Most definitely not a recommendation. Paywall, https://www.sciencedirect.com/science/article/pii/S0035378719305417 Scihub, https://sci-hub.se/10.1016/j.neurol.2019.08.007
Those things are all clinical signs of neurological disease. They indicate that the brain is diseased and not working properly. Deciding that their presence is "incongruent or inconsistent" is a simple admission of ignorance. I find it akin to refusing to acknowledge a stab wound unless the knife is sticking out.
I disagree here. What is meant by incongruent or inconsistent is that findings on a full neurological examination are not all consistent with the same sort of neurological lesion. As an example, a person with a sudden onset of right sided arm and leg weakness and difficulty speaking with loss of vision on the left side would be showing incongruity because a lesion affecting the right arm and leg and speech should give loss of vision on the right side because of the anatomy of the connections. People diagnosed with functional disorders often have abnormal movements that are incongruous in this way with their other signs. This is not a matter of ignorance but of knowing your neurology well. That certainly leaves us with the need to suggest that these people have a neurological problem that is not understood but most neurologists would admit that. Where I think the problem with FND lies is in the suggestion that somehow everyone with these incongruities has a similar class of problem. I am pretty certain that the opposite is true.
My experience and that of others is no matter how many neurological signs you have if they do not fit comfortably into a disorder you are off to the psychologist before your feet hit the floor. If you have the courage to go back in a few years when your MS or whatever is more obvious you may get diagnosed but meanwhile every headache you have is put down to anxiety or hypchondria. MRIs have changed this but it does mean that neurologists were getting it wrong for years. At one time they may have admitted that they did not know, though the descriptions of MS as a neurosis of women that could be cured by having a few babies show how rare that was. Now the immediate response to any incongruence is to assume it is emotional. We are right back to 19th century neurology where they assumed they knew everything so a young man being kicked by a horse at a certain point on the spine should not have experienced paralysis. Neurology has always been too close to the magic symptom ideas of psychology. Saying we don't know enough about the brain and can only give supportive treatments would be fine but instead it is assumed there is an answer, a psychological problem. Myotonic dystrophy is a disorder which can now be detected by a genetic test. They have found members of families who have the genes but were never diagnosed because they did not fit the classic profile. They have also found mosaicism. the paper was a bit complicated for me but it seemed to say that some parts of the body had more repeats of the bases than others (in a pattern that matched the embryo) so only some parts of the body were affected. A few papers about the disease state that it is poorly diagnosed because neurologists only recognise a classic presentation.
