BMJ Neurology Topic Collection: "Advances in Functional Neurological Disorder", 2023

I know I've seen the name Wendy Phillips (guest editor), but can't seem to recall exactly what about at the moment. Nor can I come up with any words for this, really.

(I'm guessing that's standard practice, but in any case it's good to know they're 'pleased.')

I wouldn't have posted it in this sub, I suppose it'd fit in any of 3, but there's a series of bullet points which apparently represent the submissions they're interested in. Even given the NICE 'critique' in JNNP, it's still jarring to see this sort of thing as being something this outfit wants to publish.

"No."

https://neurologyopen.bmj.com/pages/topic-collection

 

A resounding 'No' This needs standing up too or it will grow more legs in clinical practice. I am seeing this in my clinics.

@dave30th

 

Wow, promoting diagnosis creep right before our eyes!!

 

BMJ Editorial

Is there one illness (FND)?

By Simon W

 

So these people are entertaining the idea that they might have solved the pathophysiological basis of FND, and also of fibromyalgia, IBS, post-concussion syndrome and ME/CFS.

Someone who really believes this has truly lost contact with reality.

 

"Expanding the diagnostic criteria for FND: can fibromyalgia, irritable bowel, ‘post-concussion syndrome’ chronic fatigue syndrome all have the same pathophysiological basis? Should the DSM/ICD criteria be updated?"

And there is the answer to the question, why did do many FND 'experts' sign the recent opposition to the revised NICE guidelines?

 

Glaringly obvious creep.

 

It's not going away. Wack-a-mole.

FND has the biggest traction.

MUS hasn't gained traction. But, FND has. I have see adverts for psychologists to work in neuro services to develop services etc. Not for me, but it appeals to some and there are complex thinking needed to persist in pushing back. This is less straightforward than MUS.

CODES trial showed no objective benefits for a generic (not specify to trauma focus cbt) CBT for non epileptic seizures. Outcome: Perez wishes more study with subjective outcome measures....

Continued presence and pressure to push back will be incredibly helpful.

 

It was probably here, Anomalies in the review process and interpretation of the evidence in the NICE guideline for (CFS & ME), 2023, White et al

but a bit more info about her

"I am a neurology consultant, seeing patients with all neurological conditions and sub-specialising in movement disorders (particularly Parkinson's disease and multiple system atrophy) and functional neurological disorder (FND)."

https://www.cuh.nhs.uk/staff-directory/dr-wendy-phillips/, Cambridge University Hospitals

She is also an author on
Functional Neurological Disorder is a Feminist Issue 2023, McLoughlin, Chalder et al
Functional neurological disorders in personal injury , 2021, Phillips

and others that I haven't listed.

 

"We have positive signs to rule in but also the signs don't really matter, we're expanding to everyone since clearly we got away with pretending there are rule in signs that are used merely argumentatively."

And of course it's widely known that distractions work a bit on all symptoms and pain, that's why they are so popular. Just a bit, of course, and it's not as if people can be distracted all the time, this is beyond silly, it's madness. This is truly the ultimate in eating your cake and having it too, while selling NFTs, future derivatives and microtransactions that people are legally obligated to buy or else they get the hose again.

Anyone with the tiniest bit of integrity would be outraged at the idea that any process can "create any and all symptoms". It's even less serious than the Humours and other nonsense from the past. It's fitting that it's happening at the same as we are witnessing the devastation of global warming, while continuously expanding fossil fuel exploration. It's the same thing, it's just lazy greed and pure egocentrism with mindless indifference for others. This profession is in serious decline, there is no precedent for this.

 

Also they want to target concussions and I find it hard to believe that this is not motivated and funded in part by professional sports leagues, who badly want to avoid possible future litigations for their players. The evidence for those harms has been growing but all the leagues are denying it anyway. This is really all to the service of big money in the end. It's far more expensive to everyone else, but a small get to profit nicely off the suffering of others, there's a long tradition of that. With the help of doctors, hell, of the entire profession at this point. It's revolting what this has become.

 

“Functional somatic syndromes: one or many?” S Wessely et al. Lancet. 1999.

 

They really do say completely different things depending on the audience. Behind closed doors, there's a lot of that nonsense about secondary gains, malingering and other stuff that, in public, they pretend they have moved on from.

This is really all like pretending that alchemy and its methods were valid because nuclear physics and transmutation of elements are real. Or that astrology is real because of course the Sun affects all life on Earth, literally the source of it. It's such a weird modern phenomenon. It will baffle people in the future, that's for sure. Well, more people than today.

 

You could make so much money while doing absolutely nothing though. And as you treat more patients you can recruit more people who will then help you work the system even more.

 

Merged thread

Topic Collection: Advances in Functional Neurological Disorder (BMJ Neurology Open)

https://neurologyopen.bmj.com/pages/topic-collection

Topic Collection

Submission Deadline: 8th February 2024

We are pleased to offer a 25% discount on the Article Processing Charge (APC) for articles submitted to this Topic Collection. Please visit our author hub for more information about the benefits of submitting to a Topic Collection.

Functional Neurological Disorder (FND) is a common disorder, produced by functional disturbance in the brain, as opposed to a structural abnormality; patients can present with almost any neurological symptom. It is thought to be caused by excessive pre-conscious attention to the body; abnormal predictive coding; abnormal agency/ awareness of the self; inaccurate interoception and abnormal sensory processing. Prior traumas can predispose a proportion of patients to developing FND, and they are often triggered by physical events (such as injuries or illnesses). FND can be diagnosed using positive clinical signs (that distract attention from the body to normalise signs and identify incorrect ‘lay’ beliefs about illness) and is therefore not a diagnosis of exclusion. It is involuntary and the prognosis is poor without treatment. These patients are often misunderstood, and their care is very expensive, in large part because the expense is directed towards inappropriate investigation, as opposed to rehabilitation. There has been a renaissance of interest in FND in the past two decades. This interest in FND has accelerated, and many topics in FND have been recently reviewed. The importance of the disorder is being increasingly recognised, and it may be even more common than previously recognised. The aim of this topic collection is to synthesise current theories and models of FND, explore emerging trends, and highlight the cutting edge of FND research, with a focus on future directions.

• To set the scene: A review of the history of FND, from ancient hysteria to modern day FND, with comment on the political and social landscape, and how this shapes the diagnosis we have today.
• A review of landmark papers, and how this has shaped the field and moved it forward
• A synthesis of models of FND
• Expanding the diagnostic criteria for FND: can fibromyalgia, irritable bowel, ‘post-concussion syndrome’ chronic fatigue syndrome all have the same pathophysiological basis? Should the DSM/ICD criteria be updated?
• Emerging data on genetics, immunology, autonomic dysfunction, structural changes in chronic FND, biomarkers
• A comprehensive review and update of positive clinical signs
• Autonomic dysfunction and interoception
• Neurodiversity and FND
• Neurodegenerative disorders and FND
• New and emerging treatments
• Service development, costs, outcomes of FND clinics
• Future directions

Wendy Phillips Cambridge University Hospitals NHS Trust (Addenbrooke’s) and Princess Alexandra Hospital NHS Trust https://orcid.org/0000-0001-8864-2881

Mark J. Edwards King's College London https://orcid.org/0000-0002-8283-9015