Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders, Espay et al, 2018

Indigophoton

Indigophoton

Senior Member (Voting Rights)
This is a review article. I'm posting it for background reference, and because the description of FND signs in the paper doesn't look anything like ME (not to say that there isn't overlap, but this set of signs doesn't capture or describe ME. It sounds distinct and rather different).
Abstract
Importance Functional neurological disorders (FND) are common sources of disability in medicine. Patients have often been misdiagnosed, correctly diagnosed after lengthy delays, and/or subjected to poorly delivered diagnoses that prevent diagnostic understanding and lead to inappropriate treatments, iatrogenic harm, unnecessary and costly evaluations, and poor outcomes.

Observations Functional Neurological Symptom Disorder/Conversion Disorder was adopted by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, replacing the term psychogenic with functionaland removing the criterion of psychological stress as a prerequisite for FND. A diagnosis can now be made in an inclusionary manner by identifying neurological signs that are specific to FNDs without reliance on presence or absence of psychological stressors or suggestive historical clues. The new model highlights a wider range of past sensitizing events, such as physical trauma, medical illness, or physiological/psychophysiological events. In this model, strong ideas and expectations about these events correlate with abnormal predictions of sensory data and body-focused attention. Neurobiological abnormalities include hypoactivation of the supplementary motor area and relative disconnection with areas that select or inhibit movements and are associated with a sense of agency. Promising evidence has accumulated for the benefit of specific physical rehabilitation and psychological interventions alone or in combination, but clinical trial evidence remains limited.

Conclusions and Relevance Functional neurological disorders are a neglected but potentially reversible source of disability. Further research is needed to determine the dose and duration of various interventions, the value of combination treatments and multidisciplinary therapy, and the therapeutic modality best suited for each patient.
Click to expand...
Positive Signs in Categories of Functional Movement Disorders

Functional Poverty of Movement (Weakness and Slowness)

General Features
  • Extreme slowness and fatigue

  • Giveway weakness

  • Inconsistency in performance
Leg Weakness
  • Hoover sign

  • Hip abductor signa

  • Able to stand on toes or ankles despite weak plantarflexion or dorsiflexion on bed
Arm Weakness
  • Drift without pronation

  • Finger abduction signb

  • Able to remove objects from bag or put on clothes inconsistent with upper limb examination
Parkinsonism
  • Lack of speed or amplitude decrement on repetitive tapping (sequence effect)

  • Variable resistance during passive manipulation (Gegenhalten)
Functional Excess of Movement
Tremor
  • Variability in frequency

  • Entrainment or full suppressibilityc

  • Tonic coactivation of antagonistic muscles at tremor onset

  • Pause during contralateral ballistic movements

  • Whack-a-mole signd
Myoclonus
  • Entrainment or full suppressibility

  • Variability in duration and or distribution of jerks or of their latency (if stimulus sensitive)

  • Predominance of axial or facial jerks
Dystonia
  • Fixed dystonia at onset

  • Variable resistance to passive manipulation

  • Lack of sensory trick

  • Lack of overflow

  • Face: tonic pulling of the lips or jaw to 1 side; closed eyelids resist retraction by examiner
Tics
  • Not fully stereotypical

  • Interference with speech or voluntary actions

  • Lack of premonitory urge

  • Inability to voluntarily suppress tics
Functional Axial Manifestations
Gait
  • Knee buckling

  • Dragging gait with forefoot in contact with ground

  • Excessive slowness or a gait similar to walking on ice
Posture
  • Variability of positions over time

  • Inconsistent, uneconomic postures
Balance
  • No or controlled falls despite excessive swaying when walking

  • Swaying and imbalance lessened with dual tasks
Speech
  • Effortful speech

  • Sudden onset of dysphonia, stuttering, or dysprosody

  • Foreign accent
a Hip abductor sign is weakness of hip abduction in a paretic leg that resolves with contralateral hip abduction against resistance in the normal leg.

b Finger abduction sign is weakness of fingers abduction that resolves with contralateral finger abduction against resistance.

c Entrainment or ceasing of tremor to externally cued rhythmic movement or an inability to copy movement.

d Whack-a-mole sign is the emergence or worsening of an involuntary movement in a separate body part when the initially affected body part is suppressed by someone holding it down.
Click to expand...

https://jamanetwork.com/journals/jamaneurology/fullarticle/2682656?
 
this is just the distorted reasoning for empire building . tell me of any one doing extreme physical task who does not get shaking in the effected muscles . as far as facial tick are concerned there are potentially many reasons for them I had trigeminal nerve pain for nearly a decade that caused many tics . muscles that are not receiving enough energy for varying reasons will not continuously perform in the exact same way . and anyone who lives with chronic pain can tell you they adjust their posture to try and find a less painful position . I doubt that there is any good science behind any of these assumptions.
 
