commonest functional movement disorder. For each of these 5 categories we identified tests which had been validated with specificity between 90–100%. In most cases there was only one clear contender. Functional weakness of the leg: <b>Hoover’s test</b> Functional weakness of the arm: <b>Overhead arm drop test.</b> <h3>Functional seizure disorder</h3> <b>Unopened eyes during apparent generalised seizure</b>. Functional sensory loss: <b>Splitting of reported sensation sharply at the midline.</b> <h3>Functional tremor disorder</h3> <b>Entrainment of tremor.</b> Taken together these tests form the Acronym HOUSE. <h3>Conclusion</h3> Our study has identified 5 clinical validated tests with excellent specificity which cover the main presentations of FNDs. We suggest that providing consistent teaching to non-specialists on these tests rather than the traditional long range of possible options could help learning. We believe that the additional acronym ‘HOUSE’ could be a helpful mnemonic for learners.