#7100 An unusual presentation of a functional movement disorder following vaccination for COVID-19: a case report

<h3></h3> This report describes an unusual case of a patient with debilitating recurrent transient episodes of functional paralysis and pseudo-waxy flexibility. The symptoms began the day after the 65-year-old woman, who was otherwise fit and well, received a vaccination against coronavirus-19. Prior to this, her medical history comprised only of migraines and a concussive head injury 20 years ago. She reported no current psychosocial stressors and was employed as a cleaner. She presented with episodes of distressing conscious apparent paralysis. The episodes were unpredictable and of varying duration, up to a few hours. They could involve her limbs or whole body, including her mouth, speech, and swallow. On examination, the power in her limbs was variable, with internal inconsistency, including give-way weakness and a positive Hoover’s sign. When a part of her body was moved passively during an episode, she would maintain that position, in a manner reminiscent of catatonic posturing. During electromyography, periods of electrical silence were obtained just by altering the position of the tested limb, which was noted by the neurophysiologist to be as if the patient were ‘a wax doll’. Investigations, including imaging, lumbar puncture, telemetry, evoked potentials, and blood tests were otherwise unremarkable. This report emphasises the importance of recognising physical triggers for functional neurological symptoms and of making a ‘rule-in’ diagnosis where possible, utilising positive signs. It highlights the use of neurophysiology in the diagnosis of certain phenotypes of functional movement disorders and raises a potential positive neurophysiological diagnostic marker for similar cases. Management of functional neurological symptoms can vary according to local resources; however, an initial management approach can include a therapeutic explanation, education, and basic psychological techniques. Investment of resources in functional neurological disorders is required to allow access to a specialised multidisciplinary approach and targeted therapies for these often-neglected disorders. This would ideally include physiotherapy, occupational therapy and psychological therapies delivered by professionals familiar with functional neurological disorders.