It's not as if the brain is a complicated organ :banghead:

If you have a shared set of symptoms in a group of people it suggests a possible pathology in the brain. Now, psychological treatments may help people cope and retraining and rehabilitation may be useful in the same way it is for strokes and MS. But to suggest it is psychogenic - oh sorry, my bad, functional, those pesky patients hate it being called psychological even if we know it is - is totally unscientific and inhumane as it leads to people being told they don't want to get better and being dumped from social and medical help when the proferred "treatments" make no difference.

19th century medicine for the 21st.
 
I have a hankering to turn this concept and organisation into a comedy tv show.

Only thing is while the patients are variously diagnosed with these ailments week after week the comedy would be that the fearless/peerless medics would be the ones who exhibit all of the symptoms without any awareness. the patient of the week would be the more or less sane and sound counterpoint.

Well, I think it would be funny. And saying so helps me stay sane when I read this drivel.

Sorry, meant to explain that it is the explanation by the medics for the symptoms that is the disputed issue.
 
The new model highlights a wider range of past sensitizing events, such as physical trauma, medical illness, or physiological/psychophysiological events. In this model, strong ideas and expectations about these events correlate with abnormal predictions of sensory data and body-focused attention.
Click to expand...
Hmm hmm. That sounds nice. The model highlights stuff. And correlates things with other things.

Except there is no evidence whatsoever that this describes anything in reality. "Explaining the unexplainable" really sets in the absurdity of this nonsense. Not part of this paper but that's the general idea, the "rousing reassurance" model. A belief system from top to bottom. Pseudoscience that is all about power, utterly indifferent to patient welfare or even minimal success, just the appearance of.

Quite right that it's an idea straight from the 19th century. As well as the 18th, 17th and so on. Zero conceptual differences with shamanism, it just uses a different narrative but this would make a great religion.
 
Reading neurosymptoms.org is horrifying. Stating that all these diseases are caused by the nervous system not working and thinking that is an adequate explanation is breathtaking in its arrogance.

Their "positive" signs of FND just mean that there is a set of problems they are misdiagnosing routinely. If you decide that spots are a sign of a functional disease then you will then think that infections are functional. It is circular reasoning. FND has these signs so these signs mean you have FND.

The level of incompetence terrifies me. Have they never heard of glial cells, or channelopathies? Some cancers are well known for causing autoantibodies to parts of the nerve workings (the motor junction?), yet nothing.

It also gives the impression that it is all clear cut, yet this is just another story. Many people with MS for instance were originally told they had a psychological illness before MRIs gave a reliable diagnosis. The same thing must be happening for those diseases where there is not a diagnostic test yet.

There part about Complex Regional Pain Disorder illuminates their twisted thinking.

"Some people reading this will wonder what CRPS is doing on a website for patients with functional symptoms. The reasons for this are discussed in this article.
Popkirov S, Hoeritzauer I, Colvin L, Carson A, Stone J. Complex regional pain syndrome and functional neurological disorders: time for reconciliation. J Neurol Neurosurg Psychiatry. 2018; 0:jnnp-2018-318298. https://jnnp.bmj.com/content/early/2018/10/24/jnnp-2018-318298"

from the abstract

" FND is no longer assumed to be only the result of ‘conversion’ of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new ‘whole brain’ perspective of FND, we reframe the debate about the ‘psychological versus physical’ basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS."

So they are using their similarities to their fake FND to say a physical problem is biopsychosocial
 
Mithriel said:
" FND is no longer assumed to be only the result of ‘conversion’ of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new ‘whole brain’ perspective of FND, we reframe the debate about the ‘psychological versus physical’ basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS."
Click to expand...
This is some pretty advanced bullshit. It takes years to reach this level of making stuff up using words that sound half-convincing. The worst part is the same people who wrote this most likely commonly use conversion and hysteria when talking among themselves. They just learned to adapt their language to say one thing while meaning another. I hate that deceit is an essential part of this, completely dishonorable.

Still as made-up as water having selective memory. Except the consequences of giving this official credibility make it all so much worse. Pretty ironic that the people who believe in this tripe look down on people who believe in healing crystals. In some ways I think it makes it worse.
 
You must log in or register to reply here.
Back
Top Bottom