From Software to Hardware: A Case Series of Functional Neurological Symptoms and Cerebrovascular Disease 2024 Coebergh, Edwards et al

Andy

Andy

Retired committee member
Abstract

Objective:
Neuroimaging studies have identified alterations in both brain structure and functional connectivity in patients with functional neurological disorder (FND). For many patients, FND emerges from physical precipitating events. Nevertheless, there are a limited number of case series in the literature that describe the clinical presentation and neuroimaging correlates of FND following cerebrovascular disease.

Methods:
The authors collected data from two clinics in the United Kingdom on 14 cases of acute, improving, or delayed functional neurological symptoms following cerebrovascular events.

Results:
Most patients had functional neurological symptoms that were localized to cerebrovascular lesions, and the lesions mapped onto regions known to be part of functional networks disrupted in FND, including the thalamus, anterior cingulate gyrus, insula, and temporoparietal junction.

Conclusions:
The findings demonstrate that structural lesions can lead to FND symptoms, possibly explained through changes in relevant mechanistic functional networks.

Paywall, https://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.20220182
 
"We claim that FND symptoms have no physical cause, yet here are some people who, when investigated properly, are found to have physical explanations for the symptoms. Don't worry though, we'll still call it FND, even though this ruins our software/hardware dualistic explanation"
 
A practical review of functional neurological disorder FND for the general physician (2021, Clinical Medicine) —

Functional neurological disorder (FND) describing motor and sensory symptoms (such as paralysis, tremor and seizures), that are genuinely experienced and related to a functional rather than a structural disorder
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Videotelemetry electroencephalography (EEG) and high-resolution structural neuroimaging has made it clear that some people with severely disabling disorders do not have structural pathology
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Recognising and explaining functional neurological disorder (2020, BMJ) —

Functional disorders are conditions whose origin arises primarily from a disorder of nervous system functioning rather than clearly identifiable pathophysiological disease
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Functional neurological disorder and placebo and nocebo effects: shared mechanisms (2022, Nature Reviews Neurology) —

Functional neurological disorder (FND) is characterized by neurological symptoms that cannot be explained by a structural neurological cause.
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This paper's summary —

One could argue that the lesions themselves are immaterial and that FND is simply a behavioral response to a triggering health event. In this scenario, the stroke could act as a distant (patho)physiological trigger for FND. This possibility suggests that the physical and psychological experience of the stroke symptoms and the experience of having a stroke (interaction with the health care system, the reactions of family members, personal fears about the future, and so on) trigger an independent process leading to FND that is not related directly to the lesion location. This same process could also explain the sudden cessation of FND after stroke, because the physical and psychological consequences of stroke disrupt the psychophysiological process that was maintaining FND (e.g., the experience causes a diversion of attention). These can be clinically difficult situations, and therefore it is possible that FND in this context is underdiagnosed, diagnosed instead as depression or chronic pain only (which is often present), or considered a functional overlay
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However, it is of interest that the FND symptoms observed among the patients in our case series were all localized to the lesion side
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However, it is of interest that the FND symptoms observed among the patients in our case series were all localized to the lesion side.
Click to expand...

Can't access the full text of the paper quoted from above but for clarity, are the authors saying that the "FND symptoms" observed among the patients in their case series were localised to the same side as the lesion site - whereas one would usually expect, for example, left sided weakness, paralysis or sensory loss following a stroke/lesion in the right hemisphere?
 
The paper said:
One could argue that the lesions themselves are immaterial and that FND is simply a behavioral response to a triggering health event. In this scenario, the stroke could act as a distant (patho)physiological trigger for FND. This possibility suggests that the physical and psychological experience of the stroke symptoms and the experience of having a stroke (interaction with the health care system, the reactions of family members, personal fears about the future, and so on) trigger an independent process leading to FND that is not related directly to the lesion location. This same process could also explain the sudden cessation of FND after stroke, because the physical and psychological consequences of stroke disrupt the psychophysiological process that was maintaining FND (e.g., the experience causes a diversion of attention). These can be clinically difficult situations, and therefore it is possible that FND in this context is underdiagnosed, diagnosed instead as depression or chronic pain only (which is often present), or considered a functional overlay
Click to expand...
This is extremely weird and obsessive grasping at straws. It doesn't pretend to make sense, it's all so random and arbitrary about finding alternative causes, any alternative cause, no matter how senseless and unrealistic. The equivalent of finding a gas can, chemical analysis showing the presence of gas and a web browser history showing searches such as "how to start a fire that will burn down a house for sure" and still argue the fire could have been natural and the rest is just coincidence. Just weird and obsessive.

