Abnormal Eye and Cranial Movements Triggered by Examination in People with Functional Neurological Disorder, 2019, Edwards et al

Andy

Andy

Retired committee member
The diagnosis of functional neurological disorder (FND) relies on the demonstration of positive symptoms and signs, as supported by recent changes in DSM5. We recorded the findings of routine clinical eye movement assessment in 101 consecutive new patients with FND. Clinical examination triggered facial and eye movement disorders in 46% of patients, all with positive characteristics of functional movement disorder. These are useful as supporting features in making a positive diagnosis of FND.
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Paywall, https://www.tandfonline.com/doi/full/10.1080/01658107.2018.1536998
Sci hub, https://sci-hub.se/10.1080/01658107.2018.1536998
 
Yes, they really mean it

We found that functional eye movement and facial movement abnormalities were common in a group of 101 consecutive patients with FND (46%), most of whom had a FMD affecting limbs or gait. Importantly, the rate of eye/facial movement symptoms reported by patients was relatively low (13%) as was the rate of eye/facial movement signs seen during “casual” observation (16%). Thus, we found a prominent triggering of new symptoms and signs affecting the eyes and face by the act of physical examination. These included an effortful facial expression during eye movements, tonic gaze deviation, saccadic delay or convergence spasm, amongst others. We suggest that these findings are useful on both a clinical and pathophysiological level. Clinically the contrast between findings on casual observation and formal examination provides evidence for internal inconsistency, which is a defining feature of FND.
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Unfortunately there are some serious limitations in this study. There was no control group or independent observer blinded to the diagnosis. The patients also came from FND clinics which could mean that the observers were personally invested in finding evidence supporting FND.

The authors interpret their observations as follows:

the triggering of new symptoms and signs through physical examination fits very well with the central role for attentional diversion towards the body and towards the “mechanics” of movement proposed in pathophysiological models of FND.
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Formal examination could also differ from casual observation in many aspects other than different attentional diversion in patients.
 
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We have frequently observed the emergence of new symptoms and signs seemingly triggered by the act of neurological examination, and had the impression that these were most commonly seen when assessing eye movements.
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In Idiocracy, society falls to stupidity because scientists were obsessed with dumb things like trying to cure baldness in or trying to give boners to monkeys. Same outcome, different strokes. All it takes is for peer reviewed research to accept disastrously stupid claims like this to be published.

Those problems are only noticed when examining them. Because obviously it's clear that when not examining them they are not present. Because, uh, impression. I know that right now my dog is as immobile as a statue because I am not aware of her and she only seems to be moving when I am aware of her moving. Gimme research funding.

If there's anything to give confidence, despite this kind of garbage research being endlessly funded, is just how mediocre the research on the denial side is and how it does not stand a chance against real science. Meanwhile, though, wow this is so ridiculously bad and this area of research will be studied for decades, if not centuries, as a perfect example of how science can be completely derailed by magical thinking and negative influences like cost-cutting leading to disease denial research.

Intelligence without wisdom can be so absurdly bad.
 
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Importantly, the rate of eye/facial movement symptoms reported by patients was relatively low (13%) as was the rate of eye/facial movement signs seen during “casual” observation (16%).
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Yes, it's well-known that self-reports, although more or less reliable, are notoriously imprecise. This is expected. Ask people how many times on a given day they went to the bathroom, yawned, how many people they spoke to directly or similar questions and although the answers will be in a realistic range, they will inevitably be inaccurate. Here is actually evidence that those patients underestimate their symptoms, but the conclusion is that it means they are triggered by observation. Genius.

The obvious conclusion being that it's critical to rely on objective outcomes that do not rely on faulty memory or can be lost in translation because of factors like recency bias (as in asking about normal fatigue after a bout of the flu) or ambiguous terms that have relative answers. It also means that objective outcomes free of bias are always the more reliable data and any discrepancy in self-reported outcomes should favor the objective measures, with the difference being mostly down to either/or perception and recall.

I prefer my scientific research to have object permanence. But maybe that's just me.
 
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Eye movements have a particular problem here. I saw a documentary recently about an eye disease looking at children. Most of these children had been diagnosed with autism or ADD and ere very clumsy but this doctor had got them to do pictures of what they could see and it was really very little. They did not have a problem with the physical eye architecture but with the part of the brain which interprets the signal (I think it was a few months ago)

Anyway, the point is they did not know that anyone saw more than they did. It was only in the past few years I discovered that everyone does not have to stop reading very few pages till their eyes bounce a bit.

I have come to loathe FND the more I have found out about it. It is just so stupid and against any common sense, patronising and dangerous.
 
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Oops, edited my post to add missing word. My eyes bounce from side to side very quickly for about 30 seconds then I just carry on reading.

Being ill since 14 I don't know if it came after ME or not. I've always had trouble keeping to one line of text as well and often used a bookmark under the line I was reading.

Now I can't read a book without struggling with a magnifying glass but I got a kindle 5 years ago and can make the text really big - wonderful.

(I actually got points for my vision in PIP, so it must be bad :))
 
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