Successful Treatment of Functional Neurologic Symptom Disorder (Conversion Disorder) With Subdissociative Dose Ketamine in the Emergency Department.

A 28-year-old man transferred to a trauma center for suspected spinal cord injury after a fall was diagnosed with functional neurologic disorder after negative testing. His symptoms did not respond to nonsteroidal anti-inflammatory drugs or benzodiazepines. Intravenous subdissociative dose ketamine led to rapid symptom resolution and discharge. Subdissociative ketamine may be a safe, effective, and efficient therapy for acute FND exacerbations in the emergency department, though factors mediating outcomes need further study.

Study at a glance

Abstract

Functional neurologic disorder (FND) is a neuropsychiatric condition that causes psychosomatic symptoms-commonly pain, paralysis, and seizure-like activity. Because presentation can be relatively heterogeneous with symptoms that overlap with other life-threatening or disabling neurologic disorders, FND is often misdiagnosed and incorrectly managed. This results in inappropriate resource utilization and patient care, including but not limited to unnecessary hospital admissions, procedures, imaging resource use, and radiation exposure. Effective treatment of FND often includes a combination of psychotherapy and medication. This is the case of a 28-year-old male who was transferred to a regional level 1 trauma center with concern for acute traumatic spinal cord injury after a fall. Following a negative evaluation for traumatic spinal cord injury and other red flag diagnoses, the patient was diagnosed with FND. The patient's symptomatology was refractory to treatment with nonsteroidal anti-inflammatory medications and benzodiazepines. The patient was administered intravenous subdissociative dose ketamine, after which rapid symptom resolution and discharge were achieved. Subdissociative dose ketamine may be a safe, effective, and efficient therapy for FND exacerbations in the emergency department. The patient factors that mediate the clinical outcome require further exploration.