But I am especially appalled at the use of "some people might be saying" logical fallacy when they are themselves the people saying that. "One could argue" is literally the authors. They are, in effect, alluding to imaginary hearsay as support for their own argument. Amazing. This is so shamefully embarrassing and it will forever be a black mark on medicine for allowing this garbage to ruin millions of lives in such a spectacularly mediocre way, without ever caring about what happens to the patients and systematically dismissing millions of complaints and reports of mistreatment and gaslighting.

I asked ChatGPT and Gemini which logical fallacy this is and they both have difficulty, both sort of saying that it's a weaker version of appeal to authority with some false attribution, so this logical fallacy here is so extreme that it doesn't really exist. Basically it's some form of appeal to narcissistic self-authority, since they are alluding to some authority, which happens to be them. Incredible. I'm gonna call this the "Just trust me bro, I'm an expert" fallacy.
 
"But I am especially appalled at the use of "some people might be saying" logical fallacy when they are themselves the people saying that. "One could argue" is literally the authors. They are, in effect, alluding to imaginary hearsay as support for their own argument. Amazing. This is so shamefully embarrassing and it will forever be a black mark on medicine for allowing this garbage to ruin millions of lives in such a spectacularly mediocre way, without ever caring about what happens to the patients and systematically dismissing millions of complaints and reports of mistreatment and gaslighting."
this is the entire history of those claiming to have medical knowledge to supposedly help sick and injured people for a fat fee off course paid regardless of outcome.
 
The FAQ about structural changes on neurosymptoms.org is very revealing. It's a newer section that's been added to try to explain away all the evidence of structural changes. It still uses the software/hardware analogy to explain things.

https://neurosymptoms.org/en/faq-2/...-changes-to-the-structure-of-their-brain-too/

Below is what seems to be the explanation for why doctors don't need to mention to patients about these structural changes in FND:

"We may at some stage need to build in an understanding of these structural changes into our models and the way we explain FND. But at the moment we simply don’t have enough data to be able to use this information in a clinically useful way.

If the structural changes have always been there, then that’s clearly important but we still don’t know if they represent an obstacle to improvement.

If the structural changes happen because of the condition, then we need to help patients understand that FND has changed their brain, but treatment can hopefully change it back again."
 
If the structural changes happen because of FND

So unexpected!
Really as successful and comfortable as y’all BPSers are in your own particular professional niche, I never ever thought there was a real possibility you’d volunteer this information, make it public, confront the rumours and admit you had the power all along and had used the power, to conjure up structural damage to your patients brains through the application, of nothing more an an overly aggressive acronym creation program.
No, really I never thought I’d see the day where Acronym Patient Program was acknowledged as the very real physical danger that patients have long claimed it to be!
That’s gotta have potential consequences for your careers no?
I admire your professional integrity I must say.
Time to all out with a government funded public information campaign around that one, huh?
Not something we wanna play around waiting for validation for, let’s get the word out!
Sorry?
Oh.
So you’re saying your acronyms are perfectly safe for patients, if used under your profession supervision?
It was simply misuse you were warning about?
Patients are interacting with the acronyms in the wrong way?
By using their functional mental capacity to understand what the acronyms stand for, thus short circuiting their structural brains causing themselves additional
disorders?
It’s a hardware problem caused by the misuse of already a patient’s existing substandard software?
I see.

 
CRG said:
Human brains and bodies are not hardware running software: the hardware is the software.
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Yep. Software-hardware is not wetware (biology). Not even close. One of the most inappropriate analogies I have ever seen.

––––––

"We may at some stage need to build in an understanding of these structural changes into our models and the way we explain FND. But at the moment we simply don’t have enough data to be able to use this information in a clinically useful way.

If the structural changes have always been there, then that’s clearly important but we still don’t know if they represent an obstacle to improvement.

If the structural changes happen because of the condition, then we need to help patients understand that FND has changed their brain, but treatment can hopefully change it back again."​

And this, girls and boys, is what happens when one rejects falsifiability. They could not possibly be wrong. Unthinkable!

Yet their long slow tortuous descent into confession continues.
 
I have never understood the software v hardware analogy. Do they think software is some magical entity that has no physical basis? Software is just the hardware arranged in a certain way to do a certain task. Messing with the software causes real changes to the hardware and visa versa. At the most basic level there is no software, it is all just hardware.
 
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