Conversion Disorders Workup

Updated: Nov 09, 2015
  • Author: Scott A Marshall, MD; Chief Editor: David Bienenfeld, MD  more...
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Workup

Laboratory Studies

Lab tests for hemiparesis include the following:

  • MRI of brain with diffusion-weighted imaging

  • MRI of cervical region

Lab tests for pseudoseizure (PNES) include the following:

  • MRI of brain

  • EEG

  • Prolonged video-EEG monitoring

  • Echocardiogram

  • Holter monitor

  • Tilt-table test

  • Prolactin level 30 minutes after the event: An elevation above baseline can occur with partial seizures, generalized seizures, or syncope, but not with pseudoseizures.

  • Provocative EEG with placebo induction is no longer routinely performed in many centers.

Lab tests for psychogenic movement disorders include the following:

  • MRI of brain

  • Twenty-four hour urine studies for copper, serum ceruloplasmin, and slit lamp examination for evidence of Kayser-Fleisher rings to look for evidence of Wilson disease

  • Thyroid-stimulating hormone, thyroid peroxidase antibodies, thyroglobulin antibodies

  • CBC count with smear for acanthocytes

  • Erythrocyte sedimentation rate, antinuclear antibody, extractable nuclear antibody, anticardiolipin antibody, lupus anticoagulant

  • HIV antibody, Lyme antibody, anti-streptolysin O (ASO) antibody

  • Human chorionic gonadotropin

  • Urine and serum toxin screen for stimulant or illicit drug use

  • Drug levels (ie, anticonvulsants, digoxin)

Next:

Procedures

The Amytal interview was once commonly used for diagnosing conversion disorder. This procedure carries significant risk and should be carried out by experienced physicians. [31] Sodium Amytal is a barbiturate and carries risk of respiratory depression. It is contraindicated in cases of upper respiratory infection or airway edema, hemodynamic instability, significant liver or kidney dysfunction, and porphyria. A CPR cart with medications and personnel trained in their use should be available in case of emergency. [32] This is cited in the literature as a technique that may occasionally be used to help facilitate the gathering of data but is not routinely performed in many centers.

Hypnosis is used on occasion and may also facilitate the data gathering process. This technique may also help alleviate the patient's anxiety and aid in relaxation.

Brain PET scan has demonstrated evidence of left dorsolateral prefrontal cortex hypofunction.

SPECT scan has shown decrease in regional blood flow in the thalamus and basal ganglia contralateral to the deficit.

Advanced imaging is not diagnostic of conversion disorder, and routine use for this purpose is not currently standard of care.

See Causes for rCBF studies. [9]

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