Decade of progress in motor functional neurological disorder: continuing the momentum, 2021, Perez, Edwards, Hallett et al

Abstract

Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurology–psychiatry intersection. After being marginalised in the late 20th century, there has been renewed interest in this field. In this article, we review advances that have occurred over the past decade (2011–2020) across diagnosis, mechanisms, aetiologies, treatments and stigma in patients with motor FND (mFND, that is, functional movement disorder and functional limb weakness). In each content area, we also discuss the implications of recent advances and suggest future directions that will help continue the momentum of the past decade. In diagnosis, a major advance has been the emphasis on rule-in physical signs that are specific for hyperkinetic and hypokinetic functional motor symptoms. Mechanistically, greater importance has been given to determining ‘how’ functional neurological symptoms develop, highlighting roles for misdirected attention, expectation and self-agency, as well as abnormal influences of emotion/threat processing brain areas on motor control circuits. Aetiologically, while roles for adverse life experiences remain of interest in mFND, there is recognition of other aetiologic contributors, and efforts are needed to investigate links between aetiological factors and mechanisms. This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. Across patients, clinicians, healthcare systems and society, stigma remains a major concern. While challenges persist, a patient-centred integrated clinical neuroscience approach is primed to carry forward the momentum of the past decade into the future.

Paywall, https://jnnp.bmj.com/content/early/2021/03/14/jnnp-2020-323953

 

Plus ça change...

 

That is not a recognizable definition of progress. The hubris of failing while claiming victory is grotesque in the context of medicine. These people are far more delusional than the worst caricatures they made up about their patients.

 

There's an intersection now? How very dualistic.

 

What a nice sounding pile of baloney. It hasn't worked so far. Writing sentences that sound conciliatory and caring isn't going to change that. It still won't work even if you're nicer to patients and really, really listen.

This is the Little Engine that couldn't. I think I can, I think I can . . .

Decades later . . . I think I can, I think I can.

Time to recognise that the train is still in the station. And the passengers are getting restless.

And a call out the the funders of garbage:

Funding DLP was funded by the National Institute of Mental Health (NIMH) Grant K23MH111983-04 and the Sidney R. Baer Jr. Foundation. MH was supported by the National Institute of Neurological Disorders and Stroke (NINDS) Intramural Programme. GN receives research funding from the National Institute for Health Research.

By now they should all know better. They should all do better. Enough with the continuous public relations speak. Your expertise is not needed here. I was going to say it's badly needed in mental health but then realised that you fail there too.

 

Well said. If they call this sad state of affairs progress, I’d hate to see what they’d consider stagnation.

 

What's funny is i've had psychiatrists tell me they sometimes get sent these kind of patients and they have no clue what to do with them, and the neurologists will always refuse to address this issue. It's been like this for decades and the issue of the lack of communication between psychiatry and neurology is a hot topic and daily debate but somehow nothing ever gets done. So the patients are left stuck in an endless loop where the psychiatrist tells them to keep looking for a good neurologist, and the neurologists tell them to look for a good psychiatrist, or refer them to go back to that one psych who said the illness is psychosomatic and you will be cured if you stop thinking about having an illness. What an egregious waste of resources...

 

That's why I've taken to label this as a con: it is built entirely on making confident claims and sticking to them. There is nothing else, as evidenced by the fact that the claims are the exact same decades later, the only cosmetic changes being a few spins of the euphemism wheel.

Frankly it's not the least bit surprising after having made manipulation and persuasion the core of this ideology. These people have managed to convince funders and policy-makers, using the same set of skills they use with patients, though with very different results. After too long of this, people actually forget how it all started and the con basically sustains itself.

Medical con artists, high on their own supply. The con must flow or else it is admission of catastrophic mistake. Just like the war on drugs or any other self-defeating policies. Political medicine is a disaster.

 

I tried to explain these recent FND papers to my husband and it was impossible. What exactly do they think is the cause of FND? Do they think that people become sick for the secondary gains like the BPS people, or the Freudian subconscious is seeking gratification? Is it the case that the brain resets bodily parameters?

They talk about brain plasticity but that doesn't explain why the body uses that plasticity to change it.

If anyone has come across a paper or talk where they state explicitly or even allude to what they think is the basic problem I would be very interested to know.

 

Being a bit cheeky, I'd like to know what bullying does to brain plasticity? And are researchers in need of therapy?

 

I wonder if Hallett is still actively involved in NIH's intramural PI-MECFS study, and if so how the FND aspect of his work influences his work in the ME field...