B – 45 Onset of Functional Neurological Disorder (FND) Following Concussion: A Case Study of FND Phenotypes

Abstract Objective The epidemiology of functional neurological disorder (FND) following concussion is unknown. Physical exertion as an active treatment for FND has received little attention within the literature. Similarly, Sertraline has shown variable efficacy for different FND phenotypes. Exertion therapy is a type of physical therapy that emphasizes dynamic, high-intensity exercise. To our knowledge, this is the first case study implementing a combination of vestibular therapy, exertion therapy, and Sertraline as successful treatments for persistent postural-perceptual dizziness (PPPD) and functional gait disorder (FGD). Method 31-year-old Asian American female presented to the concussion specialty clinic 14 months post-injury following a work-related concussion sustained as a flight attendant where the cockpit door of a plane struck her in the back of the head (Immediate symptoms: headache, dizziness, nausea, fatigue, increased anxiety). She underwent evaluation from neuropsychology, psychiatry, vestibular therapy, and exertion therapy. Results Computerized neurocognitive testing via Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) yielded average verbal memory (51st percentile), average visual memory (51st percentile), borderline visual motor speed (5th percentile), and borderline reaction time (3rd percentile). Vestibular/Ocular Motor Screening (VOMS) was notable for moderate baseline headache and dizziness provocation across vestibular-ocular reflex (horizontal and vertical) and visual motion sensitivity items; measurement of near-point convergence was unremarkable. Generalized Anxiety Disorder – 7 and Patient Health Questionnaire – 9 yielded severe psychopathology, respectively. Conclusion Exertion therapy and Sertraline both yielded clinically significant results. The patient’s FGD and PPPD symptoms had resolved. The current study highlights the efficacy of exertion therapy and Sertraline as adjunctive treatments of FND phenotypes.