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Not necessarily, and perhaps most probably not. They may be driven purely by peripheral immune signals or a mismatch in a regulatory process that involve both immune signals and neural signals. The point for me is that FND covers a very specific group of people who have specifically...

Absolutely and without any justification. If FND is a useful label I don't think it can be applied to people without signs suggestive of a local neurological lesion, yet discordant.

In reality that depends entirely on the particular context. In each situation the relevant level depends on decades of experience with patterns of illness. In FND there is a discrepancy with any pattern of known mechanism and a discrepancy that appears to require an explanation involving...

Indeed and if I am not mistaken these people are only too keen to release more flawed trials - except flawed in ways not on their list. There is a word 'disingenuous'. (As in 'as disingenuous as the Cochrane founders'.)

This is quit interesting. I suspect it reflects the fact that six doctors prefer to tick the 'functional illness' box, 2 doctors like FND and one dares to diagnose ME. There isn't actually any difference between the patients.

None of them knows I am afraid.

I think they might well do. The software/hardware analogy is never very good but as far as I know nobody has actually pinned down abnormalities in psychosis. Glutamate and domain could easily be called software since they are signals rather than structure. I see your point but I don't think...

Nobody is disputing that and we are not even calling them psychogenic seizures. But there are people with seizure-like episodes that are incongruent with standard seizures in typical ways and who over long periods show no evidence of a structural lesion. They need help and doing another MRI...

Good point.

No, David, the symptoms fall into a specific category: abnormal movements, paralysis, sensory loss, blindness and seizure type movements all suggestive of local neurological lesions but nearly always without any possible interpretation in terms of a known structural lesion no structural lesion...

It seems people at MEA have learnt nothing at all. And have no understanding of the simple, clear, cogent arguments raised by members here. They seem to have missed the point that the problem for PWME has not been what flavour of theory someone wants to promote but primarily bad methodology...

The rule in signs prove to be pretty reliable. Not always and there are mistakes, but usually due to careless assessment. If you look at the stuff Hutan posted it is interesting that conversion disorder is always presented as one explanation, as 'sometimes known as' or 'has been regarded by...

The issue is that the symptoms actually have nothing to do with the hypermobility. There is no evidence that they do. The symptoms attributed to 'hEDS' are just as common in people who are not hyper mobile and have nothing to do with bendiness as far as we know. So the category is not only...

So what about schizophrenia and paranoid psychosis? Those are subtle dysfunctions of the brain's software that make people very ill indeed.

I am not sure what the problem is. For structural lesions neurologists have established that an expert clinical assessment can pin almost anything down precisely on the basis of known anatomical connections and functions. If a clinical pattern cannot be fitted into that one has to assume that it...

Yes this is exactly the sort of pseudoarithmetic nonsense we have seen with GRADE and RoB from statisticians. It has nothing whatever to do with reality.

Well you *****y well shouldn't @Hutan! 1. If someone does not have a full grasp of problem issues with trials and how to apply them consistently they should not be an editor. This isn't difficult. All clinicians get a training in all the things we discuss here. The big problem is that many of...

The point is the there is no need to suggest that the patient perceives something that isn't there. It is there and is perceived. But it may not be at the level it feels to be. Our perceptions of our bodies make it seem as if we fell pain in the toe, but we know that the pain is generated in the...

It seems a farce. A bit like suggested criteria for bad music (some applied to Mozart and Wagner) 'Too many notes' 'Fails to use sonata form' 'Too small an orchestra' 'Boring old stuff' 'Keeps playing the same tune' It is a classic example of the floating expert phenomenon. How do you...

I don't disagree with that for a minute. My point was that until things have actually changed in that way it may not necessarily be helpful to tell someone who has been told they have FND that FND does not exist. I am not sure but I don' t think it is easy to be sure. In India the fast lane of...