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These patients had 'mostly sleep disorders'. Goodness knows whether anyone outside the Czech Republic would diagnose them as FND. And if there were no differences in CSF protein levels it is a bit difficult to know what to make of cell population differences. And who were the 'clinical...

No doubt he still thinks the same. But physicians of all stripes find it useful to use 'functional' to mean all shades of things. And of course if you are biopsychosocial like Sharpe he would deny that it could possibly mean psychological alone. It would have to mean a bit of bio and a bit of...

I don't think it is as simple as that. The 'functional' term was introduced widely in medicine to cover problems without an identifiable structural cause. Many physicians found it useful to cover patients they thought had a psychological basis but the term was also used by physicians who had no...

I think there is a significant difference. 'Conversion disorder' explicitly describes an illness in which your leg gives way because you cannot get rid of the bad thoughts due to being bullied by your elder sister when you were four. Whether or not all the mates in the pub know that, some...

"The information gained from this project and the toolkit will provide the essential bedrock for any effective change to clinical practice and service development." I wonder where that sentence comes from. It sounds like a selling point in a project application or, if not that a selling point...

I agree in principle and do not underestimate the harms. The only problem is that there is no 'zero' harmless option available to the community as of now. The 'harms of the FND label' have to be interpreted as 'how much more harm you get with the FND label than with X' where we have to know...

It's Mr Bloggs in fact and I know him well and he is very happy.

Well, imaging findings may have changed in recent years but this is talk of meta-analysis, suggesting that these findings aren't actually any use on individual patients so not diagnostically relevant? And as you say the statistical changes may be secondary.

A Hoover's sign in isolation would mean nothing. It is rarely used, except in cases where other signs do not point consistently to a clear explanation. If a patient had asymmetrical reflexes, cogwheeling or an upgoing plantar response a Hoover sign would be pretty irrelevant. No one sign in...

Probably right but I would be careful about using oligoclonal bands as an endpoint in the shorter term (less than a year). The kinetics of response is likely to be very complex and in most patients the clinical aim is to prevent new demyelinating foci. Nobody knows what determine those but it...

Good programme. Well done Chris and the lady with ME.

If that's 18,000 data points it is very encouraging. I doubt the difference from 20,000 is going to be statistically critical. It is also quite interesting to see the numbers that are achievable as a very indirect index of prevalence and diagnostic rates etc.

I have at no point denied that David. I have no argument with you on that. I have been pointing out that if some, maybe just a minority, of physicians and patients find a sensible usage of FND keeps the patient in a job and lets them enjoy a pint in the pub with friends without feeling mocked...

The bird of course. It sings: Chiff chaff chiff chaff chiff chaff chiff chiff chaff (just to catch you out at the end). The Iberian chiffchaff on the other hand makes a balls-up of the whole thing.

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.